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Thyroid Agents General Statement.
Usual initial dose: 25-50 … 2002 Mild Hypothyroidism. /viewarticle/934510
Singer PA, Cooper DS, Levy EG et al. Natural hormone replacement provides both T4 and T3 hormones, and since it is isolated from pig thyroid gland, its dosage is different from that of synthetic T4. 6th ed. A retrospective, single‐center analysis was … AHFS Drug Information 2008. Levothyroxine IV:PO ratio. Replace with oral therapy as soon as possible.Available as liothyronine sodium; dosage expressed in terms of liothyronine.Each 25 mcg of liothyronine is approximately clinically equivalent to 60–65 mg of thyroid or thyroglobulin or 100 mcg or less of levothyroxine.Adjust dosage carefully according to clinical and laboratory response to treatment.Initiate at a lower dosage level in geriatric patients, in patients with functional or ECG evidence of cardiovascular disease, and in patients with severe, long-standing hypothyroidism or other endocrinopathies.Initiate therapy as soon as possible after diagnosis of hypothyroidism to prevent deleterious effects on intellectual and physical growth and development.Maintenance dosage: Infants a few months old may require only 20 mcg daily.For management of mild hypothyroidism, recommended initial dosage is 25 mcg once daily.For management of severe hypothyroidism (e.g., myxedema), recommended initial dosage is 5 mcg once daily.In patients who do not have severe cardiovascular disease, recommended initial dose is 25–50 mcg IV.Replace with oral therapy as soon as patient’s condition stabilizes and drug can be given orally.When switching from IV to oral liothyronine therapy, discontinue IV liothyronine, then initiate oral liothyronine at low dosage and increase gradually according to patient’s response.When switching from IV liothyronine to oral levothyroxine therapy, consider delay (several days) in onset of activity of levothyroxine and discontinue IV liothyronine Limited clinical experience with dosages >100 mcg daily.Initiate therapy at lower dosages than those recommended for patients without cardiovascular disease.If liothyronine therapy is clinically indicated, smaller initial IV doses (i.e., 10–20 mcg) may be necessary.Initiate therapy at lower dosages than those recommended for younger patients.Reduced initial IV dose may be appropriate in geriatric patients because of increased risk of cardiovascular disease.Concomitant use of IV liothyronine with artificial rewarming of patients.Known hypersensitivity to any ingredient in the formulation.Should not be used for the treatment of obesity or for weight loss either alone or with other therapeutic agents.Should not be used in the treatment of male or female infertility unless this condition is associated with hypothyroidism.Hypersensitivity to thyroid hormone is not known to occur.Periodically perform appropriate laboratory tests (e.g., serum TSH, total THypopituitarism, adrenal insufficiency, and other endocrine disorders such as diabetes mellitus and diabetes insipidus are characterized by signs and symptoms which may be diminished in severity or obscured by hypothyroidism.In patients with secondary or tertiary hypothyroidism, consider possibility of additional hypothalamic/pituitary hormone deficiencies and treat if diagnosed.Chronic autoimmune thyroiditis may occur in association with other autoimmune disorders (e.g., adrenal insufficiency, pernicious anemia, type 1 diabetes mellitus).Patients with concomitant adrenal insufficiency should be treated with replacement corticosteroids prior to initiation of thyroid agents.Patients with diabetes mellitus may require increased dosages of antidiabetic agents when treated with liothyronine.During pregnancy, serum free tetraiodothyronine (thyroxine, TAlthough thyroid hormones are distributed minimally into human milk, exercise caution when administering to a nursing woman.Safety and efficacy of IV liothyronine not established in pediatric patients.The goal of treatment in pediatric patients with hypothyroidism is to achieve and maintain normal intellectual and physical growth and development.Neonates with suspected hypothyroidism should receive thyroid agent therapy pending results of confirmative tests.Monitor patients closely to avoid undertreatment or overtreatment.Treated children may manifest a period of catch-up growth, which may be adequate in some cases to achieve normal adult height.Pseudotumor cerebri and slipped capital femoral epiphysis have been reported in children receiving thyroid agents.Because of the increased risk of cardiovascular disease among geriatric patients, liothyronine therapy should not be initiated at the full replacement dose.Because of age-related decreases in renal function, may be useful to monitor renal function.Adverse reactions result from overdosage and resemble manifestations of hyperthyroidism,Potential increased metabolism of thyroid agent with drugs that induce hepatic microsomal enzymes resulting in increased thyroid agent dosage requirements.Carefully monitor PT and adjust anticoagulant dosage accordingly when thyroid agent therapy is initiatedIncreased risk of cardiac arrhythmias and CNS stimulation when levothyroxine is used with tricyclics or tetracyclicsAntidiabetic agents (biguanides, meglitinides, sulfonylureas, thiazolidinediones, insulin)Thyroid agent may cause increased antidiabetic agent or insulin requirementsCarefully monitor diabetic control, especially when thyroid therapy is initiated, changed, or discontinuedβ-Adrenergic blocking agents (e.g., propranolol hydrochloride dosages >160 mg daily)Impaired antihypertensive effects when hypothyroid patient is converted to euthyroid stateBile acid sequestrants (e.g., cholestyramine, colestipol)Administer liothyronine ≥4 hours apart from these agentsDecreased serum digitalis glycoside concentrations in patients with hyperthyroidism or in patients with hypothyroidism in whom a euthyroid state has been achieved; potential for reduced therapeutic effects of digitalis glycosides with thyroid agent useMay need to increase dosage of digitalis glycoside Corticosteroids (e.g., dexamethasone at dosages >4 mg daily)Short-term administration of large doses of corticosteroids may decrease serum TEstrogen or estrogen-containing oral contraceptivesPatients without a functioning thyroid gland may require liothyronine dosage increaseAdminister thyroid agents ≥4 hours apart from this agentConcomitant use with levothyroxine produces transient increases in serum free TGI drugs (e.g., antacids [aluminum hydroxide, magnesium hydroxide, calcium carbonate], simethicone, sucralfate)Administer liothyronine ≥4 hours apart from these agentsExcessive use of thyroid agents with growth hormones may accelerate epiphyseal closure; however, untreated hypothyroidism may interfere with growth response to growth hormoneConcomitant use with levothyroxine produces transient increases in serum free TConcomitant use with levothyroxine produces transient increases in serum free TConcomitant use with levothyroxine produces transient increases in serum free TAdminister liothyronine ≥4 hours apart from this agentPotentiation of sympathomimetic effects; increased risk of coronary insufficiency in patients with CADObserve patient carefully when sympathomimetic agent is administeredClearance of xanthine derivatives may be decreased in hypothyroid patients but returns to normal when the euthyroid state is achievedVarious drugs or concomitant medical conditions (e.g., pregnancy, infectious hepatitis) may adversely affect thyroid function (e.g., alter endogenous thyroid hormone secretion, reduce TSH secretion) resulting in hypothyroidism or hyperthyroidism or interfere with laboratory tests used to assess thyroid function.Some drugs may affect transport of thyroid hormones (TEstrogens, oral (including estrogen-containing oral contraceptives)Almost completely absorbed from the GI tract (about 95%).Thyroid hormones do not readily cross the placenta;Circulating thyroid hormones are >99% bound to plasma proteins, including TBG, thyroxine-binding prealbumin (TBPA), and albumin.
of tacrolimus have been determined following intravenous (IV) and/or oral (PO) administration in healthy volunteers, and in kidney transplant, liver transplant, and heart transplant patients. Controlled studies in pregnant women show no evidence of fetal risk.Synthetic T4; thyroid hormone increases basal metabolic rate, increases utilization and mobilization of glycogen stores, promotes gluconeogenesis; involved in growth development and stimulates protein synthesisBioavailability: 64% (nonfasting); 79-81% (fasting)Deiodinated in blood and then 50% converted to active metabolite, triiodothyronine (T3), also by liverHalf-life: 9-10 days (hypothyroid); 3-4 days (hyperthyroid); 6-7 days (euthyroid)Add 5 mL of NS to vial containing 200 or 500 mcg and shake until a clear solution is obtained; resultant solutions contain approximately 40 or 100 mcg/mL, respectivelyUse reconstituted solutions immediately; discard any unused portionsAlternatively, add 2 mL NS to vial containing 200 mcg to produce Synthroid solution containing approximately 100 mcg/mLTake tabs with full glass of water preferably 30 min to 1 hr before breakfast on empty stomachDo not use foods that decrease absorption (soybean products) for administering levothyroxineAdminister oral levothyroxine >4 hr apart from drugs known to interfere with absorptionAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans.
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