Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

birth to 4 months

1st line – monitoring and stabilization

Back
ONGOING
|
birth to 4 months
1st line – 

monitoring and stabilization

Treatment involves managing complications. Because complications occur at predictable ages in a patient's life, management should be tailored to the age of the child. Newborns should be assessed for specific conditions common at this age, and treatment should be targeted accordingly.

Treatment of infants is characterized by stabilizing life-threatening abnormalities and characterizing the extent of disease.[52]

Plus – surgical repair after stabilization

Back
ONGOING
|
birth to 4 months
|
with congenital heart disease
Plus – 

surgical repair after stabilization

Treatment recommended for ALL patients in selected patient group

About 80% of patients have congenital heart disease.[47][92]​ Conotruncal anomalies such as interrupted aortic arch type B and truncus arteriosus are the most characteristic, but tetralogy of Fallot, ventricular septal defect, and others are also common.[92][93]​​

Cardiac anomalies must be managed as appropriate, and echocardiography performed to define the cardiac anatomy and plan surgical repair.[52]

Infants with cardiac disease secondary to DiGeorge syndrome are managed as other infants with the same cardiac anatomy; although they may be at increased risk of postoperative infection this does not seem to impact length of stay or mortality.[95]

Plus – supportive specialty care

Back
ONGOING
|
birth to 4 months
|
with palatal abnormalities
Plus – 

supportive specialty care

Treatment recommended for ALL patients in selected patient group

Managed by adaptive feeding approaches in consultation with nutritionists, occupational therapists, feeding specialists, and orthodontists. Options include specialized nipples, prosthetics, and frequent burping. Additional options include prosthetic devices that may improve palatal function without surgical intervention.

Plus – feeding therapy

Back
ONGOING
|
birth to 4 months
|
with feeding difficulty
Plus – 

feeding therapy

Treatment recommended for ALL patients in selected patient group

Children in this age group routinely have feeding difficulties that may not be associated with cleft palate. First-line therapy is modified feeding approaches to ease feeding, including changing nipples, using bottle feeding if breastfeeding is inadequate, thickening feeds, or changing formulas. Second-line therapy may be required and usually involves placing a percutaneous gastrostomy tube. This should be considered if a child does not gain weight despite other feeding interventions.

Plus – calcium + calcitriol

Back
ONGOING
|
birth to 4 months
|
with hypocalcemia
Plus – 

calcium + calcitriol

Treatment recommended for ALL patients in selected patient group

Present in up to 60% of patients.[96]​ Often becomes less problematic as the child matures.[60]

Managed by oral calcium and vitamin D (calcitriol) supplementation as necessary.[52]​ Calcium levels should be corrected for albumin, or ionized calcium measurements used. 

Doses should be titrated to reach low-normal calcium levels.

Calcium levels can usually be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

If long-term correction is required, urine should be checked to maintain 24-hour urine calcium <300 mg.

Primary options

calcium gluconate: consult specialist for guidance on oral dose

and

calcitriol: 0.04 to 0.08 micrograms/kg orally once daily

Consider – hydrochlorothiazide

Back
ONGOING
|
birth to 4 months
|
with hypocalcemia
Consider – 

hydrochlorothiazide

Treatment recommended for SOME patients in selected patient group

Hypercalciuria is the major complication of treatment for hypocalcemia. If urinary calcium is >300 mg in 24 hours, dose of calcium and calcitriol must be reduced or hydrochlorothiazide may be added to reduce urine calcium excretion if required.

Primary options

hydrochlorothiazide: 0.5 to 2 mg/kg/day orally given in 1-2 divided doses

Consider – intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Back
ONGOING
|
birth to 4 months
|
with hypocalcemia
Consider – 

intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Treatment recommended for SOME patients in selected patient group

Calcium levels can usually be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

Up to 60% of patients have hypocalcemia, and hypocalcemic seizures are common in neonates.[60][96]​ Hypocalcemia often becomes less problematic as the child matures.[60]

Calcium levels should be corrected for albumin, or ionized calcium measurements used. Infusion should be adjusted to maintain serum calcium of about 8.0 mg/dL.

