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Levothyroxine

Hypothyroidism, TSH suppression after thyroid cancer

Indications

  • Hypothyroidism
  • TSH suppression after thyroid cancer

Adult dosing

  • standard: dose: 1.6; unit: mcg/kg/day; route: PO; interval: Take on empty stomach, 30-60 min before breakfast; weightBased: true; elderly: dose: 25; unit: mcg; route: PO daily; interval: Start low, increase by 12.5-25mcg q4-6 weeks; fixed: true

Contraindications

  • Untreated adrenal insufficiency (treat with cortisol first)
  • Acute MI (relative — start low dose)

Clinical pearls

  • Full replacement dose is ~1.6 mcg/kg/day for most adults
  • Elderly or cardiac patients: start 25mcg and increase slowly
  • Take consistently: same time daily, empty stomach, separate from calcium/iron by 4 hours
  • Recheck TSH 4-6 weeks after any dose change
  • Pregnancy: increase dose by ~30% as soon as pregnancy confirmed

Source and review

  • ATA Guidelines for Hypothyroidism 2014. Last reviewed: 2024-11-01