Treatment for primary hypothyroidism: current approaches and future possibilities

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. Hypothyroidism, a reduction in thyroid hormone levels, is one of the most common diseases worldwide. The medication most used to treat hypothyroidism is levothyroxine, a compound that acts as a replacement for a person’s thyroid hormone. People with hypothyroidism will often need to take levothyroxine for a long time, typically for the rest of their life, so it is important that their treatment is monitored closely and the dose is adjusted for the best effect as needed.

Initial Dosing and Dose Adjustment of Levothyroxine During Therapy

Patients need to feel comfortable to alert me of any changes in their status in terms of their symptoms. But also specific medical changes that may indicate there may be a need for a dose change or something that could have affected their thyroid hormone levels. For adult patients with primary hypothyroidism, titrate until the patient is clinically euthyroid and the serum TSH returns to normal. If levothyroxine is ingested along with food, its absorption can be impaired 15, 51.

Consensus Statement on Pediatric Benign and Malignant Thyroid Surgery

A key part for the patients is to make sure that they’re getting the brand-name SYNTHROID that we have prescribed. And, as a practicing thyroid specialist, I have extensive clinical experience with using this medication. In addition to testing TSH, sometimes it may be important to run other labs such as a free T4, in addition to the TSH, to ensure you have accurate dosing in the medication.

Hypothyroid medications require precise

When commencing levothyroxine therapy, initial dose requirements can vary greatly from small doses such as 25–50μg in an individual with mild or subclinical disease, where the therapy may be supplementing endogenous function, to larger doses of 88–175 μg in cases of patients with negligible endogenous thyroid function. In keeping with this concept, the initial dose of levothyroxine in patients presenting to a clinic with primary hypothyroidism can be predicted by the patient’s TSH value prior to initiation of treatment 9. In the case of surgically athyreotic patients, the dose of levothyroxine required may be slightly higher than in those with autoimmune thyroid disease 8, presumably reflecting some retained thyroid hormone production in those with autoimmune thyroid disease. An example of the dose requirement in those with Hashimoto’s thyroiditis without residual function and post-surgical hypothyroidism is approximately 1.6 μg/kg 8. The dose of levothyroxine required by a patient following thyroidectomy can be predicted by either body weight or body mass index (BMI) 10–12. Body weight, BMI, ideal body weight, and lean body mass can all predict the initial dose requirement, with the latter three parameters providing the more accurate estimates 10, 13.

• HypothyroidismSYNTHROID® (levothyroxine sodium) tablets, for oral use is indicated as a replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism.
• 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.
• SYNTHROID is not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis.
• Furthermore, although there is increasing evidence from observational studies for an association between subclinical hypothyroidism and the risk of cardiovascular disease-related morbidity and mortality, randomized controlled trial evidence showing that levothyroxine treatment reduces the risk is still lacking.

Oral selenium supplementation appears to have efficacy in modifying the natural history of Graves’ orbitopathy,100 and may prove to have immunomodulatory actions in other forms of autoimmune thyroid disease. In pregnancy, results of ongoing and future clinical trials are awaited to inform whether all pregnant women should be screened and synthroid alopecia treated for subclinical hypothyroidism. A significant minority of hypothyroid patients treated with levothyroxine do not feel completely well and have a poorer quality of life.11 There are several possible causes for impaired wellbeing in these patients.

This is a key issue for some of the elemental things like calcium and iron, that can interfere with thyroid hormone absorption and thus should be taken approximately 4 hours apart. They can have changes in the female hormone status, either going on or off a birth control pill, going through menopause. Knowing that patient behaviors and consistency of treatment are key factors in treatment success, I educate patients on the process as they begin treatment. To minimize the risk of hyperactivity, start at one-fourth the recommended full replacement dosage, and increase on a weekly basis by one-fourth the full recommended replacement dosage until the full recommended replacement dosage is reached. ​Inquire whether patients are taking biotin or biotin-containing supplements.

For patients at risk of atrial fibrillation or patients with underlying cardiac disease, start with a lower dosage and titrate the dosage more slowly to avoid exacerbation of cardiac symptoms. Its chemical structure was determined in 1926 by Harington, and it was synthesised in 1927 by Harington and Barger 1, 2. The acidity of the thyroxine molecule, which caused diminished absorption resulting in low bioavailability, was an unresolved problem for more than 20 years following its discovery 3.

STARTING DOSE CALCULATOR FOR ADULTS

• Several studies have shown that the levothyroxine dose requirement is decreased in older individuals 8, 48, 49.
• Family history is very important when talking to these patients because there is a strong predisposition amongst family members in the primary setting to have another family member with hypothyroidism.
• Levoxyl treats hypothyroidism (low thyroid hormone) and treats or prevents goiter.
• When there is an accompanying change in the TSH level, especially in a patient who has stayed on a stable dosage for some time, other reasons should be explored before adjusting the levothyroxine dosage.

Family history is very important when talking to these patients because there is a strong predisposition amongst family members in the primary setting to have another family member with hypothyroidism. One of the difficulties of the diagnosis of hypothyroidism is that the signs and symptoms are non-specific to the disease. So, in order to diagnose the disease accurately, given the non-specific symptoms, you must use the TSH level as a screening tool to assist in the family history and signs and symptoms that you have come across.

Synthroid is a prescription medicine used to treat hypothyroidism (low thyroid hormone). Levothyroxine is given when your thyroid does not produce enough of this hormone on its own. This is important as 32% of patients who think they are on SYNTHROID are actually not given this because substitutions are made at the pharmacy. 54% of prescriptions for SYNTHROID were not protected with a DAW or state-specific language in one study. The FDA has determined that drugs that are classified as therapeutically equivalent can be substituted with the full expectation that the substituted product will produce the same clinical effect and safety profile as the reference product. Particularly when SYNTHROID is written in a non-protective manner for the state language.

Assess compliance, dose of medication administered, and method of administration prior to increasing the dose of SYNTHROID. A recent survey, which queried the treatment of hypothyroidism by presenting 13 theoretical patients and offering 6 therapeutic options, was emailed to the members of the American Thyroid Association (ATA) prior to a satellite symposium of their Spring Meeting and also before the annual Endocrine Society and ATA Meetings. A multivariate analysis of the results revealed that physician characteristics may affect prescription patterns, with residents of North America, for example, being more inclined to prescribe therapies incorporating liothyronine than their colleagues in Europe 85, 86. However, the study was not designed to investigate whether this was due to physician-patient interaction, specific education following the meetings, the influence of pharmaceutical companies, or media exposure, or a combination of these.