Intravenous calcium is highly irritating if extravasation occurs, and infusion that is too rapid can cause cardiac arrest. A central line should be used if possible, and bicarbonate and phosphate are incompatible and must be infused in another line. Cardiac monitoring is strongly recommended when giving intravenous calcium.

Primary options

calcium gluconate: consult specialist for guidance on intravenous dose

Plus – levothyroxine

Back
ONGOING
|
birth to 4 months
|
with hypothyroidism
Plus – 

levothyroxine

Treatment recommended for ALL patients in selected patient group

Up to 20% of patients have thyroid disease of some type.[108]​ Thyroid function (TSH and free T4) should be assessed at birth, and replacement therapy started accordingly. Dose is adjusted at 4- to 6-week intervals according to serum TSH.

Primary options

levothyroxine: children <3 months of age:10-15 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH; children ≥3 months of age: 8-10 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH

Plus – specialist consultation

Back
ONGOING
|
birth to 4 months
|
with renal obstruction or hypoplasia
Plus – 

specialist consultation

Treatment recommended for ALL patients in selected patient group

Ultrasound should be performed to identify renal hypoplasia or obstruction. Specialty consultation is needed for management.

infants and toddlers (4 months to 5 years)

1st line – continued monitoring

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
1st line – 

continued monitoring

Treatment involves managing complications. Because complications occur at predictable ages in a patient's life, management should be tailored to the age of the child. Infants and toddlers should be assessed for specific conditions common at this age, and treatment should be targeted accordingly.

Plus – monitoring and possible surgery

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with congenital heart disease
Plus – 

monitoring and possible surgery

Treatment recommended for ALL patients in selected patient group

About 80% of patients have congenital heart disease.[47][92]​ Conotruncal anomalies such as interrupted aortic arch type B and truncus arteriosus are the most characteristic, but tetralogy of Fallot, ventricular septal defect, and others are also common.[93][94]​ Patients who have undergone surgical intervention for congenital heart disease require long-term follow-up; further surgical intervention is often required in later childhood and adolescence.[52]

For children with congenital heart disease those with 22q11.2 deletion may be more likely to need dialysis post cardiac surgery, and have a greater risk of postoperative infection; but this does not seem to increase mortality or length of intensive care or hospital stay.[95]

Plus – supportive speciality care

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with palatal abnormalities
Plus – 

supportive speciality care

Treatment recommended for ALL patients in selected patient group

Managed by adaptive feeding approaches in consultation with nutritionists, occupational therapists, feeding specialists, and orthodontists. Options include specialized nipples, prosthetics, and frequent burping. Additional options include prosthetic devices that may improve palatal function without surgical intervention.

Consider – surgery

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with palatal abnormalities
Consider – 

surgery

Treatment recommended for SOME patients in selected patient group

Surgical repair is required for frank clefts and submucous clefts.[52]​ Patients who have only palatal insufficiency may not need surgical correction, although if speech therapy fails to adequately improve diction and intelligibility, there are surgical options to improve this. Speech outcomes are improved by surgical intervention to improve oronasal closure.[97]​ There are multiple possible procedures to accomplish this. One report has found repair with pharyngeal flaps to be superior to sphincter pharyngoplasty.[109]​​ Another systematic review found modest evidence that obstructive pharyngoplasties were superior to the less obstructive fat injection or palatoplasty. Obstructive sleep apnea is a complication of any of these procedures and should be monitored for following surgery.[110]

