From the FDA Drug Label
The general aim of therapy is to normalize the serum TSH level In adult patients with primary hypothyroidism, monitor serum TSH levels after an interval of 6 to 8 weeks after any change in dosage. In patients on a stable and appropriate replacement dosage, evaluate clinical and biochemical response every 6 to 12 months and whenever there is a change in the patient’s clinical status
The typical management for Hashimoto thyroiditis involves normalizing serum TSH levels through levothyroxine replacement therapy. The dosage is adjusted based on regular monitoring of serum TSH levels, typically every 6 to 8 weeks after any change in dosage, and every 6 to 12 months thereafter. The goal is to maintain serum TSH levels within the normal range, which may vary depending on the individual patient and their clinical status 1.
From the Research
The typical management for Hashimoto thyroiditis centers on thyroid hormone replacement therapy, primarily with levothyroxine (T4), with a starting dose of 1.4 to 1.8 mcg/kg/day, as recommended by the most recent and highest quality study 2.
Key Considerations
- The treatment is usually initiated when the patient develops hypothyroidism, indicated by elevated thyroid-stimulating hormone (TSH) levels.
- The medication should be taken on an empty stomach, 30-60 minutes before breakfast, and separated from calcium, iron supplements, and certain medications that can interfere with absorption.
- Dose adjustments are made based on TSH levels, which should be checked 6-8 weeks after starting therapy or changing doses, with a target TSH typically between 0.5-2.5 mIU/L.
- Once stabilized, annual TSH monitoring is recommended.
- Levothyroxine is generally a lifelong treatment as Hashimoto's causes permanent thyroid damage.
Special Considerations
- Patients older than 60 years or with known or suspected ischemic heart disease should start at a lower dosage of levothyroxine (12.5 to 50 mcg per day) 3.
- Women with hypothyroidism who become pregnant should increase their weekly dosage by 30% up to nine doses per week (i.e., take one extra dose twice per week), followed by monthly evaluation and management 3.
- Some patients may benefit from combination therapy with T3 (liothyronine), though this remains controversial and is not standard first-line treatment 2.
Monitoring and Follow-up
- Regular monitoring of TSH levels is essential to adjust the dose of levothyroxine and ensure that the patient remains euthyroid.
- Patients with persistent symptoms after adequate levothyroxine dosing should be reassessed for other causes or the need for referral 3.
- The relations between thyroid function, mental status, and psychiatric disorders seem to be complex, and the mechanisms underlying the interactions remain to be clarified 4.