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Levothyroxine Dosage Chart By Weight

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Last Updated: 28 November 2020

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General | Latest Info

Objective To determine the effect of Levothyroxine sodium Starting dose on cognitive development, growth, or behavior in children with congenital Hypothyroidism identified by NEONATAL screening. Design Systematic review of cohort studies. Two analyses were perform: between-study comparison of mean Starting dose with mean Developmental score and analysis of within-study effects of Starting dose on cognitive development, growth, or Behavior. Results between-study comparison find that standardized mean IQ or Developmental quotient scores range from 90 to 115 but were not associated with the mean starting dose of Levothyroxine. Within-study comparison of 4 cohort studies that report effect of starting dose of Levothyroxine on cognitive Development find no consistent effects. There was weak evidence for the effect of starting dose on growth and on behavior problems. Conclusions evidence for the effect of starting dose of Levothyroxine on cognitive development, growth, or behavior is too weak to justify recommendations in favor of high-or standard-dose regimens. More reliable information, based on randomized control trial of starting dose or meta-analysis of individual patient data currently available, is required to inform treatment policies. NEONATAL screening for congenital Hypothyroidism was introduced in the early 1970s in response to the finding that children who were diagnosed based on symptoms of congenital Hypothyroidism had better developmental outcomes before treatment was start. The 1-3 screening test involves detection of raised levels of thyroid-stimulating hormone and / or low levels of thyroxine in filtered paper blood samples collected shortly after birth. The sensitivity of these screening tests is 90 % to 100 % depending on the method used. 4 5 Confirmation of diagnosis is based on sequential analysis of serum levels of free thyroxine and TSH to rule out transient Hypothyroidism. Although early studies clearly support treatment of children with Hypothyroidism, evidence to support specific dose regimens is lacking. Replacement therapy for congenital Hypothyroidism was initially determined empirically and was based on use of Desiccated thyroid. 6 in the early 1970s, children were treated with a combination of triiodothyronine 7 and standardized preparations from desiccate thyroid or Levothyroxine sodium, and later with Levothyroxine sodium alone at doses of approximately 100 g / m 2 per day. 8 9 The starting dose of Levothyroxine sodium has gradually increased since the introduction of NEONATAL screening, and current regimens vary from 5 to 10 g / kg per day in some centers 10 11 to 10 to 15 g / kg per day in others. 12-15 Starting doses of 10 to 15 g / kg per day have been reported to result in normalization of total thyroxine levels within a few days, 16 to 3 weeks, 13-15 17, whereas doses of less than 8 g / kg per day result in normalization within 6 to 8 weeks. 18 19 However, there is lack of evidence that earlier normalization of biochemical markers improves developmental outcome or growth after taking into account severity of Hypothyroidism at diagnosis. In addition, there are possible adverse effects of high-dose regimens and elevated T 4 levels on temperament and behavior in later childhood.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Levothyroxine Dosage

Dosing should be individualized with consideration of age, cardiovascular status, concomitant medical conditions, and specific nature of condition; follow clinical response and laboratory parameters Closely As DOSE is Adjust: INITIAL DOSES: Primary Hypothyroidism: Healthy Individuals who have been Hypothyroid FOR Short Time INITIAL DOSE: 1. 6 mcg / kg orally once day-Adjust DOSE to 12. 5 to 25 mcg increments every 4 to 6 weeks until clinically euthyroid and TSH returns to normal individuals over 50 years and / or Patients with Cardiovascular Disease: INITIAL DOSE: 12. 5 to 25 mcg orally once day-Adjust DOSE at 6 to 8-weeks intervals until clinically euthyroid and TSH returns to normal Severe Longstanding Hypothyroidism: INITIAL DOSE: 12. 5 to 25 mcg orally once day-Adjust DOSE to increments OF 12. 5 to 25 mcg / day every 2 to 4 weeks until clinically euthyroid and TSH returns to normal MAINTENANCE DOSE: Approximately 1. 6 mcg / kg / day is Full replacement DOSE MAXIMUM DOSE: 200 to 300 mcg / day Secondary or Tertiary Hypothyroidism:-Dosing As described above except serum free-T4 level will be used to Monitor therapy; serum TSH levels are not reliable Measure and should not be used until clinically euthyroid and serum free-T4 levels are restore to upper half OF normal range Comments:-DOSE should be individualize with regular monitoring OF clinical status and laboratory parameters.-Peak effect OF give DOSE may not be attain FOR 4 to 6 weeks.-NOT indicate FOR TREATMENT OF Hypothyroidism during recovery phase OF subacute thyroiditis.-Co-administer food and concomitant medications may significantly affect absorption; Take on empty stomach and at least 4 hours before or after Drugs know to interfere with levothyroxine absorption. Use: As replacement therapy in Primary, Secondary, and Tertiary Congenital or acquire Hypothyroidism