Plus – sulfamethoxazole/trimethoprim + intravenous immune globulin

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with marked immunodeficiency
Plus – 

sulfamethoxazole/trimethoprim + intravenous immune globulin

Treatment recommended for ALL patients in selected patient group

Patients with demonstrated immune dysfunction should be referred to an immunologist.[55]​ Those with mild to moderate immunodeficiency should be monitored for infection. Those with significant T-cell deficiency (marked T-cell lymphopenia and absent proliferative responses) should be given sulfamethoxazole/trimethoprim prophylaxis and intravenous immune globulin, and should undergo thymic transplant or adoptive transfer of mature T cells. Infants with significant T-cell immunodeficiency (<600 T cells/mm^3) should receive no live virus vaccines and should receive only irradiated, filtered (leukodepleted) blood products.[99][100][101][102][103][104][105]

Primary options

sulfamethoxazole/trimethoprim: 5-10 mg/kg/day orally given in 2 divided doses on 2-3 days per week, maximum 320 mg/day; or 5-10 mg/kg orally once daily, maximum 320 mg/day

More

and

immune globulin (human): dose depends on brand; consult product literature for guidance on dose

Plus – immune reconstitution

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with marked immunodeficiency
Plus – 

immune reconstitution

Treatment recommended for ALL patients in selected patient group

For patients with severe immunodeficiency, transplantation of thymus restores T-cell numbers and improves survival. Thymus is harvested from thymectomy at the time of cardiac surgery and cultured to remove T cells. The remaining thymic epithelium is transplanted into the quadriceps muscle of the recipient. As the immunodeficiency in DiGeorge syndrome is due to lack of an appropriate developmental environment (T cells are produced normally by the bone marrow, but have no thymus in which to develop), replacing the thymus corrects the defect. However, the procedure is technically demanding and available in only two centers worldwide.[111]

As an alternative method for immune reconstitution, mature T cells may be transferred from a matched donor by peripheral blood mononuclear cell transfusion or unconditioned bone marrow transplantation. Mature T cells can proliferate without the need for a thymus, and reported outcomes have been similar to those of thymic transplant. Adoptive transfer of T cells has the advantage of being much easier to perform, but repopulating the T-cell pool does not include as many naive T cells as thymic transplant.[16]

Plus – calcium + calcitriol

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with hypocalcemia
Plus – 

calcium + calcitriol

Treatment recommended for ALL patients in selected patient group

Up to 60% of patients have hypocalcemia.[96]​ Often becomes less problematic as the child matures.[60]

Managed by oral calcium and vitamin D (calcitriol) supplementation as necessary. Calcium levels should be corrected for albumin, or ionized calcium measurements used.

Doses should be titrated to reach low-normal calcium levels.

Calcium levels can usually may be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

If long-term correction is required, urine should be checked to maintain 24-hour urine calcium <300 mg.

Primary options

calcium gluconate: consult specialist for guidance on oral dose

and

calcitriol: children <1 year of age: 0.04 to 0.08 micrograms/kg orally once daily; children 1-5 years of age: 0.25 to 0.75 micrograms orally once daily

Consider – hydrochlorothiazide

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with hypocalcemia
Consider – 

hydrochlorothiazide

Treatment recommended for SOME patients in selected patient group

Hypercalciuria is the major complication of treatment for hypocalcemia. If urinary calcium is >300 mg in 24 hours, dose of calcium and calcitriol must be reduced or hydrochlorothiazide may be added to reduce urine calcium excretion if required.

Primary options

hydrochlorothiazide: 0.5 to 2 mg/kg/day orally given in 1-2 divided doses

Consider – intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with hypocalcemia
Consider – 

intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Treatment recommended for SOME patients in selected patient group

Calcium levels can usually be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

Up to 60% of patients have hypocalcemia, and hypocalcemic seizures are more common in neonates.[60] Often becomes less problematic as the child matures.[60]

Calcium levels should be corrected for albumin, or ionized calcium measurements used. Infusion should be adjusted to maintain serum calcium of about 8.0 mg/dL. Intravenous calcium is highly irritating if extravasation occurs, and infusion that is too rapid can cause cardiac arrest. A central line should be used if possible, and bicarbonate and phosphate are incompatible and must be infused in another line.

Cardiac monitoring is strongly recommended when giving intravenous calcium.

