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Levothyroxine Treat

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Last Updated: 27 October 2020

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General | Latest Info

Thyroid gland in your neck makes a hormone called thyroxine. Thyroxine controls how much energy your body use. It's also involved in digestion, how your heart and muscles work, brain development and bone health. When the thyroid gland does not make enough thyroxine, many of the body's functions slow down. Some of the most common symptoms of underactive Thyroid gland are: tiredness feeling cold, difficulty concentrating weight gain feeling depressed. Levothyroxine is a synthetic version of thyroxine. You take levothyroxine tablets to replace thyroxine that your thyroid gland cannot produce and prevent symptoms of hypothyroidism. One of the symptoms of underactive Thyroid gland is weight gain. So, once you start taking levothyroxine, you may lose weight as your body's hormones rebalance. Losing weight can also be a sign that your dose of levothyroxine is too high. Once your Thyroid hormone levels have returned to normal, your tendency to gain or lose weight is the same as for people who do not have Thyroid problems. If you have underactive Thyroid, you're entitled to free prescriptions for all of your medicines. To claim your free prescriptions you'll need to have a medical exemption certificate. The application form for the medical exemption certificate is called FP92A. You can get this from your doctor's surgery. You will need to fill in the form, then your doctor will sign it and send it off. It's having underactive Thyroid that causes hair loss-not treatment with levothyroxine. Because the natural hair growth cycle takes several months, hair loss related to Thyroid disease might only be seen months after illness has begin. If treatment with levothyroxine has already start, it may seem like medicine-rather than underlying illness-is causing hair loss. Hair usually regrow after treatment with levothyroxine, but it may take many months.

* 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

Treatment

To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after six to eight weeks. After that, blood levels are generally checked six months later. Excessive amounts of hormones can cause side effects, such as: increased appetite, Insomnia, Heart palpitations Shakiness If you have coronary artery disease or severe Hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to an increase in metabolism. Levothyroxine causes virtually no side effects when used at an appropriate dose and is relatively inexpensive. If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking drugs because you're feeling better. If you do, symptoms of Hypothyroidism will gradually return.

* 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

Alternative medicine

C omplementary and Alternative Medicine is defined by the National Institutes of Health AS group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional Medicine. According to the 2007 National Health Interview Survey, one third of US adults have use some form of CAM with annual costs estimated to exceed $4 billion. CAM practices are usually grouped into four broad categories: Natural products, mind and body Medicine practices, manipulative practices, and body-base practices. The majority of patients using CAM approaches DO so to complement their conventional care rather than AS Alternative. By definition, CAM practices are not part of conventional Medicine. In part, this may be because there is insufficient proof that they are safe and effective. CAM is used for a wide range of common problems including pain, common cold, stiffness, anxiety, and depression. Patients often use CAM approaches to treat or provide symptom relief for cancer, cardiovascular diseases, and lung diseases. In particular, CAM use is more prevalent among women, adults with higher educational attainment, and in individuals with existing health conditions who make frequent medical visits to conventional health care professionals. Many of these descriptors apply to patients with Thyroid cancer. Patients' use of therapies other than those prescribed by their allopathic physicians must be acknowledged and assessed for their impact on conventional medical therapies. While there have been surveys conducted to analyze CAM use specifically in patients with cancer, number of patients with Thyroid cancer in these surveys were small, definitions of what constitutes CAM Therapy vary, and questions were not specific to Thyroid cancer. The incidence and prevalence of CAM use among patients with Thyroid cancer is therefore not know. Despite the high prevalence of patient use, fewer than half of patients who use CAM typically discuss it with their clinician, and health care professionals DO not consistently inquire about or record patients' use of CAM. This is concerning because the potential for interactions between CAM modalities and patients' Thyroid cancer treatment is unknown; for example, interaction with radioactive iodine ablation or Thyroid hormone suppressive Therapy. The primary goal for this study was to assess the incidence and prevalence of CAM use among patients with Thyroid cancer. We examine relationships between CAM use, demographics, and cancer treatment among patients with Thyroid cancer and assess the extent to which patients communicate their CAM use to their providers.


