Hypothyroidism
Initially 100micrograms (50micrograms if elderly) daily, adjusted in steps of 50micrograms every 6 weeks until TSH is within normal reference range (usually 100-150micrograms daily); where there is cardiac disease, initially 25micrograms daily or 50micrograms on alternate days, adjusted in steps of 25micrograms every 3 weeks.
Initially 100micrograms (50micrograms if elderly) daily, adjusted in steps of 50micrograms every 6 weeks until TSH is within normal reference range (usually 100-150micrograms daily); where there is cardiac disease, initially 25micrograms daily or 50micrograms on alternate days, adjusted in steps of 25micrograms every 3 weeks.
Initially 100micrograms (50micrograms if elderly) daily, adjusted in steps of 50micrograms every 6 weeks until TSH is within normal reference range (usually 100-150micrograms daily); where there is cardiac disease, initially 25micrograms daily or 50micrograms on alternate days, adjusted in steps of 25micrograms every 3 weeks.
Initially 50-100micrograms (50micrograms if elderly) daily before breakfast, adjusted in steps of 25-50micrograms every 6 weeks until TSH is within normal reference range (usually 50-200micrograms daily); where there is cardiac disease, initially 25-50micrograms daily, adjusted in steps of 25micrograms every 4 weeks.
Initially 50-100micrograms (50micrograms if elderly) daily before breakfast, adjusted in steps of 25-50micrograms every 6 weeks until TSH is within normal reference range (usually 50-200micrograms daily); where there is cardiac disease, initially 25-50micrograms daily, adjusted in steps of 25micrograms every 4 weeks.
Prescribing Notes:
- Prior to treatment it is important to establish that TSH is elevated thus confirming primary hypothyroidism. A normal or low TSH suggests pituitary or hypothalamic disease for which specialist referral is necessary.
- Thyroid stimulating hormone should be checked 6 weeks after starting levothyroxine or after any change in dose, then annually once stable.
- Be aware of clinical and subclinical hypothyroidism in women of child bearing age, women who are pregnant or planning pregnancy have specific monitoring requirements.
- If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient (specify the name of the manufacturer on the prescription). If problems persist seek specialist advice.
- Ideally to be taken 30-60 minutes before breakfast, caffeinated drinks and other medication.
- In a very small proportion of patients, liothyronine may be indicated for the treatment of hypothyroidism, usually in combination with levothyroxine. Treatment with liothyronine should only be initiated and adjusted under the advice and ongoing supervision of an endocrinologist. When the specialist initiates therapy they should clarify a plan for monitoring blood tests and reviewing the patient, usually within 3 months of initiation of treatment. Once stable the patient should only require annual blood tests.
History Notes
16/02/2022
East Region Formulary content agreed.
5-20 micrograms by slow intravenous injection, repeated every 12 hours or as often as every 4 hours if necessary.
Prescribing Notes:
- Liothyronine injection is given by slow intravenous injection to treat hypothyroid coma.
History Notes
16/02/2022
East Region Formulary content agreed.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
For dose, refer to BNF for Children and follow specialist advice.
Prescribing Notes:
- Levothyroxine should be taken at the same time each day, preferably 30 minutes before meals, caffeine-containing drinks, or other medicines; this could be before breakfast or another more convenient time.
- See the Medicines for Children leaflet: Levothyroxine for hypothyroidism.
- Prior to treatment it is important to establish that TSH is elevated thus confirming primary hypothyroidism. A normal or low TSH suggests pituitary or hypothalamic disease for which specialist referral is necessary.
- Check t4 levels at least 4 hours post levothyroxine dose.
- If a patient or their carer reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If problems persist seek specialist advice.
- For more information refer to Scottish Paediatric Endocrine Group (SPEG) Clinical Guidelines: Management of Congenital Hypothyroidism.
History Notes
29/02/2024
East Region Formulary content agreed.
For dose, refer to BNF for Children and follow specialist advice.
Prescribing Notes:
- Liothyronine injection is given by slow intravenous injection to treat hypothyroid coma.
History Notes
29/02/2024
East Region Formulary content agreed.