Once the diagnosis of hypothyroidism is made, medication is initiated. Typically levothyroxine in the form of a tablet is provided. There are liquid formulations but they often tend to be expensive. Tablets are just as effective and can be easily crushed for young patients who cannot chew or swallow them.
Levothyroxine is typically given on an empty stomach. However, in infants who are feeding frequently this is not possible. For this population, the important thing is being consistent with when the medication is provided. It is best to avoid supplements such as iron and calcium for at least 4 hours as they tend to impair the absorption of the medication. Simethicone, antacids, and soy products also impact the absorption. It is also recommended not to crush the tablet and place into a baby’s bottle. There are two reasons for this. One there is concern that the infant will not finish the bottle and two, the medication has an affinity for plastic.
If a dose is missed at the usual scheduled time, the dose can be provided when the parent remembers later in the day. The dose can also be doubled the next day.