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Primary hypothyroidism -management and follow up

Primary hypothyroidism –management recommendations by NICE , Offer levothyroxine ( LT4 ) as first line treatment.


do not routinely offer liothyronine ( LT3 ) either alone or in combination
○ T3 is the active thyroid hormone , majority is produced by the peripheral conversion of levothyroxine ( T4 )
○ it is more difficult to select , monitor and adjust the dose of T3 preparations
○ potential risks from T3 as osteoporosis and arrhythmia
○ T3 ( Liothyronine 20 mcg tablets are quite expensive , about £ 244 for 28 tablets ) NICE does not support use of T3 as there is not enough evidence that it offers benefit over levothyroxine (T4 ) and its long term effects are uncertain (for the same reason NICE does not recommend use of natural thyroid extract )


aim to maintain TSH within reference range adjust dose further if symptoms persist to achieve optimal well-being but avoid using doses that cause TSH suppression or thyrotoxicosis in people with a very high TSH before starting treatment or a prolonged period of untreated hypothyroidism it may take up to 6 months for the TSH to return to the reference range


  1. Thyroid disease : assessment and management NICE Guideline 145 November 2019 Recommendations | Thyroid disease: assessment and management | Guidance | NICE
  2. North of Tyne Area and Gateshead Area Prescribing Committee Liothyronine (T3) for Hypothyroidism – Prescribing Guideline




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