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Optimizing Treatment of Hypothyroidism

  • Therapy In Practice
  • Published:
Treatments in Endocrinology

Abstract

Several thyroid hormone preparations are currently available, including levothyroxine sodium (thyroxine), liothyronine (triiodothyronine), and desiccated thyroid extract, as well as a combination of levothyroxine sodium and liothyronine. Levothyroxine sodium monotherapy at an appropriate daily dose provides uniform levels of both thyroxine and triiodothyronine in the circulation without diurnal variation. Therefore, it is the preparation of choice in most patients with hypothyroidism of both the primary and central types. A normal thyrotropin (TSH) level of 1–2 mU/L is considered the determinant of optimal daily levothyroxine sodium dose in patients with primary hypothyroidism, whereas normal thyroxine and triiodothyronine levels in the mid or upper normal range may denote optimal replacement in patients with central hypothyroidism.

Optimal daily levothyroxine sodium dose may be determined according to serum TSH level at the time of diagnosis of primary hypothyroidism. Initial administration of close to the full calculated dose of levothyroxine sodium is appropriate for younger patients, reducing the need for follow-up visits and repeated laboratory testing for dose titration. In the elderly and in patients with a history of coronary artery disease (CAD), the well established approach of starting with a low dose and gradually titrating to the full calculated dose is always the best option. Levothyroxine sodium can and should be continued in patients receiving treatment for CAD. Even minor over-replacement during initial titration of levothyroxine sodium should be avoided, because of the risk of cardiac events. Chronic over-replacement may induce osteoporosis, particularly in postmenopausal women, and should also be avoided.

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Table I

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

This preparation of this manuscript was funded by a grant from the Suvarnam Foundation Inc., Urbandale, Iowa, USA. The authors have no conflicts of interest directly relevant to the content of this review.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA

    Nick Clarke &  Udaya M. Kabadi (Professor of Medicine)

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  1. Nick Clarke
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  2. Udaya M. Kabadi
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Correspondence to Udaya M. Kabadi.

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Clarke, N., Kabadi, U.M. Optimizing Treatment of Hypothyroidism. Mol Diag Ther 3, 217–221 (2004). https://doi.org/10.2165/00024677-200403040-00003

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