How do I install the Ata Mild Ch Management skill?

Run npx skillmds@latest add dromlakhani/ata-mild-ch-management in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Is Ata Mild Ch Management free to use?

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Who published Ata Mild Ch Management?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Mild Ch Management by dromlakhani

Name: Ata Mild Ch Management
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ata Mild Ch Management

Manages suspected mild central hypothyroidism in patients with pituitary disease and low-normal free thyroxine (fT4). Initiates levothyroxine (L-T4) when suggestive symptoms are present or when serial fT4 shows a decrease of 20% or more.

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Manage suspected mild central hypothyroidism with low-normal fT4

STEP 1 — Gather Information

Confirm pituitary disease history or imaging; measure serum fT4; assess for suggestive hypothyroid symptoms (fatigue, cold intolerance, constipation, dry skin, weight gain, menorrhagia).

STEP 2 — Rule In / Rule Out

If pituitary disease is absent or fT4 is not low-normal (i.e., below reference range or markedly elevated), rule out mild CH and evaluate for primary thyroid disease or other causes; otherwise proceed.

STEP 3 — Classify or Stratify

If suggestive symptoms are present, classify as "treat now"; if absent, classify as "monitor serial fT4".

STEP 4 — Decide

If classified as treat now, start levothyroxine (L-T4) at a low dose (e.g., 25–50 µg daily) and titrate based on clinical response and fT4; if classified as monitor, repeat fT4 in 6–12 weeks and start L-T4 if the level decreases by ≥20% from baseline.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on TSH alone to diagnose or monitor CH; evaluate for adrenal insufficiency before initiating L-T4 to avoid precipitating adrenal crisis; avoid over-replacement targeting fT4 above the upper reference limit; be aware that GH therapy may mask CH by maintaining fT4 in the reference range.

Concrete Clinical Example

A 48-year-old man with a nonfunctioning pituitary macroadenoma has fT4 0.85 ng/dl (reference 0.70–1.48) and mild fatigue. Repeat fT4 at 3 months is 0.66 ng/dl, a 22% decrease. Start L-T4 25 µg daily, recheck fT4 in 6 weeks.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the ata-mild-ch-management calculator

---name: ata-mild-ch-managementdescription: Manages suspected mild central hypothyroidism in patients with pituitary disease and low-normal free thyroxine (fT4). Initiates levothyroxine (L-T4) when suggestive symptoms are present or when serial fT4 shows a decrease of 20% or more.---# Manage suspected mild central hypothyroidism with low-normal fT4## STEP 1 — Gather InformationConfirm pituitary disease history or imaging; measure serum fT4; assess for suggestive hypothyroid symptoms (fatigue, cold intolerance, constipation, dry skin, weight gain, menorrhagia).## STEP 2 — Rule In / Rule OutIf pituitary disease is absent or fT4 is not low-normal (i.e., below reference range or markedly elevated), rule out mild CH and evaluate for primary thyroid disease or other causes; otherwise proceed.## STEP 3 — Classify or StratifyIf suggestive symptoms are present, classify as "treat now"; if absent, classify as "monitor serial fT4".## STEP 4 — DecideIf classified as treat now, start levothyroxine (L-T4) at a low dose (e.g., 25–50 µg daily) and titrate based on clinical response and fT4; if classified as monitor, repeat fT4 in 6–12 weeks and start L-T4 if the level decreases by ≥20% from baseline.## Clinical Guardrails / Mimics / PitfallsDo not rely on TSH alone to diagnose or monitor CH; evaluate for adrenal insufficiency before initiating L-T4 to avoid precipitating adrenal crisis; avoid over-replacement targeting fT4 above the upper reference limit; be aware that GH therapy may mask CH by maintaining fT4 in the reference range.## Concrete Clinical ExampleA 48-year-old man with a nonfunctioning pituitary macroadenoma has fT4 0.85 ng/dl (reference 0.70–1.48) and mild fatigue. Repeat fT4 at 3 months is 0.66 ng/dl, a 22% decrease. Start L-T4 25 µg daily, recheck fT4 in 6 weeks.**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, doi:10.1210/jc.2016-2118> **TODO:** consider adding scripts/calc.py for the ata-mild-ch-management calculator

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