Hypothyroidism

Thyroid gland is a butterfly-shaped endocrine gland located in lower front of the neck. Their job is to make hormones which are secreted into blood and then carried to every tissue in the body. Thyroid hormones help the body make energy, metabolize, regulate temperature, and keep the brain, heart, muscles, and other organs working as they should. When the body isnt making enough thyroid hormone, symptoms can include fatigue, weight gain, hair thinning, dry skin, and depression. Experts believe that between 40 and 60 percent of people with thyroid disease do not know they have it. Low thyroid hormone can also cause more serious symptoms like difficulty sleeping, changes in menstruation, or gastrointestinal symptoms. Because symptoms of hypothyroidism can resemble those of other diseases and vary widely from person to person, patients may not recognize them as problem warranting exploration or treatment. Experts believe that between 40 and 60 percent of people with thyroid disease do not know they have it.

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Uses

Levothyroxine is USE TO treat underactive thyroid gland. It replaces or provides more thyroid hormone, which are normally produced by thyroid gland. Low thyroid hormone levels can occur naturally or when the thyroid gland is injured by radiation / medications or removed by surgery. Having enough thyroid hormone is important for normal mental and physical activity. In children, having enough thyroid hormones is important for normal mental and physical development. This medication is also USE TO treat other types of thyroid disorders. This medication should not be USE TO treat infertility unless it is caused by low thyroid hormone levels.


Side Effects

Hair loss may occur during the first few months of treatment. This effect is usually temporary as your body adjusts to this medication. If this effect persists or worsens, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if any of these unlikely but serious effects of high thyroid hormone levels occur: increased sweating, sensitivity to heat, mental / mood changes, tiredness, diarrhea, shaking, headache, shortness of breath, bone pain, easily broken bones. Get medical help right away if any of these rare but serious effects of high thyroid hormone levels occur: chest pain, fast / pounding / irregular heartbeat, swelling hands / ankles / feet, seizures. Very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of serious allergic reaction, including: rash, itching / swelling, severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact 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 or at www. FDA. Gov / medwatch. In Canada-Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

* 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

Side Effects

Get emergency medical help if you have signs of allergic reaction to levothyroxine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Fast or irregular heartbeats; Chest pain, pain spreading to your jaw or shoulder; Shortness of breath; fever, hot flashes, sweating; tremors, or if you feel unusually cold; weakness, tiredness, sleep problems; memory problems, feeling depressed or irritable; headache, leg cramps, muscle aches; feeling nervous or irritable; dryness of your skin or hair, hair loss; irregular menstrual periods; or vomiting, diarrhea, appetite changes, weight changes. Certain side effects may be more likely in older adults. Chest pain, irregular heartbeats; shortness of breath; tremors, muscle pain or weakness; headache, leg cramps; feeling nervous or irritable, trouble sleeping; increased appetite; feeling hot; weight loss; changes in your menstrual periods; diarrhea; or skin rash, partial hair loss. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

* 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

Taking levothyroxine

BACKGROUND Thyroxine is the main hormone secrete by Thyroid gland. Levothyroxine is a synthetic form of Thyroxine and is one of the most commonly prescribed medications in the world. The main indication for Levothyroxine is for treatment of Hypothyroidism. Other indications for Levothyroxine include for decreasing size OF Thyroid nodules or OF goiter, although this indication has largely been shown to be ineffective. Levothyroxine has also been inappropriately used for treatment of problems that ARE not related to Thyroid. Sometimes patients have been prescribed Levothyroxine for a long time, but it is not clear why it was started or if they still need to be taking it. Also, while most patients with Hypothyroidism require life-long treatment, in some patients Hypothyroidism may resolve. The main goal of this STUDY was to determine how often such patients had normal Thyroid hormone levels off Levothyroxine treatment, suggesting that Levothyroxine treatment was no longer needed. The Authors also compared features of individuals who ultimately had normal Thyroid hormone levels off treatment, compared to those who had abnormal levels consistent with ongoing Hypothyroidism. FULL ARTICLE TITLE: Livadas S et al 2018 Levothyroxine replacement therapy and overuse: timely diagnostic approach. Thyroid. Epub 2018 Oct 23. PMID: 30351232. SUMMARY OF STUDY authors recruited 291 Levothyroxine-treated patients from academic Endocrinology clinic in Athens, Greece in 2015 and 2016. Patients were taking levothyroine for more than a year and abnormal pre-treatment Thyroid function studies were not clearly established in medical record. All patients had normal Thyroid hormone levels on Levothyroxine treatment. Authors exclude individuals who had prior Thyroid surgery, goiter, patients who had abnormal Thyroid hormone levels on L-T 4 treatment, individuals on medications that could alter Thyroid hormone levels, and women planning to get pregnant or who had given birth in last year. Investigators also evaluate thyroid hormone levels before and after stopping Levothyroxine treatment. All patients had neck Ultrasound to evaluate the appearance of Thyroid. Most OF patients were women and the average age was 48 years. After stopping Levothyroxine treatment for 6 to 8 weeks, 61% OF patients continue to have normal Thyroid hormone levels. There was no significant difference in age, body mass index, duration OF Levothyroxine use, baseline Thyroid hormone levels on Levothyroxine, Levothyroxine dose, sex, family history OF Thyroid disease, or positivity OF Thyroid antibodies between patients who had normal Thyroid hormone levels off Levothyroxine compared to those whose levels become abnormal after pausing treatment. Irregular texture of thyroid was seen more often in patients who had abnormal Thyroid hormone levels off treatment compared to those whose levels remained normal. WHAT ARE the IMPLICATIONS OF this STUDY? Authors conclude that a substantial proportion of individuals taking Levothyroxine in whom original indication for treatment is unclear, may not need to be taking this hormone.

* 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

7. Cautions with other medicines

Some medicines can interfere with Thyroid Hormones, so the dose of Levothyroxine may need to be change. They include: medicines for fits or seizures-such as carbamazepine and phenytoin rifampicin amiodarone oestrogens-such as in combined contraceptive pills or hormone replacement therapy. Levothyroxine can change how other medicines work, so their doses may need to be alter. These medicines include: medicines for diabetes-either insulin or tablets blood thinning medicine, warfarin some medicines should not be taken at the same time of day as Levothyroxine as they can reduce the amount of Levothyroxine your body takes in, including: antacids calcium salts, iron salts orlistat, medicine used for weight loss sucralfate, medicine use to treat stomach ulcers some cholesterol-lowering medicines such as colestyramine, colestipol or colesevelem read Information Leaflet supply with these medicines or speak to your pharmacist for advice on how much time to leave between taking these medicines and taking Levothyroxine.


Interactions

Medicines that interact with levothyroxine may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with levothyroxine. Interaction between two medications does not always mean that you must stop taking one of medications. However, sometimes it does. Speak to your doctor about how drug interactions should be manage. Amiodarone or other medications that affect iodine, such as radioactive iodine amphetamines, such as dexamphetamine or phentermine anticoagulants, such as warfarin anticonvulsants such as carbamazepine, phenobarbital, or phenytoin antidepressants, such as sertraline or anti-anxiety medications aspirin ciprofloxacin estrogens and oral contraceptives heart medications, such as digoxin, metoprolol, or propranolol HIV medications medications for diabetes, including insulin medications that can affect absorption of levothyroxine, such as antacids, calcium carbonate, cholestyramine, iron, orlistat sucralfate, sevelamer, or proton pump inhibitors rifampin. Note that this list is not all-inclusive and includes only common medications that may interact with levothyroxine. You should refer to prescribing information for levothyroxine for a complete list of interactions.


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.

* 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

Warnings

Thyroid hormones, 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 manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects. This medication contains Levothyroxine. Do not take SYNTHROID, LEVOXYL, L Thyroxine, Levo T, Levothroid, Levothyroxine T4, Levoxine, Tirosint, or Unithroid If you are allergic to Levothyroxine or any ingredients contained in this drug. Keep out of reach of children. In case of overdose, get medical help or contact the Poison Control Center immediately.

* 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

Take as directed

Levothyroxine should not be used alone or along with other treatments to treat obesity or cause weight loss. Levothyroxine may cause serious or life-threatening problems when given in large doses, especially when taken with amphetamines such as amphetamine, dextroamphetamine, and methamphetamine. Tell your doctor if you have any of the following symptoms while you are taking levothyroxine: chest pain, rapid or irregular heartbeat or pulse, uncontrollable shaking of part of your body, nervousness, anxiety, irritability, difficulty falling asleep or staying asleep, shortness of breath, or excessive sweating. Talk to your doctor about potential risks associated with this medication. Levothyroxine is used to treat Hypothyroidism. It is also used with surgery and radioactive iodine therapy to treat Thyroid cancer. Levothyroxine is in a class of medications called hormones. It works by replacing Thyroid hormone that is normally produced by the body. Without Thyroid hormone, your body cannot function properly, which may result in poor growth, slow speech, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. When used correctly, levothyroxine reverses these symptoms. Levothyroxine comes as a tablet and capsule to take by mouth. It usually is Take once a day on an empty stomach, 30 minutes to 1 hour before breakfast. Follow directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take levothyroxine exactly as direct. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow capsules whole; do not chew or crush them. Do not remove the capsule from the package until you are ready to take it. Take tablets with a full glass of water as they may get stuck in your throat or cause choking or gagging. If you are giving levothyroxine to an infant, child, or adult who cannot swallow tablet, crush and mix it in 1 to 2 teaspoons of water. Only mix crush tablets with water; do not mix them with food or soybean infant formula. Give this mixture by spoon or dropper right away. Do not store it for later use. Your doctor will probably start you on a low dose of levothyroxine and gradually increase your dose. Levothyroxine controls Hypothyroidism but does not cure it. It may take several weeks before you notice a change in your symptoms. Continue to take levothyroxine even if you feel well. Do not stop taking levothyroxine without talking to your doctor.

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Subclinical Hypothyroidism

BACKGROUND Subclinical Hypothyroidism is a mild form OF Hypothyroidism in which the level OF Thyroid Stimulating Hormone is increase, but Thyroid hormone level is within normal range. This is compared to overt Hypothyroidism where TSH is increased and Thyroid Hormone levels ARE low. Subclinical Hypothyroidism is much more common than overt Hypothyroidism in adults, and its rate increases with age. Some studies suggest that Subclinical Hypothyroidism may affect up to 25% of individuals over the age OF 75. Treatment OF Subclinical Hypothyroidism is controversial as beneficial effects ARE hard to show in many studies. Studies have shown that many elderly patients with Subclinical Hypothyroidism complain of fatigue, poor memory, dry skin, depressed mood and other symptoms that ARE non-specific. Further, these symptoms may also be seen commonly in the elderly population who do not have Thyroid problem. Several studies have been conducted to evaluate if prescribing Thyroid Hormone in adults with Subclinical Hypothyroidism may improve these symptoms. The Current STUDY was designed to examine the effect of treating Subclinical Hypothyroidism in patients who ARE 80 or older. FULL ARTICLE TITLE Mooijaart SP et al 2019 Association between Levothyroxine treatment and Thyroid-relate symptoms among adults age 80 years and older with Subclinical Hypothyroidism. JAMA. Epub Oct 30: 1-11. PMID: 31664429. SUMMARY OF STUDY The Authors analyze data from two previous randomized clinical trials in Europe, but focus their analysis specifically on individuals who were 80 or older. They all had abnormal TSH levels, ranging from 4. 6 to 19. 9 mIU / L in two or more blood tests which were 3 months apart. People who were taking Thyroid Hormone, lithium and amiodarone or had recent Thyroid surgery, radioactive iodine therapy as well as individuals with terminal illness and severe heart disease were exclude. Patients were divided into two groups; one received Thyroid Hormone therapy and the other placebo. The Dose OF Thyroid Hormone was increased gradually to achieve normal TSH result. A total OF 2 989 individuals were screened for inclusion in this STUDY. A total OF 1883 individuals had abnormal TSH result initially that returned to normal in future tests. A total OF 251 patients with an average age OF 85 years were included in STUDY. Almost half were women. After careful analysis, rate of tiredness, other symptoms and heart related events were not different between the two groups. WHAT ARE the IMPLICATIONS OF this STUDY? This STUDY shows that the vast majority of individuals over age OF 80 with initial increase TSH with normal Thyroid Hormone levels will have normal TSH on follow up testing. In those patients with persistent Subclinical Hypothyroidism, treatment with Thyroid Hormone does not improve fatigue or other non-specific symptoms. This confirms prior studies that many symptoms like tiredness, problems with memory and changes in mood ARE common in older adults, but ARE not specific to Thyroid Disease. Thus, this STUDY shows there is no clear benefit OF treatment OF elderly patients with Subclinical Hypothyroidism with Thyroid Hormone.


Treatment

Having defined scope, natural history, clinical features, and potential morbidity of mild Thyroid failure, one must next ask whether treatment of the condition has demonstrable benefits. A number of studies have addrest this issue. Symptoms. There have been three randomized control trials examining effects of L-thyroxine treatment on general symptoms in subjects with mild Thyroid failure. Two of these RCTs report that mild Thyroid failure subjects who were treated with L-thyroxine had significantly greater improvement in general hypothyroid symptom scores than did subjects who were treated with placebo. Third RCT showed no symptomatic treatment benefit; in this study, however, mean serum TSH level on L-thyroxine treatment was 4. 6 U / ml, which was at the high end of the normal range. One uncontrolled study also reported a reduction of general somatic complaints after L-thyroxine treatment was institute. Neurobehavioral abnormalities and neuromuscular function. Memory has been shown to improve significantly in one RCT and in two uncontrolled studies in which mild Thyroid failure patients were given L-thyroxine therapy. Other reported benefits from uncontrolled interventional studies include reduction in neuromuscular complaints and normalization of initially abnormal electromyograms. Cardiac-pulmonary function. Studies that have examined effects of L-thyroxine treatment on cardiac function, including one RCT, have reported modest but relatively consistent beneficial results. Observed responses to treatment have included enhanced cardiac contractility, improvement of diastolic function, and normalization of videodensitometric myocardial texture. Increases in pulmonary vital capacity, anaerobic threshold and oxygen uptake at anaerobic threshold have also been demonstrate. Cardiovascular risk factor. Report lipid and lipoprotein responses to treatment of mild Thyroid failure with Thyroid hormone have been somewhat inconsistent. Retrospective evaluation suggests that Thyroid hormone replacement had very little lipid-lowering effect in patients whose initial TSH values were less than 10 U / ml. However, two quantitative literature reviews of prospective studies examining this issue have concluded that L-thyroxine treatment of patients with mild Thyroid failure lowers serum total cholesterol by approximately 0. 2-0. 4 mmol / liter and LDL cholesterol by about 0. 26 mmol / liter. Observe cholesterol reductions were greater in patients with inadequately treated overt hypothyroidism than in those with untreated spontaneous mild Thyroid failure and were also greater in patients with higher initial cholesterol levels. There have been no reported beneficial effects on high-density lipoprotein cholesterol or triglycerides. One intriguing, but uncontrolled, retrospective analysis shows progression of coronary atherosclerosis in subjects on L-thyroxine therapy with elevated serum TSH levels compared with those with normal TSH levels. Treatment goals. Firm data-base guidelines for treatment goals have not yet been establish. The distribution of serum TSH values in normal population is skew, with the majority of individuals having TSH values at the lower end of the normal range.

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* 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

Myxedema Coma

In patients with Myxedema Coma, effective approach consists of the following: if adrenal insufficiency is suspect, that diagnosis should be investigate. If adrenal insufficiency is confirm, stress doses of IV glucocorticoids should be given before Hypothyroidism is treat. If the patient's condition is critical and there is no time to complete workup for adrenal insufficiency before necessary use of IV LT4, patient must be given stress-dose glucocorticoids to prevent catastrophic complication of adrenal crisis. The use of IV LT3 is controversial and based on expert opinion. It is associated with a higher frequency of adverse cardiac events and is generally reserved for patients who are not improving clinically on LT4. LT3 can be given initially as 10 g IV bolus, which is repeated every 8-12 hours until the patient can take maintenance oral doses of T4. Advanced age, high-dose T4 therapy, and cardiac complications have the highest associations with mortality in Myxedema Coma.


