UMEM Educational Pearls

Category: Endocrine

Title: Treatment of Severe Hypothyroidism

Keywords: Hypothyroidism, treatment (PubMed Search)

Posted: 7/20/2013 by Michael Bond, MD (Updated: 12/5/2021)
Click here to contact Michael Bond, MD

Treatment of Severe Hypothyroidism

We do not see patient's with severe hypothyroidism often, but it is important that they be treated aggressively. Some treatment pearls are

  • Rule out aggravating cause (i.e.: infection [UTI, pneumonia], myocardial infarction)
  • Start IV levothyroxine dosing
    • Initial dose 400-500 mcg. This is a large dose but it only saturates the thyroid receptors and will not cause a rebound hyperthyroidism state.
    • Daily dose 100 mcg/day
  • Consider starting Dexamethasone/hydrocortisone
    • Patients may also have adrenal insufficiency from primary pituitary failure or may have secondary adrenal suppression due to the severe hypothyroidism.  If dexamethasone/hydrocortisone is not provided they may develop severe adrenal insufficiency once you kick start their metabolism.