A practical guide to starting levothyroxine therapy

Calculate full replacement dose: 1.6 mcg/kg/day

Young, otherwise healthy patient:

 • Initiate therapy at full weight-based dose

Older patient OR known CAD OR shorter anticipated duration of therapy

 • Start at 25-50 mcg/day OR 2/3-3/4 anticipated dose



Counsel patients to take their pill on an empty stomach with water, 30-60 mins before breakfast

AVOID proximity to PO iron, calcium carbonate, bile acid resins



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