6.2.1 Thyroid hormones

Levothyroxine
  • Tablets 25 micrograms, 50 micrograms, 100 micrograms (£1.66 = 100 microgram)
  • Oral solution 25 micrograms, 50 micrograms, 100 micrograms/5ml (£229.80 = 100 micrograms/5ml)

Indications

Liothyronine
  • Tablets 20 micrograms (£206.71)

Indications

  • Hypothyroidism that has not responded adequately to levothyroxine therapy or patients who have persistent symptoms felt to be secondary to thyroid hormone deficiency despite seemingly adequate replacement therapy with levothyroxine
  • Preparation for radioiodine remnant ablation (RRA) in patients with thyroid cancer (secondary care only)

Dose

  • Hypothyroidism: Oral, 10 micrograms daily as a single, or in 2 divided doses, in combination with a reduced dose of levothyroxine
  • Elderly - smaller initial doses.

Notes

  1. Liothyronine is not appropriate for initiation by GPs
  2. Liothyronine may be suitable for a small number of patients whose symptoms have not resolved despite optimal treatment with levothyroxine. Liothyronine is restricted to a maximum dose of 10 micrograms daily as dual therapy with levothyroxine initiated by an endocrinologist. Liothyronine monotherapy is not supported
  3. 10 micrograms liothyronine is approximately equivalent to 50 micrograms levothyroxine. 10 microgram doses may be achieved by dispersing a 20 microgram tablet in 20ml water, swirling over 10 minutes, then withdrawing the dose of 10ml using an oral syringe
  4. Secondary care to carry out the initial assessment, monitoring and dose adjustment, and prescribe an initial supply of two packs of 28 x 20 microgram tablets. GPs will be asked to prescribe following this and will be informed if the treatment is to continue or not following the formal 3-month assessment
  5. Consider a trial off liothyronine every 3rd year to ensure continued clinical benefit
  6. There is no convincing evidence to support routine use of thyroid extracts, liothyronine monotherapy, compounded thyroid hormones, iodine containing preparations, dietary supplementation and over the counter preparations in the management of hypothyroidism
  7. Liothyronine for RRA should be prescribed from the centre undertaking the treatment, and should not be prescribed in primary care
  8. NHS Devon CCG and local endocrinologists have agreed protocols to support specialist initiation, and GP review of liothyronine. Click here for initiation protocol (new patients) and here for the review protocol (existing patients)

 

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