Hypothyroidism Treatment

Hypothyroidism 

• TSH is high 
• T4 is low 
• T3 is normal or low 

Treatment goals 

• reverse any hypothyroid symptoms
• normalize TSH 
• reduce goiter size if present 

Treatment options 

Treatment of choice: Levothyroxine (synthetic T4)

• Take on an empty stomach in the morning 
• Brand names: Synthroid, Levoxyl, Tryosint 
• Prescribe tablets, insurance usually won't cover capsules and you will have more busy work to fix it later 
• Tablet options: 25 mcg, 50 mcg, 88 mcg, 100 mcg, 112 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg 
• Initial dose: 25-50mcg levothyroxine 
• Adjusting dose: check TSH every 6-8 weeks and adjust dose by 12-25 mcg until TSH in normal range (I just go up to the next available tablet dose available, ex. 50mcg to 88mcg) 

Adjunct therapy: Liothyronine (T3)

• Brand name: Cytomel 
• divide into morning and afternoon doses 
• consider adding in patients who;
  • still experience symptoms with optimal T4 therapy (TSH in normal range, free T4 in normal range)
  • have low T3

Commercially available combo T4-T3 products: Desiccated Thyroid 

• Brand names: Armour Thyroid, NP Thyroid 
• It is not preferred to start patients on desiccated thyroid. Try to start with levothyroxine and convert patients over to levothyroxine when possible. 
• Some patient's have strong preference so educate and make a decision on how you feel comfortable proceeding 

Come back weekly for new blog posts that can be helpful in practice. I'd love to connect- email me at [email protected] or DM me on social! 

Would you benefit from an experienced NP as a mentor to go over lab results with you, talk about difficult cases, or just ask questions/vent? Check out my 1:1 mentor program here and email me at [email protected] to set up a free 15 minute phone call to discuss further.

 Check out all the other blog posts here.