Hypothyroidism: levothyroxine therapy

Hypothyroidism: levothyroxine therapy

• initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease. The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100mcg od
• following a change in thyroxine dose thyroid function tests should be checked after 8-12 weeks
• the therapeutic goal is 'normalisation' of the thyroid stimulating hormone (TSH) level. As the majority of unaffected people have a TSH value 0.5-2.5 mU/l it is now thought preferable to aim for a TSH in this range
• women with established hypothyroidism who become pregnant should have their dose increased by at least 25-50 micrograms levothyroxine due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value
• there is no evidence to support combination therapy with levothyroxine and liothyronine

• hyperthyroidism: due to over treatment
• reduced bone mineral density
  reduced bone mineral density
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• worsening of angina
• atrial fibrillation

• iron, calcium carbonate
  Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart
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  Importance: 77
  • absorption of levothyroxine reduced, give at least 4 hours apart
    Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart
    You've never been tested on this concept
    You've not yet rated this concept.
    Importance: 77