Primary options

calcium gluconate: consult specialist for guidance on intravenous dose

Plus – targeted antibiotic therapy

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with sinopulmonary infections
Plus – 

targeted antibiotic therapy

Treatment recommended for ALL patients in selected patient group

Recurrent infections with pneumonia, mastoiditis, and evidence of bronchiectasis may be seen. Antibiotics are adjusted according to syndrome and culture results. Patients with hypogammaglobulinemia are particularly susceptible to encapsulated organisms, including Streptococcus pneumoniae and Haemophilus influenzae type B, enteroviral infections, and Giardia lamblia.[112]

Therapy for infections is performed according to typical sinusitis management, but if hypocalcemia is present, it should be corrected to avoid potential complications with macrolide antibiotics.

Plus – levothyroxine

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with hypothyroidism
Plus – 

levothyroxine

Treatment recommended for ALL patients in selected patient group

Up to 20% of patients have thyroid disease of some type.[108]​ Thyroid function should be assessed regularly by TSH and free T4 monitoring, and replacement therapy started accordingly. Dose is adjusted at 4- to 6-week intervals according to serum TSH.

Primary options

levothyroxine: children ≥4 months: 8-10 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH; children 6-11 months of age: 6-8 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH; children 1-5 years of age: 5-6 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH

Plus – feeding therapy

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with feeding difficulty
Plus – 

feeding therapy

Treatment recommended for ALL patients in selected patient group

Children in this age group routinely have feeding difficulties that may not be associated with cleft palate. First-line therapy is modified feeding approaches to ease feeding, including changing nipples, using bottle feeding if breastfeeding is inadequate, thickening feeds, or changing formulas. Second-line therapy may be required and usually involves placing a percutaneous gastrostomy tube. This should be considered if a child does not gain weight despite other feeding interventions. Feeding difficulties may persist for months to years, but generally resolve before school age.

Plus – speech therapy and early bridging sign language +/- surgery

Back
ONGOING
|
infants and toddlers (4 months to 5 years)
|
with delayed speech acquisition
Plus – 

speech therapy and early bridging sign language +/- surgery

Treatment recommended for ALL patients in selected patient group

In older toddlers, delayed acquisition of speech is a characteristic feature.[52]​ This is not due solely to palate defects, but occurs in most children. Should be treated with speech therapy early and use of bridging sign language. Specific recommendations are available for the management of speech therapy in DiGeorge syndrome.[43]

For those with velopharyngeal insufficiency, surgical repair may be indicated to improve speech outcomes.[97]

school-aged children (5 to 18 years)

1st line – continued monitoring

Back
ONGOING
|
school-aged children (5 to 18 years)
1st line – 

continued monitoring

By school age most feeding issues have improved. The primary issues in this age range are learning disorders and behavioral problems. Those with a history of palatal abnormalities or congenital heart disease may require continued follow-up.

Plus – calcium + calcitriol

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with hypocalcemia
Plus – 

calcium + calcitriol

Treatment recommended for ALL patients in selected patient group

Present in up to 60% of patients.[96]​ Managed by oral calcium and vitamin D (calcitriol) supplementation as necessary. Calcium levels should be corrected for albumin, or ionized calcium measurements used.

Doses should be titrated to reach low-normal calcium levels.

Calcium levels can usually be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

If long-term correction is required, the urine should be checked to maintain 24-hour urine calcium <300 mg.

Primary options

calcium gluconate: consult specialist for guidance on oral dose

and

calcitriol: children <6 years of age: 0.25 to 0.75 micrograms orally once daily; children ≥6 years of age: 0.25 to 2 micrograms orally once daily

Consider – hydrochlorothiazide

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with hypocalcemia
Consider – 

hydrochlorothiazide

Treatment recommended for SOME patients in selected patient group

Hypercalciuria is the major complication of treatment for hypocalcemia. If urinary calcium is >300 mg in 24 hours, dose of calcium and calcitriol must be reduced or hydrochlorothiazide may be added to reduce urine calcium excretion if required.

