Medication Summary

Levothyroxine is generally considered to be the treatment of choice for patients with hypothyroidism.

Class Summary

Levothyroxine is the preferred form of thyroid hormone replacement in all patients with hypothyroidism. Rarely, patients with congenital hypothyroidism display a "reset thyrostat" (ie, the serum TSH is not suppressed to reference range even with supraphysiologic replacement of levothyroxine). The primary therapeutic goal in patients with congenital hypothyroidism is to maintain the free serum T4 level within the high end of the reference range without resulting in symptoms of hyperthyroidism.

Thyroid hormones only should be used as replacement therapy in children with hypothyroidism. In active form, thyroid hormone influences growth and maturation of tissues, metabolism, and development. It does not enhance final adult height in euthyroid children.

Levothyroxine (Levothroid, Levoxyl, Synthroid, Thyquidity)

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Synthetic drug identical to human T4. Adjust dose on basis of total T4 and TSH (if primary hypothyroidism) or free T4 (if secondary or tertiary hypothyroidism); target range is normal total or free T4, with TSH < 5 mcU/mL. Use a single brand to avoid variations in potency between brands. Several commercial preparations are available and share equal efficacy, despite different potency. With age, dose decreases on a weight basis, although daily dose approximates 100 mcg/m², IV dose is approximately 40-50% of the PO dose.

Follow-up

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Author

Sunil Kumar Sinha, MD Clinical Assistant Professor, Division of Pediatric Endocrinology, University of Arizona College of Medicine

Sunil Kumar Sinha, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew J Bauer, MD Director, The Thyroid Center, Division of Endocrinology, The Children's Hospital of Philadelphia

Andrew J Bauer, MD is a member of the following medical societies: American Academy of Pediatrics, American Thyroid Association, Pediatric Endocrine Society, Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Sasigarn A Bowden, MD Associate Professor of Pediatrics, Section of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Associate Fellowship Program Director, Division of Endocrinology, Nationwide Children’s Hospital; Affiliate Faculty/Principal Investigator, Center for Clinical Translational Research, Research Institute at Nationwide Children’s Hospital

Sasigarn A Bowden, MD is a member of the following medical societies: American Society for Bone and Mineral Research, Central Ohio Pediatric Society, Endocrine Society, International Society for Pediatric and Adolescent Diabetes, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Thomas A Wilson, MD Professor of Clinical Pediatrics, Chief and Program Director, Division of Pediatric Endocrinology, Department of Pediatrics, The School of Medicine at Stony Brook University Medical Center

Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Pediatric Endocrine Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Robert J Ferry Jr, MD Le Bonheur Chair of Excellence in Endocrinology, Professor and Chief, Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Tennessee Health Science Center

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Eli Lilly & Co Grant/research funds Investigator; MacroGenics, Inc Grant/research funds Investigator; Ipsen, SA (formerly Tercica, Inc) Grant/research funds Investigator; NovoNordisk SA Grant/research funds Investigator; Diamyd Grant/research funds Investigator; Bristol-Myers-Squibb Grant/research funds Other; Amylin Other; Pfizer Grant/research funds Other; Takeda Grant/research funds Other

Ann Marie Straight, MD Fellow, Department of Pediatrics, Walter Reed Army Medical Center, National Naval Medical Center

Disclosure: Nothing to disclose.