What is the typical starting dose of NP (Natural Porcine) thyroid?

NP Thyroid Starting Dose Recommendations

The typical starting dose of NP (Natural Porcine) Thyroid is 15-30 mg daily for most adults, with gradual titration based on TSH levels and clinical response.

Dosing Considerations

Initial Dosing

• Start with 15-30 mg daily for most adults
• For elderly patients (≥65 years) or those with cardiac disease: Start with lower dose of 15 mg daily
• For patients with severe hypothyroidism: Consider starting at 30 mg daily

Dose Titration

• Measure TSH and free T4 at 6-8 weeks after starting therapy
• Increase dose by 15-30 mg increments every 6-8 weeks until euthyroidism is achieved
• Target TSH within normal reference range (typically 0.4-4.5 mIU/L)

Special Populations

Elderly Patients

• Lower starting doses (15 mg daily) are recommended
• Elderly patients require approximately one-third lower weight-based dosing compared to younger adults 1
• Slower metabolism of thyroid hormone in advanced age necessitates more conservative dosing

Patients with Cardiac Disease

• Start at lowest possible dose (15 mg)
• Monitor for cardiac symptoms (palpitations, tachycardia, chest pain)
• More frequent monitoring of TSH (every 4-6 weeks initially)

Pregnant Women

• Increase weekly dosage by approximately 30% (an extra dose twice weekly) 2
• Monitor TSH monthly during pregnancy
• Maintain trimester-specific TSH reference ranges
• Return to pre-pregnancy dose immediately after delivery

Monitoring Recommendations

Initial Follow-up

• Check TSH and free T4 at 6-8 weeks after starting therapy
• Assess for symptom improvement (energy, cold tolerance, constipation, etc.)

Ongoing Monitoring

• For stable patients: Check TSH every 6-12 months
• For patients with TSH 0.1-0.45 mIU/L: Monitor every 3 months
• For patients with TSH <0.1 mIU/L: Monitor every 4-6 weeks 3

Clinical Pearls

• NP Thyroid contains both T4 and T3, unlike levothyroxine which contains only T4
• Conversion factor: 60 mg of NP Thyroid is approximately equivalent to 100 mcg of levothyroxine
• Take on an empty stomach, 30-60 minutes before breakfast for optimal absorption
• Avoid taking with calcium, iron supplements, or antacids which can reduce absorption
• Patients switching from levothyroxine to NP Thyroid may require dose adjustment

Common Pitfalls to Avoid

• Starting with too high a dose in elderly or cardiac patients, which can precipitate cardiac events
• Inadequate monitoring of thyroid function tests during dose titration
• Failure to adjust dosing during pregnancy, which can lead to maternal and fetal complications
• Not recognizing drug interactions that affect thyroid hormone metabolism
• Overreliance on symptoms alone without laboratory confirmation of appropriate dosing

Remember that while NP Thyroid contains both T4 and T3, there is no evidence that combination therapy provides better outcomes than T4 alone for most patients with persistent symptoms and normal TSH levels 2.