Primary options

hydrochlorothiazide: 0.5 to 2 mg/kg/day orally given in 1-2 divided doses

Consider – intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with hypocalcemia
Consider – 

intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Treatment recommended for SOME patients in selected patient group

Calcium levels can usually be corrected orally, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

Up to 60% of patients have hypocalcemia, and hypocalcemic seizures are more common in neonates.[60] Often becomes less problematic as the child matures.[60]

Calcium levels should be corrected for albumin, or ionized calcium measurements used. Infusion should be adjusted to maintain serum calcium of about 8.0 mg/dL. Intravenous calcium is highly irritating if extravasation occurs, and infusion that is too rapid can cause cardiac arrest. A central line should be used if possible, and bicarbonate and phosphate are incompatible and must be infused in another line. Cardiac monitoring is strongly recommended when giving intravenous calcium.

Primary options

calcium gluconate: consult specialist for guidance on intravenous dose

Plus – targeted antibiotic therapy

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with sinopulmonary infections
Plus – 

targeted antibiotic therapy

Treatment recommended for ALL patients in selected patient group

Recurrent infections with pneumonia, mastoiditis, and evidence of bronchiectasis may be seen. Antibiotics are adjusted according to syndrome and culture results. Patients with hypogammaglobulinemia are particularly susceptible to encapsulated organisms, including Streptococcus pneumoniae and Haemophilus influenzae type B, enteroviral infections, and Giardia lamblia.[112]

Therapy for infections is performed according to typical sinusitis management, but if hypocalcemia is present, it should be corrected to avoid potential complications with macrolide antibiotics.

Plus – levothyroxine

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with hypothyroidism
Plus – 

levothyroxine

Treatment recommended for ALL patients in selected patient group

Up to 20% of patients have thyroid disease of some type.[108]​ Thyroid function should be assessed regularly by TSH and free T4 monitoring, and replacement therapy started accordingly. Dose is adjusted at 4- to 6-week intervals according to serum TSH.

Primary options

levothyroxine: children 1-5 years of age: 5-6 micrograms/kg orally once daily; initially, adjust dose according to response and serum TSH children 6-12 years of age: 4-5 micrograms/kg orally once daily; initially, adjust dose according to response and serum TSH; children >12 years of age (growth/puberty incomplete): 2-3 micrograms/kg orally initially, adjust dose according to response and serum TSH; children >12 years of age (growth/puberty complete): 1.6 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH, usual dose 50-200 micrograms/day

Plus – behavioral modification techniques

Back
ONGOING
|
school-aged children (5 to 18 years)
|
with learning disorders and behavioral problems
Plus – 

behavioral modification techniques

Treatment recommended for ALL patients in selected patient group

Children may be shy, withdrawn, or anxious. Rates of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and autistic spectrum disorders are higher than in the general population.[106] Initial approach should involve standard behavioral modification techniques. Managing these symptoms may require consultation with developmental pediatricians and psychiatrists.

Although children have speech delay, their language abilities are relatively preserved later in life when nonverbal learning disorders become predominant. Math skills may be weak. These aspects should be approached with an individualized education plan.

adults

1st line – continued monitoring

Back
ONGOING
|
adults
1st line – 

continued monitoring

Regardless of age at diagnosis, follow-up in adults with DiGeorge syndrome is required. Congenital or early-onset features also require frequent monitoring and management as appropriate.[15] Psychiatric disorders comprise the majority of late-onset features in this age group.[44]

Plus – calcium + calcitriol

Back
ONGOING
|
adults
|
with hypocalcemia
Plus – 

calcium + calcitriol

Treatment recommended for ALL patients in selected patient group

Present in up to 60% of patients.[96]​ Managed by oral calcium and vitamin D (calcitriol) supplementation as necessary. Calcium levels should be corrected for albumin, or ionized calcium measurements used. 

Doses should be titrated to reach low-normal calcium levels.

