Treatment of thyroid dysfunction in a medical specialist’s office – the role of levothyroxine

Abstract

Synthetic levothyroxine is the first line treatment for hypothyroidism, one of the most common endocrine disorders, independently its cause, in all age groups. The Polish Endocrinological Society, together with European Thyroid Association, American Thyroid Association and American Association of Clinical Endocrinologists, do not recommend the use of dried thyroid preparations, triiodothyronine or combined preparations of thyroxine with triiodothyronine. The objective of treatment is to achieve biochemical and clinical euthyroidism monitored by TSH and/or FT4 levels. The daily dose of levothyroxine depends on many factors, including the etiology and severity of hypothyroidism, age, body weight, pregnancy and comorbidities. Routinely, levothyroxine is administered on an empty stomach at least 30 minutes before breakfast (ATA 2014 recommend up to 60 minutes interval between meal and taking the drug). Levothyroxine can also be used in combination therapy in Graves’ disease. Currently, the routine use of synthetic sodium levothyroxine in patients with multinodular goiter is not recommended because it increases the risk of osteoporosis in postmenopausal women and atrial fibrillation in patients after 60 year of life.