# Hypothyroidism - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Liothyronine Sodium 20 microgram Tablets SmPC section 4.2 (eMC product 11109): "Adolescents: 12 - 17 years: Initially 10-20 micrograms daily; increased to 60 micrograms daily in 2-3 divided doses." The adult schedule in the same section is "Starting dose of 10 or 20 micrograms every 8 hours", so the daily total here sits below the label's adult starting schedule. · Egyptian National Drug Formulary - Endocrine System 2024 - Verified date: 2026-08 ## Verified against - Liothyronine Sodium 20 microgram Tablets SmPC section 4.2 (eMC product 11109): "Adolescents: 12 - 17 years: Initially 10-20 micrograms daily; increased to 60 micrograms daily in 2-3 divided doses." The adult schedule in the same section is "Starting dose of 10 or 20 micrograms every 8 hours", so the daily total here sits below the label's adult starting schedule. - Egyptian National Drug Formulary - Endocrine System 2024 - Hypothyroidism - disease-level clinical article (hypothyroidism-clinical.txt) ## Treatment metadata - Levothyroxine — 0.05 mg — oral.solid - Referral & safety-netting (no drug therapy) - Liothyronine — 0.02 mg — oral.solid ## Complete treatment card ```text HYPOTHYROIDISM Sources: Liothyronine Sodium 20 microgram Tablets SmPC section 4.2 (eMC product 11109): "Adolescents: 12 - 17 years: Initially 10-20 micrograms daily; increased to 60 micrograms daily in 2-3 divided doses." The adult schedule in the same section is "Starting dose of 10 or 20 micrograms every 8 hours", so the daily total here sits below the label's adult starting schedule. · Egyptian National Drug Formulary - Endocrine System 2024 Review status: REVIEWED against Liothyronine Sodium 20 microgram Tablets SmPC section 4.2 (eMC product 11109): "Adolescents: 12 - 17 years: Initially 10-20 micrograms daily; increased to 60 micrograms daily in 2-3 divided doses." The adult schedule in the same section is "Starting dose of 10 or 20 micrograms every 8 hours", so the daily total here sits below the label's adult starting schedule., Egyptian National Drug Formulary - Endocrine System 2024, Hypothyroidism - disease-level clinical article (hypothyroidism-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Cold intolerance, puffiness, reduced sweating and skin changes are the classic complaints, though not always present [cold intolerance · sweating] - Symptom checklist includes dry skin, voice change, hair thinning, bowel slowing, tiredness and cramping muscles, plus irregular periods [abnormal uterine bleeding · dry skin · fatigue · hoarseness · irregular periods · muscle cramps] - Depression, anxiety, psychosis or memory loss can occasionally be the presenting complaint [anxiety · low mood · memory loss] - Episodic neck pain or a sore throat is a feature more specific to Hashimoto disease [neck pain · sore throat] - Painless enlargement of the thyroid is another clue pointing toward Hashimoto disease SIGNS - what you find (4) - The thyroid gland itself may be visibly and palpably enlarged on exam - Slowed speech and movement with a dull facial expression can be seen on exam - Pallor or jaundice, a dull facial expression, and an enlarged tongue may all be present [jaundice · pallor] - A slow pulse, pericardial fluid, and delayed return of the ankle reflex are additional findings [bradycardia] TESTS (7) - Elevated TSH together with low free T4 confirms overt primary hypothyroidism - Subclinical disease shows a raised TSH with the free T4 still within the normal range - Thyroid peroxidase antibody positivity in subclinical disease predicts about half will progress to overt hypothyroidism within 20 years - Raised cholesterol, creatine kinase, liver enzymes and anemia can accompany hypothyroidism on routine bloods - Central hypothyroidism is diagnosed from a low free T4 rather than from the TSH level - Neck ultrasound isn't a routine part of the hypothyroidism work-up - Population screening every 5 years starting at age 35 is the recommended interval IF NOT THIS - what else fits (5) - Fatigue on its own can also