Calcium levels may be corrected orally in most cases, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

If long-term correction is required, the urine should be checked to maintain 24-hour urine calcium <300 mg.

Primary options

calcium gluconate: consult specialist for guidance on oral dose

and

calcitriol: 0.25 to 2 micrograms orally once daily

Consider – hydrochlorothiazide

Back
ONGOING
|
adults
|
with hypocalcemia
Consider – 

hydrochlorothiazide

Treatment recommended for SOME patients in selected patient group

Hypercalciuria is the major complication of treatment for hypocalcemia. If urinary calcium is >300 mg in 24 hours, dose of calcium and calcitriol must be reduced or hydrochlorothiazide may be added to reduce urine calcium excretion if required.

Primary options

hydrochlorothiazide: 25-100 mg/day orally given in 1-2 divided doses

Consider – intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Back
ONGOING
|
adults
|
with hypocalcemia
Consider – 

intravenous calcium for any episode of tetany, seizure, or prolonged QT interval

Treatment recommended for SOME patients in selected patient group

Up to 60% of patients have hypocalcemia.[60]

Calcium levels may be corrected orally in most cases, but if there are significant symptoms, such as tetany, seizure, or prolonged QT interval, intravenous correction is indicated.

Calcium levels should be corrected for albumin, or ionized calcium measurements used. Infusion should be adjusted to maintain serum calcium of about 8.0 mg/dL. Intravenous calcium is highly irritating if extravasation occurs, and infusion that is too rapid can cause cardiac arrest. A central line should be used if possible, and bicarbonate and phosphate are incompatible and must be infused in another line. Cardiac monitoring is strongly recommended when giving intravenous calcium.

Primary options

calcium gluconate: consult specialist for guidance on intravenous dose

Plus – targeted antibiotic therapy

Back
ONGOING
|
adults
|
with sinopulmonary infections
Plus – 

targeted antibiotic therapy

Treatment recommended for ALL patients in selected patient group

Increased risk for sinopulmonary infections persists, and infections should be treated aggressively with appropriate antibiotic therapy.

Recurrent infections with pneumonia, mastoiditis, and evidence of bronchiectasis may be seen. Antibiotics are adjusted according to syndrome and culture results. Patients with hypogammaglobulinemia are particularly susceptible to encapsulated organisms, including Streptococcus pneumoniae and Haemophilus influenzae type B, enteroviral infections, and Giardia lamblia.[112]

Therapy for infections is performed according to typical sinusitis management, but if hypocalcemia is present, it should be corrected to avoid potential complications with macrolide antibiotics.

Plus – levothyroxine

Back
ONGOING
|
adults
|
with hypothyroidism
Plus – 

levothyroxine

Treatment recommended for ALL patients in selected patient group

Up to 20% of patients have thyroid disease of some type.[108]​ Thyroid function should be assessed regularly by TSH and free T4 monitoring, and replacement therapy started accordingly. Dose is adjusted at 4- to 6-week intervals according to serum TSH.

Primary options

levothyroxine: 1.6 micrograms/kg orally once daily initially, adjust dose according to response and serum TSH, usual dose 50-200 micrograms/day

Plus – psychiatric consultation and management

Back
ONGOING
|
adults
|
with psychiatric disorders
Plus – 

psychiatric consultation and management

Treatment recommended for ALL patients in selected patient group

Psychiatric disorders comprise the majority of late-onset features in this age group.[44]​ Psychiatrists should manage patients with psychosis or schizophrenia with appropriate antipsychotic therapy. Depression, anxiety disorders, and bipolar disorder also occur and are managed typically.[15]

Therapy of schizophrenia is generally typical, but there may be more resistance to antipsychotic therapy. There are few published data on therapeutic recommendations for patients with DiGeorge syndrome, but one case report has successfully used aripiprazole for treatment of resistant psychosis, while another successfully used quetiapine. If hypocalcemia is present it should be corrected, as hypocalcemia alone may provoke psychosis.[107]

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer