Zipes MD, in Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2019 Treatment of Overt Hypothyroidism Have the patient take the iron between 2:00 and 6:00 Pm on an empty stomach and away from any hormone treatments.ĭouglas P. Make sure that the patient does not take any iron supplements within 6 hours or calcium within 2 hours of the morning thyroid dose or the thyroid hormone will not be absorbed.
LEVOTHYROXINE 100 MCG FREE
Therefore, I predominantly use free T 4 levels to monitor therapy. As T 3 is largely produced and functions intracellularly, we do not have normal ranges for exogenously given T 3. 19 Because of the hypothalamic suppression, TSH may be low despite inadequate hormonal dosing. Do not use TSH or T 3 levels to monitor thyroid replacement. Īdjust the thyroid dose clinically using the dose that feels the best to the patient, as long as the free T 4 test does not show hyperthyroidism.In most patients, however, I usually recommend beginning with Armour Thyroid. If the free or total T 3 result is low or low-normal, begin with Armour Thyroid, which has both T 3 and T 4, instead of levothyroxine, which is only T 4. For every 50 μg of levothyroxine, have the patient take 0.5 grain (30 mg) of Armour Thyroid. If the patient does not respond to levothyroxine, switch to Armour Thyroid, and vice versa. Small amounts are eliminated into the bile and feces. Primary route of elimination is through the kidneys. The liver is the major site of degradation for both T 4 and T 3. The major pathway of thyroid hormone metabolism is through sequential deiodination. The higher affinity of both TBG and TBPA for T 4 partially explains the higher serum levels, slower metabolic clearance, and longer half-life of T 4 (6 to 8 days) compared with T 3 (less than 2 days). Circulating thyroid hormones are greater than 99% bound to plasma proteins (thyroxine-binding globulin, thyroxine-binding prealbumin, and albumin ). The metabolic actions of thyroid hormones include augmentation of cellular respiration and thermogenesis, as well as metabolism of proteins, carbohydrates, and lipids. Approximately 80% of T 3 is derived from T 4 (levothyroxine) by deiodination in peripheral tissues. Actions are produced predominantly by T 3 (triiodothyronine). Thyroid hormones regulate multiple metabolic processes and play an essential role in normal growth and development. Thyroid hormone synthesis and secretion is regulated by the hypothalamic-pituitary-thyroid axis. Effective replacement for decreased or absent thyroid hormone.
Manufacturer states, “Do not add to other IV fluids.” RATE OF ADMINISTRATIONġ00 mcg or fraction thereof over 1 minute. Reconstituted solution is preservative-free and stable for 4 hours any remaining solution is discarded. Store dry product at CRT and protect from light.
May be given through Y-tube or three-way stopcock of infusion set. Reconstituted concentrations will be 20 mcg/mL for the 100-mcg vial and 100 mcg/mL for the 500-mcg vial. Each vial of lyophilized powder is diluted with 5 mL of NS for injection (without preservatives). DILUTIONĪvailable in different strengths read label carefully. ■ Reduce dose in elderly, functional or ECG evidence of cardiovascular disease (including angina), long-standing thyroid disease, other endocrinopathies, and severe hypothyroidism. DOSE ADJUSTMENTSĪge, general condition, cardiac risk factors, and clinical severity of myxedema symptoms should be considered when determining the starting and maintenance dosages. See pediatric literature for dosing guidelines. Any IV dose should be 50% to 75% of the established oral dose. Given orally (may be crushed in food or liquid). Follow with once-daily intravenous maintenance doses between 50 and 100 mcg.
Myxedema coma:ģ00 to 500 mcg as an initial dose. Average maintenance dose is 50 to 100 mcg/day PO. Base dosing on clinical response and serum thyroid and TSH levels. Increase in increments of 12.5 mcg every 2 to 4 weeks. Usual IV starting dose would be 6.25 to 12.5 mcg/day. Hypothyroidism (when oral therapy is not possible): Initiate oral treatment as soon as possible. When oral ingestion is not practical, IV dose should be ½ of any previously established oral dose see Indications and Uses, Limitation of Use. Shelly Rainforth Collins PharmD, BCGP, in Gahart's 2022 Intravenous Medications, 2022 LEVOTHYROXINE SODIUM
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