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Treatment of hypothyroidism

Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Jean E Mulder, MD


In most patients, hypothyroidism is a permanent condition requiring lifelong treatment. Therapy consists of thyroid hormone replacement unless the hypothyroidism is transient (as after painless thyroiditis or subacute thyroiditis) or reversible (due to a drug that can be discontinued). (See "Disorders that cause hypothyroidism".)

The goal of therapy is restoration of the euthyroid state, which can be readily accomplished in almost all patients by oral administration of synthetic T4 (levothyroxine). Appropriate treatment reverses all the clinical manifestations of hypothyroidism.

This review will discuss the major issues that must be addressed in the treatment of patients with overt primary hypothyroidism. Our approach described below is largely consistent with the American Thyroid Association (ATA) Guidelines for the Treatment of Hypothyroidism [1].

The approach to therapy of patients with subclinical, congenital, and central hypothyroidism is discussed separately. (See "Subclinical hypothyroidism in nonpregnant adults" and "Treatment and prognosis of congenital hypothyroidism" and "Central hypothyroidism".)


The treatment of choice for correction of hypothyroidism is synthetic T4 (levothyroxine). Approximately 80 percent of a dose of T4 is absorbed and, because the plasma half-life of T4 is long (seven days), once-daily treatment results in nearly constant serum thyroxine (T4) and triiodothyronine (T3) concentrations when a steady state is reached [2].


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Literature review current through: Sep 2016. | This topic last updated: Feb 22, 2016.
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