point toward iron deficiency anaemia, sleep apnoea, depression, or a rheumatologic illness - The differential list is broad precisely because hypothyroidism's signs and symptoms are so subtle - Goitre, myxedema coma and anaemia are also weighed in the differential - Riedel thyroiditis, subacute thyroiditis and thyroid lymphoma are further thyroid-specific possibilities - Addison disease and chronic fatigue syndrome are also named in the differential Source StatPearls "Hypothyroidism" - disease-level clinical article Status traced to the source above 1. LEVOTHYROXINE [1st line] Adult Take before breakfast. Under 50 years: initially 50 to 100 mcg daily, adjusted at 3-4 week intervals by 50 mcg until normal metabolism is maintained; the final daily dose may be up to 100 to 200 mcg. Over 50 without cardiac disease: initially 25-50 mcg daily, same 50 mcg steps every 3-4 weeks; final daily dose up to 50 to 200 mcg. Over 50 with cardiac disease: 25 mcg daily, or 50 mcg on alternate days, raised by 25 mcg every 4 weeks; final daily dose up to 50 to 200 mcg. - long-term Peds Egyptian formulary, "Acquired hypothyroidism in children", verbatim: "Initially 12.5- 50 mcg per day. The dose should be increased gradually every 2 to 4 weeks according to the clinical findings and thyroid hormone and TSH values until the full replacement dose is reached." The same monograph gives the maintenance target as "generally 100 to 150 micrograms per m² body surface area" and states plainly that "The dose for children depends on their age, weight and the condition being treated." Titrate on TSH under paediatric endocrinology. A newborn with congenital hypothyroidism is a different dose entirely - look that up under its own name. Source Egyptian National Drug Formulary - Endocrine System 2024 (levothyroxine monograph, Dosage Regimen - Adult dosing, Hypothyroidism) Why Synthetic thyroxine (T4) that replaces deficient endogenous thyroid hormone, restoring normal metabolic rate; the standard replacement therapy for hypothyroidism, started low in the elderly or those with ischaemic heart disease. Caution Take on empty stomach 30-60 minutes before breakfast. Separate from calcium, iron, antacids by 4 hours. Over 50, and especially with cardiac disease, the formulary starts at 25 mcg daily or 50 mcg on alternate days and raises it in 25 mcg steps every 4 weeks - slower and lower than the under-50 schedule. Egypt T4-THYRO 50 MCG 100 TABS. MUP 9.00 EGP (0.09/unit) HYPOTHYRONOR 50 MCG 100 TABS. ACDIMA INTERN... 39.00 EGP (0.39/unit) THYROXINE 50MCG 100 TAB. UP PHARMA 46.00 EGP (0.46/unit) EQUITHERA 50MCG 50 TABS. MARCYRL PHARM... 26.00 EGP (0.52/unit) ELTROXIN 50 MCG 100 TABS. ASPEN > PHOEN... 78.00 EGP (0.78/unit) EUTHYROX 50MCG 50 TAB. MERCK KGAA F.... 46.00 EGP (0.92/unit) EUTHYROX 50MCG 100 TAB. MERCK KGAA F.... 105.00 EGP (1.05/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hypothyroidism - disease-level clinical article (hypothyroidism-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Myxedema coma is an endocrine emergency requiring prompt ICU-level recognition and treatment. 3. LIOTHYRONINE [2nd line] Adult 10-20 mcg (20 mcg tab) daily divided in 2-3 doses - long-term Peds Specialist use only in children Source Liothyronine Sodium 20 microgram Tablets SmPC section 4.2 (eMC product 11109): "Adolescents: 12 - 17 years: Initially 10-20 micrograms daily; increased to 60 micrograms daily in 2-3 divided doses." The adult schedule in the same section is "Starting dose of 10 or 20 micrograms every 8 hours", so the daily total here sits below the label's adult starting schedule. Why NOT AVAILABLE IN EGYPT - liothyronine is not registered with the Egyptian Drug Authority and no Egyptian brand exists; levothyroxine monotherapy is the only practical option locally. Caution NOT MARKETED IN EGYPT - no local brand available; would require import. Avoid in active angina or heart failure. Liothyronine has a rapid onset of action, with risk of cardiac arrhythmias. Specialist supervision is required. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)