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Introduction

Following total thyroidectomy, optimal replacement of thyroid hormone is imperative, yet often challenging to achieve. Suppressive doses of levothyroxine increase risks of accelerated bone loss, fractures, arrhythmias, and decrease leave ventricular function. Prolonged periods of under treatment are associated with clinical features of hypothyroidism, weight gain, dyslipidemia and cardiovascular dysfunction. Both over-treatment and under-treatment are sources of dissatisfaction for patients and potential source of increased healthcare costs due to increased frequency of laboratory testing and physician visits. The majority of recommendations on thyroid hormone therapy originate from literature on primary hypothyroidism and is applied to surgically induced hypothyroid patients. In primary hypothyroidism, residual thyroid tissue may produce endogenous thyroid hormones complicating true requirement of exogenous thyroxine. Thus, studies examining surgically induced hypothyroid patients are ideal to accurately assess thyroid hormone replacement in this subset. Common practice for initial dosing of levothyroxine is weight base, with a recommended range of 1. 6-1. 7 mcg / kg / day with certain reports advocating up to 2. 1 mcg / kg. Dose adjustments are subsequently made following serial thyroid stimulating hormone concentrations and clinical evaluation. Goal TSH levels are dependent on pathology. In thyroid cancer, TSH suppression is preferred as adjuvant treatment to reduce tumor reoccurrence. Therefore, this study focused on patients with benign thyroid disease whose goal is to achieve TSH value in the normal range. According to surgical literature, time to achieve euthyroidism following thyroidectomy is highly variable, ranging from 2 weeks to 2. 5 years, with a median of 3. 6 months. Post-operatively, many patients require multiple dose adjustments over time prior to achieving euthyroidism. The Conventional methods of thyroid replacement therapy involve an empiric dose of 100-150 micrograms per day. Following this regimen, between 21-37 % of patients attain euthyroid state at initial follow up. The generation of sensitive TSH immunoassays allows serial titrations of levothyroxine contingent on TSH values, creating weight-base dosing more feasible. Unfortunately, widely practiced WBD for initial thyroid hormone replacement has not improved predictability of actual euthyroid dose. Sukumar et al compared the empiric dosing method to WBD and found the latter to require significantly more visits before reaching goal TSH levels. Multiple variables effecting LT4 requirements have been evaluated, including age, sex, body weight, lean body mass, ideal body weight, body surface area, menopausal state, hormonal status, and pathology. Moreover, co-ingestion of calcium supplements, ferrous sulfate, proton pump inhibitors, bile acid sequestrants, and sucralfate can modify LT4 absorption can easily be modified by and further complicate post-operative dosing. Few studies suggest lean body mass predicts LT4 requirement in both surgically induced and primary hypothyroid patients. However, more recent literature has shown no superior predictive value of LBM compared to actual body weight. From a practical standpoint, accurate calculation of lean body mass requires complicated techniques that are impractical in a clinical setting. Research using ideal body weight has disclosed inconsistent outcomes.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Methods

Calculating levothyroxine dose by weight is comparable to using body-fat percentages or BMI, according to data present here. Traditionally, starting replacement doses of levothyroxine have been calculated by multiplying patients ' total body weight by 1. 6 ug / kg, researchers write. However, this simple calculation does not take into account several factors like obesity, gender, sex, age, body fat percentage, hormonal state, interfering medications or supplements and other comorbidities. Malek Cheikh, MD, of Medstar Union Hospital in Baltimore, and colleagues evaluated survey data from 51 adults with hypothyroidism to determine if the standard calculation for deciding levothyroxine dose needs revision. There was 44 % estimate of compliance with therapy. Through bivariate analysis, adherence to medication was the only factor that showed a meaningful relationship to normal thyroid state. No significant differences were found in levothyroxine dose that was effective to control thyroid levels between traditional weight-base thyroid dose, or those calculated using body-fat percentage or BMI. So far, our data indicate that the only variable significantly affecting dose is adherence to medication, researchers write. However, we are in the process of analyzing retrospective data collected from euthyroid patients on thyroid hormone replacement who underwent thyroidectomy to further clarify the ideal relationship between weight and thyroid dose.-By Amber Cox Cheikh M, et al. Abstract 1104. Present at: AACE 24 Annual Scientific & Clinical Congress; May 13-17 2015; NASHVILLE, Tenn.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Conclusion

In contrast to previous studies suggesting that age affects LT 4 replacement requirements, we find that age-base differences in doses are secondary to differences in BW and gender. In addition, in contrast to prior studies showing that lean body mass, but not gender, affect LT 4 dose, we instead find a significant impact on gender. Gender-base differences in dose requirement only become apparent either when IBW was used to correct For dose or when degree of overweight was included in the model. Gender differences in LT 4 dose requirement exist, but are mask unless gender-base differences in degree of overweight are also consider.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

5. Side effects

Fast or irregular heartbeats, chest pain, shortness of breath, fever, hot flashes, sweating, tremors, feeling cold, weakness, tiredness, sleep problems, memory problems, feeling depress, nervous or irritable, headache, leg cramps, muscle aches, dryness of skin or hair, hair loss, changes in your menstrual periods, vomiting, diarrhea, appetite changes, weight changes get medical help right away, If You have any of symptoms list above. Muscle weakness, headache, leg cramps, nervousness, trouble sleeping, diarrhea, skin rash, partial hair loss tell doctor if you have any side effects that bother you or that do not go away. These are not all possible side effects of SYNTHROID. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Thyroid hormones, including SYNTHROID, either alone or with other therapeutic agents, should not be used for treatment of obesity or for weight loss. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life threatening manifes tations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.


What is levothyroxine?

Taking levothyroxine with certain drugs may result in an increase in adverse effects. Examples of these drugs include: antidepressants such as amitriptyline and maprotiline. Side effects of both of these antidepressants and levothyroxine may increase when you take these drugs together. This may put you at risk for irregular heart rhythms. Sympathomimetic drugs such as pseudoephedrine and albuterol. The effects of both sympathomimetic drugs and levothyroxine may increase when you take these drugs together. This may put you at risk of serious heart problems. Blood thinners such as warfarin. Taking these drugs with levothyroxine may increase your risk of bleeding. Your doctor may need to decrease the dosage of your blood thinner if youre also taking levothyroxine. Ketamine. Taking this drug with levothyroxine may increase your risk of high blood pressure and fast heart rate.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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