DIAGNOSIS and DIFFERENTIAL

Myxedema coma is a clinical diagnosis, so clinicians require a high index of suspicion. Elderly patients may present particularly subtle findings. Even though rare, diagnosis of myxedema coma should be considered in any hypothermic, obtunded patient. Medical history in these patients, including prior history of hypothyroidism, may only be able to be confirmed from other sources. Friends, relatives and acquaintances might have noted increasing lethargy, complaints of cold intolerance, and changes in voice. Clues to diagnosis include an outdated container of L-T4 discovered with patients ' belongings. In medical record, reports of prior thyroid hormone use, previous referral to treatment with radioactive iodine, or history of thyroidectomy all can raise suspicion. On physical examination, finding of thyroidectomy scar or goiter should raise suspicion as to diagnosis.


Management and treatment of the disease

Myxedema coma is a medical emergency and should be treated in the intensive care unit. Mainstays of therapy are: supportive care with ventilatory and hemodynamic support, rewarming using non-heat blanket correction of hyponatremia and hypoglycemia; and treatment of precipitating incident administration of thyroid hormone sedatives, hypnotics, narcotics and anesthetics must be minimized or avoided altogether due to their extended duration of action and exacerbation of obtundation in hypothyroid patient. See Table III. Hypothermia-Its severity may be underestimated if thermometer use do not register below 30C. Patients should be kept in a warm room and covered with blankets. Active heating should be avoided since it increases oxygen consumption and promotes peripheral vasodilation and circulatory collapse. Active heating is recommended only for situations of severe hypothermia where ventricular fibrillation is an immediate threat. In these cases, rate of rewarming should not exceed 0. 5 C per hour. Adrenal insufficiency-510% incidence of coexisting adrenal insufficiency, intravenous steroids are indicated before initiating L-T4 therapy. When possible, serum cortisol should be obtained and ACTH stimulation test should be carried out, if necessary, to document underlying adrenal function. Thyroid hormone treatment-Parenteral administration of thyroid hormone is necessary initially due to uncertain absorption through the gut. The reasonable approach is an initial intravenous loading dose of 200-400 mcg L-T4. If there is inadequate improvement in state of consciousness, blood pressure or core temperature during the first 6 to 12 hours after administration, another dose of L-T4 should be given to bring total dose during the first 24 hours to 0. 5 mg. This should be followed by 50-100 mcg intravenously every 24 hours until the patient is stabilize. Alternatively, one can use L-T3 at dosage of 12. 5-25 mcg intravenously every 6 hours until the patient is stable and conscious. Once the patient is stable, patient should be switched to L-T4. Follow serum levels of FT4 or FTI daily until the patient recovers, with goal levels in the mid-to upper half of normal range. Once patient is clinically stable on oral dose of levothyroxine, FT4 or FTI and TSH should be re-check in 6-8 weeks and oral dose adjusted as in routine hypothyroidism. Expectation is medical stabilization and mental status clearing in 24-48 hours.

* 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

Thyroid Hormone Replacement

Thyroid medications were once prepared from desiccated samples of ground Thyroid glands from cows, and standardization was based on the iodine content of extract rather than its T 3 or T 4 content. Actual thyroid hormone content of products vary considerably from manufacturer to manufacturer, and even within products from the same manufacturer, depending on the thyroid status of cows. Fortunately, this method of preparing Thyroid hormones has been abandon, and replacement is now accomplished primarily with synthetic Thyroid hormones. Recent analysis 8 of four levothyroxine preparations, including two brand-name products and two generic preparations, demonstrate relative bioequivalence. Patients who switch from any one of four preparations to another show insignificant variations in their thyroid function tests. Among the four products, only difference note was that Synthroid produced more rapid and higher rise in T 3 level after administration. However, difference was not statistically significant and is of questionable clinical importance.

* 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.

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