From the Guidelines
The primary treatment for Hashimoto's thyroiditis is oral T4 monotherapy, specifically levothyroxine sodium, which is the principal treatment for hypothyroidism. This treatment approach is based on the recommendation from the US Preventive Services Task Force 1. The goal of treatment is to replace the thyroid hormone that the body can no longer produce adequately, thereby restoring normal metabolism throughout the body.
When initiating treatment, the starting dose of levothyroxine typically ranges from 25-125 mcg daily, taken on an empty stomach 30-60 minutes before breakfast. The dosage is adjusted based on thyroid function tests, particularly TSH levels, which are checked every 6-8 weeks initially and then annually once stabilized 1. It is essential to take the medication consistently at the same time each day and avoid taking it with calcium supplements, iron, or certain foods that can interfere with absorption.
Regular monitoring is crucial as dosage needs may change over time, especially during pregnancy, significant weight changes, or with aging. Some patients may need to try different brands of levothyroxine to find the one that works best for them, as slight differences in formulations can affect individual responses. The treatment is typically lifelong, and most patients require ongoing therapy to manage their condition effectively.
Key considerations in the treatment of Hashimoto's thyroiditis include:
- Starting dose: 25-125 mcg daily
- Administration: on an empty stomach 30-60 minutes before breakfast
- Dosage adjustments: based on TSH levels, checked every 6-8 weeks initially and then annually
- Potential interactions: avoid taking with calcium supplements, iron, or certain foods
- Monitoring: regular checks of TSH levels and adjustment of dosage as needed
- Lifelong therapy: most patients require ongoing treatment to manage their condition effectively 1.
From the FDA Drug Label
As replacement or supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis As pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto's) and multinodular goiter The treatment for Hashimoto's thyroiditis is replacement or supplemental therapy with thyroid hormone drugs, such as liothyronine, to manage hypothyroidism. Additionally, liothyronine can be used as a TSH suppressant to treat or prevent euthyroid goiters, including Hashimoto's thyroiditis 2.
- Key points:
- Replacement or supplemental therapy for hypothyroidism
- TSH suppressant for euthyroid goiters, including Hashimoto's thyroiditis
- Liothyronine is a treatment option for Hashimoto's thyroiditis 2
From the Research
Treatment for Hashimoto's Thyroiditis
The treatment for Hashimoto's thyroiditis (HT) depends on the clinical presentation of the disease.
- For patients with thyrotoxicosis, the management is based on symptoms control, usually with β-blockers 3.
- For patients with euthyroidism, periodical thyroid stimulating hormone measurements are required to assess for progression to hypothyroidism 3.
- For patients with hypothyroidism, the treatment is based on thyroid hormone replacement therapy, typically with levothyroxine (LT4) 3, 4, 5, 6.
Levothyroxine Dosage
The dose of levothyroxine used for treatment is based on the degree of preserved thyroid functionality and lean body mass, and usually ranges from 1.4 to 1.8 mcg/kg/day 3.
- However, the optimal dose may vary depending on the underlying cause of hypothyroidism, with patients with ICI-associated hypothyroidism requiring a higher dose than those with Hashimoto's thyroiditis 5.
- The dose should be adjusted based on thyroid function tests, with the goal of achieving a stable euthyroid state 5.
Other Considerations
- There is insufficient evidence to recommend for or against therapy with triiodothyronine (T3), apart from in pregnancy when only levothyroxine is indicated 3.
- Patients with Hashimoto's thyroiditis may experience persistent impairments in cognitive functioning and general well-being despite long-term levothyroxine replacement 7.
- The treatment of hypothyroidism should be individualized, taking into account the underlying pathology, age, sex, patient preference, and availability of expert thyroid surgical care 6.