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Principles of treatment The aim of treatment is to achieve a T4 level in the normal range a TSH level in the normal range AND The doses is primarily titrated to the TSH level The typical dose is 1.6g/Kg, but the dose should be started low and titrated up to this Typically this means doses are in the 100-200g per day range Initially give 25-50g, and review after 6 weeks Start at the lower end for frail and elderly patients Adjust the dose every 6 weeks so that TSH levels are in the normal range (not suppressed) Low TSH suggests over-replacement of T4 (even if T4 is not elevated) titrate the dose down until TSH returns to the normal range High TSH suggests under-replacement increase the dose of levothyroxine The half life of T4 is about 7 days, so any change in the dose will not be clinically noticeable for about 4 weeks

But the key here is to make sure that regardless of what type of treatment you are using, your thyroid function is optimized

Mild nausea during the first day or two after a dose increase is normal as your body adjusts

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Increasing the affinity of a human IgG1 for the neonatal Fc receptor: biological consequences