Levothyroxine is first-line for hypothyroidism, but getting it right requires precision. In this episode, Dr. Busti explains the TSH–T4–T3 feedback loop, why T4 is preferred over T3 or desiccated thyroid, and how half-life and protein binding shape dosing and monitoring. We cover steady-state timing (6–8 weeks), dose step sizes, manufacturer switches, and how food and cation supplements (calcium, iron, magnesium) alter absorption. You’ll also learn how anticonvulsants, rifampin, beta-blockers, steroids, and amiodarone affect levels or peripheral conversion.
Special populations receive focused guidance: immediate dose increases in pregnancy, careful titration in cardiovascular disease, and intentional TSH suppression after thyroidectomy for cancer. Practical counseling points include consistent administration habits, spacing from multivitamins/antacids, pausing biotin before labs, and symptom-based safety checks (palpitations, tremor, heat intolerance, weight change).
If you teach, precept, or practice, this review helps you move beyond memorization to the “why” that improves bedside decisions.
Access bonus materials and downloads at https://www.thisiswhy.health/topics/pharmacology-review-thyroid-hormone-replacement
Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.
