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Replacement or substitutive therapy when thyroid function is decreased or completely absent: hypothyroid coma (IV), cretinism; myxedema; non-toxic goiter; hypothyroidism in general; hypothyroidism resulting from surgical removal of the gland, or from poor function, as a result of the app. of radiation or tto. with antithyroid agents. Suppression of thyrotropin secretion (TSH) that is required in tto. non-endemic simple goiter and lymphocytic thyroiditis. Thyrotoxicosis, in combination with antithyroid agents, to prevent hypothyroidism. Recurrence prophylaxis after euthyroid goiter surgery, depending on post-surgical hormonal status.
How to Treat enign Euthyroid Goiter
Treatment of benign euthyroid goiter; prevention of recurrence after euthyroid goiter surgery, depending on post-surgical hormonal status; replacement therapy in cases of hypothyroidism; suppressive therapy in thyroid carcinoma; concomitant supplementation during treatment of hyperthyroidism with antithyroid drugs; diagnostic use for thyroid suppression test.
To lower blood cholesterol in arteriosclerosis or xanthomatosis. Obesity of hypothyroid origin.
How Long Does Treatment Last?
The duration of the treatment It is for life in the replacement therapy of hypothyroidism, after a strumectomy or thyroidectomy and for the prevention of recurrent goiter after removal of euthyroid goiter. Concomitant therapy of hyperthyroidism, once the euthyroid state is reached, is indicated during the period in which the antithyroid drug is administered. For benign euthyroid goiter, tto is necessary. between 6 months and 2 years. In cases of goiter in which the tto. drug therapy is insufficient, surgical treatment or radioiodine therapy should be considered.
Buy Levothyroxine Online Dosage
Tablets: single dose in the morning, on an empty stomach, 1/2 h before breakfast, with a little liquid (eg 1/2 glass of water).
Children: daily dose in a single dose at least 30 minutes before the first meal of the day. The tablets will dissolve in a little water and the resulting suspension, which must be prepared at the time of taking, will be administered by adding a little more liquid.
Contraindications
Levothyroxine sodium
hypersensitivity; hyperthyroidism, heart failure adrenal, insuf. adrenocortical insuf. pituitary (when it leads to adrenal insuf. requiring treatment), insuf. untreated pituitary and thyrotoxicosis; AMI, acute myocarditis, and acute pancarditis; Concomitant administration with antithyroid drugs in pregnancy and lactation.
Warnings and precautions
Levothyroxine sodium
Diabetics and patients under tto. anticoagulant. Before starting therapy rule out or treat: insuf. Coronary, insuf. Cardiac, myocardial infarction, angina pectoris, atherosclerosis, hypertension, elderly, heart failure. Pituitary, insuf. Cortico and adrenal, insuf. Pituitary, adrenocortical dysfunction (treat to prevent acute adrenal insufficiency), autonomic thyroid nodule (perform THR test or suppression scintigraphy), secondary hypothyroidism (rule out simultaneous adrenal insuf.), iodine intolerance, progressive tuberculosis, IR and anorectic states.
Avoid Psychotic Disorders!
At risk of psychotic disorders start with a low dose to gradually increase the dose at the beginning of therapy, monitor the patient. If signs of psychotic disorders appear, adjust dose.
Avoid mild hyperthyroidism induced by drugs in insuf. Coronary, insuf. Cardiac or tachycardia arrhythmias, carry out frequent controls. In secondary hypothyroidism, determine the cause before administering replacement therapy.
If thyroid autonomy is suspected, monitor the hypothalamic TSH-releasing factor (TSH-RH) or a suppression scintigram before starting treatment.
In very low birth weight preterm infants, monitor hemodynamic parameters, as circulatory collapse may occur due to immature adrenal function.
Do not administer for weight reduction. High doses could cause serious adverse reactions or even endanger the life of the patient. Do not combine high-dose levothyroxine with certain substances for weight reduction (sympathomimetics).
If a change to another drug containing levothyroxine is required, closely monitor, adjust dose.
Risk of hypothyroidism and/or reduced control of hypothyroidism. concomitant with orlistat (monitor serum hormone levels).
