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.