{ "schema_version": 1, "kind": "condition", "id": "hypothyroidism", "name": "Hypothyroidism", "category": "chronic", "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", "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)", "verified_date": "2026-08", "treatments": [ { "id": 949, "generic": "Levothyroxine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.05, "adult_dose": "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.", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (levothyroxine monograph, Dosage Regimen - Adult dosing, Hypothyroidism)", "rationale": "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.", "cautions": [ "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "T4-THYRO 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 9.0, "pack_count": 100, "unit_price": 0.09, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYPOTHYRONOR 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ACDIMA INTERNATIONAL TRADING", "price_egp": 39.0, "pack_count": 100, "unit_price": 0.39, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "THYROXINE 50MCG 100 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 46.0, "pack_count": 100, "unit_price": 0.46, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EQUITHERA 50MCG 50 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 26.0, "pack_count": 50, "unit_price": 0.52, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ELTROXIN 50 MCG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ASPEN > PHOENIX GROUP", "price_egp": 78.0, "pack_count": 100, "unit_price": 0.78, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUTHYROX 50MCG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK KGAA F.R.GERMANY > MERCK LIMITED - EGYPT", "price_egp": 46.0, "pack_count": 50, "unit_price": 0.92, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EUTHYROX 50MCG 100 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MERCK KGAA F.R.GERMANY > MERCK LIMITED - EGYPT", "price_egp": 105.0, "pack_count": 100, "unit_price": 1.05, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hypothyroidism" }, { "id": 951, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Hypothyroidism - disease-level clinical article (hypothyroidism-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Myxedema coma is an endocrine emergency requiring prompt ICU-level recognition and treatment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "hypothyroidism" }, { "id": 950, "generic": "Liothyronine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.02, "adult_dose": "10-20 mcg (20 mcg tab) daily divided in 2-3 doses", "adult_duration": "long-term", "dose_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.", "rationale": "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.", "cautions": [ "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist use only in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "hypothyroidism" } ] }