Drugs · Brain health technique
Thyroid Hormone Replacement
Evidence grade: Context Dependent
Standard therapy for hypothyroidism or subclinical hypothyroidism using levothyroxine (Synthroid®, Levoxyl®, Tirosint®) or, less commonly, combination T4/T3 preparations (e.g., liothyronine / Cytomel®, or desiccated thyroid). Restores normal thyroid hormone levels to optimize metabolism, energy, and cognitive performance.
- Practice
- Drugs
- Principle
- Treatment
- Tactic
- Hormonal Therapies
- Evidence grade
- Context Dependent
- Strength of evidence
- Medium
How to practice Thyroid Hormone Replacement
Evaluate with TSH, free T4, and sometimes free T3. Begin low-dose levothyroxine (25–75 µg/day) and titrate based on TSH (target 0.5–2.5 mIU/L). Reassess every 6–8 weeks after dose changes. Avoid overtreatment (TSH <0.3). Combination or natural preparations only when symptoms persist despite normal TSH and under endocrinologist guidance.
The evidence behind Thyroid Hormone Replacement
Both overt and mild thyroid hormone deficiencies are linked to fatigue, depression, and slowed cognition. Evidence shows normalization of thyroid hormone levels improves attention and working memory and reduces depressive symptoms. Mechanism: thyroid hormones regulate cerebral glucose metabolism, myelination, and synaptic plasticity. Over-replacement increases atrial fibrillation and bone loss risk.
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