How do you adjust levothyroxine dose for elderly individuals with decompensated heart failure on low dose levothyroxine therapy presenting with TSH >10?  

I think this depends on what the FT4 is. If subclinical hypothyroidism vs overt hypothyroidism. With elderly who have decompensated heart disease, etc, it may be best to start low (12.5 - 25 mcg of levothyroxine daily) and titrate up by 12.5 - 25 mcg every 2 weeks or so. If >80 years of age, don'...

Consider whether the decompensated heart failure state/gut edema has a role in reduced oral levothyroxine dose absorption when the abnormal labs are being obtained - so that iatrogenic hyperthyroidism does not set in later on the higher dose when the patient is adequately diuresed/euvolemic.