6.9.2. Hypothyroidism

Combination levothyroxine and liothyronine should not be used routinely in the management of hypothyroidism as there is insufficient population based clinical evidence to show that combination therapy is superior to levothyroxine monotherapy. It may be initiated by an NHS Consultant Endocrinologist ONLY in circumstances where all other treatment options have been exhausted:

1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)

2. Where alternative causes of symptoms have been excluded.

Hypothyroidism should be treated first line with Levothyroxine.
Liothyronine monotherapy is not recommended in hypothyroidism and should only be prescribed in exceptional circumstances, in line with RMOC/JPC guidance.

Levothyroxine Lactose Free

Teva brand is an option for lactose free requirements, others may be available.

For SPS Guidance on Levothyroxine monitoring in Adults in Primary Care please click here

For information regarding the prescribing of Liothyronine click here 

For Liothyronine Shared Care click here

For position Statement of Armour Thyroid click here