Monitor thyroid function
Monitor thyroid function in postmenopausal patients with hypothyroidism and increased risk of osteoporosis, as well as in patients receiving concomitant levothyroxine and other drugs (such as amiodarone, tyrosine kinase inhibitors) that may affect thyroid function. start treatment with low doses. Do not administer in hyperthyroid states except as concomitant therapy to treatment. antithyroid. Interrupt treatment in case of surgery requiring general anesthesia.
Needs may increase in situations of protein loss, nephrotic syndrome. Control the comatose condition before starting treatment. (myxedema coma develops several years after untreated hypothyroidism).
Levothyroxine Sodium Interactions
See Warnings and Precautions, in addition:
Effect reduced by: drugs containing aluminum (antacids, sucralfate), drugs with iron, Ca carbonate; lopinavir/ritonavir.
Decreased efficacy by: sertraline, chloroquine, proguanil, tyrosine kinase inhibitors (imatinib, sunitinib, sorafenib, or motesanib).
Increases effect of: coumarin anticoagulants; adjust their dose if necessary.
Absorption inhibited by: cholestyramine, sevelamer, colestipol and Ca and Na salts of the ac. polystyrene sulfonic acid, soy-containing products.
Hepatic clearance increased by: barbiturates, rifampicin, carbamazepine, phenytoin.
Decreases effect of: antidiabetics.
Free T4 fraction increased by: salicylates, dicumarol, furosemide (high doses), clofibrate.
Peripheral conversion of T4 to T3 inhibited by: propylthiouracil, glucocorticoids, ß-sympatholytics (especially propranolol), amiodarone and iodinated contrast media. Potency effect of: catecholamines. Needs increased with: estrogens. Protease inhibitors (ritonavir, indinavir, lopinavir): strict monitoring of thyroid hormone values.
Pregnancy
Levothyroxine sodium
Levothyroxine treatment should be continued during pregnancy. It may even be necessary to increase the dose during pregnancy. As the rise in serum TSH can occur as early as 4 weeks of gestation, pregnant women taking levothyroxine should have their TSH monitored every trimester to ensure that serum TSH values are within the normal range. specific reference for each trimester of pregnancy. Because postpartum TSH levels are similar to prepregnancy values, the levothyroxine dose should return to the same prepregnancy dose immediately after delivery. Between 6 and 8 weeks postpartum, data on serum TSH levels should be obtained.
There is no evidence of teratogenicity and/or foetotoxicity in humans at recommended therapeutic doses. Excessively high doses during pregnancy may have negative effects on the fetus and postnatal development.
During pregnancy, estrogens may increase levothyroxine requirements. Monitor thyroid function during and after pregnancy and adjust the dose of thyroid hormone if necessary.
Treatment of hyperthyroidism with levothyroxine in combination with antithyroid drugs is not indicated during pregnancy. This combination might require higher doses of antithyroid drugs, which are known to cross the placenta and cause hypothyroidism in the fetus. Hyperthyroidism during pregnancy should be treated with a monotherapy, low-dose antithyroid drug. Do not perform the suppression
test Diagnostic thyroid suppression tests should not be performed during pregnancy, since the administration of radioactive substances in pregnant women is contraindicated.
Lactation
Levothyroxine sodium
Thyroid hormone treatment should be given regularly, particularly during lactation. During lactation, the suppression test should not be performed.
Levothyroxine is secreted in breast milk, but the concentrations achieved with the recommended therapeutic dose are not sufficient to develop hyperthyroidism or eliminate TSH secretion in the baby.
Adverse reactions
Levothyroxine sodium
Tachycardia, palpitations, cardiac arrhythmia (eg atrial fibrillation and extrasystoles), angina, headache, muscle weakness and cramps, flushing, heat intolerance, sweating, fever, vomiting, menstrual disturbances, pseudotumor cerebri, tremor, agitation, insomnia, hyperhidrosis, weight loss, diarrhea, allergic reactions, leukopenia, cerebral embolism, psychiatric disorders, angina, headache, muscle weakness and cramps, flushing, fever, pseudotumor cerebri.
