Treatment for primary hypothyroidism: current approaches and future possibilities
Synthroid is a prescription synthroid oxycodone 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.
It’s very important to make sure that you write “Dispense as written,” or whatever state-specific language, on the prescription when you prescribe the medication. I go over with the patient there are treatment goals that are very important in the process. And the other is to improve the clinical symptoms that they’ve been experiencing. Because the long-acting nature of the medication, I do indicate that it may take several months to see an improvement in both of these levels.
Drugs That May Alter Hepatic Metabolism of T4 (Hypothyroidism)
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.
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.
Thyroid
Nevertheless, these studies suggest that bedtime dosing of levothyroxine could be tried as an alternative strategy in those patients who have problems in taking morning levothyroxine on an empty stomach. After more than 120 years since Murray first successfully treated hypothyroidism with sheep thyroid extract29 and numerous subsequent advances in the field, there remain many uncertainties surrounding the management of this common disease. What is the target thyroid function for hypothyroid patients on levothyroxine replacement?
DISCUSS THE FOLLOWING WITH PATIENTS WHEN PRESCRIBING SYNTHROID
- Another group is those that have underlying cardiac disease or are at risk for atrial fibrillation.
- Pregnancy or weight gain can also affect the dose of levothyroxine needed by the patient, so patients and physicians need to work in partnership to ensure that the treatment is working as well as it can.
- Women with hypothyroidism who become pregnant should increase their weekly dosage by 30% up to nine doses per week (i.e., take one extra dose twice per week), followed by monthly evaluation and management.
- Moreover, patients feeling unwell are more likely to seek medical advice and thus get their thyroid function tested.
- Administer SYNTHROID as a single daily dose, on an empty stomach, one-half to one hour before breakfast.
The “optimal dose” was determined for each patient as that dosage of thyroxine being taken when the thyrotropin-releasing hormone (TRH) response was normal (ie, an increase in TSH of between 4.7 and 25 mIU/L). Pituitary Thyrotropin (Thyroid Stimulating Hormone, TSH) SuppressionSYNTHROID is indicated in adult and pediatric patients, including neonates, as an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer. These medications are those where small changes in the dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions. Monitor serum free-T4 levels and maintain in the upper half of the normal range in these patients. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
Causes of primary hypothyroidism
- Prolonged untreated hypothyroidism can lead to persistent bradycardia, an adverse atherogenic lipid profile, and deterioration in myocardial function.
- Furthermore, in thyroidectomized rats, tissue euthyroidism could be achieved by infusion of both levothyroxine and triiodothyronine and not by levothyroxine alone.49 These observations led to the hypothesis that a triiodothyronine-levothyroxine combination is necessary to restore tissue euthyroidism in patients with hypothyroidism.
- It’s very important to make sure that you write “Dispense as written,” or whatever state-specific language, on the prescription when you prescribe the medication.
- The goal is to achieve steady TSH levels within the appropriate therapeutic range.
- In a subset of hypothyroid patients in whom poor compliance with daily dosing of levothyroxine is suspected, a onceweekly dosage of levothyroxine may be used as an alternative.
As a person progresses through life, their dose may need to be adjusted because other diseases or medications can affect the dose needed for effective treatment. Pregnancy or weight gain can also affect the dose of levothyroxine needed by the patient, so patients and physicians need to work in partnership to ensure that the treatment is working as well as it can. The goal of this partnership is to maintain normal thyroid hormone levels without the patient experiencing any side effects or negative health consequences of taking too much or too little levothyroxine.
Women with hypothyroidism who become pregnant should increase their weekly dosage by 30% up to nine doses per week (i.e., take one extra dose twice per week), followed by monthly evaluation and management. Patients with persistent symptoms after adequate levothyroxine dosing should be reassessed for other causes or the need for referral. Most patients with subclinical hypothyroidism do not benefit from treatment unless the thyroid-stimulating hormone level is greater than 10 mIU per L or the thyroid peroxidase antibody is elevated.
Factors Potentially Contributing to the Need for Levothyroxine Dose Adjustments Throughout a Patient’s Life Span
The manufacture of sodium thyroxine (levothyroxine) thus resulted in a major pharmacological achievement in endocrinology, giving a more stable and effective thyroid hormone compound that, over the last few decades, has considerably improved the lives of millions of patients with various forms of hypothyroidism. Although the diagnosis and treatment of hypothyroidism is often considered simple, there are large numbers of people with this condition who are suboptimally treated. Even in those people with hypothyroidism who are biochemically euthyroid on levothyroxine replacement there is a significant proportion who report poorer quality of life. This review explores the historical and current treatment options for hypothyroidism, reasons for and potential solutions to suboptimal treatment, and future possibilities in the treatment of hypothyroidism. For healthy adults with hypothyroidism, thyroid hormone replacement should begin at a full replacement dose of 1.6 micrograms per kilogram per day and the doses adjusted or titrated up by 12 ½ to 25 micrograms every 4-6 weeks until the patient is clinically euthyroid and the TSH is normalized.
Medical Writing, Editorial, and Other Assistance
Levothyroxine is the standard therapy for patients with hypothyroidism, a condition that affects up to 5% of people worldwide. While levothyroxine therapy has substantially improved the lives of millions of hypothyroid patients since its introduction in 1949, the complexity of maintaining biochemical and clinical euthyroidism in patients undergoing treatment with levothyroxine cannot be underestimated. Initial dosing of levothyroxine can vary greatly and may be based on the amount of residual thyroid function retained by the patient, the body weight or lean body mass of the patient, and thyroid-stimulating hormone levels. As levothyroxine is usually administered over a patient’s lifetime, physiological changes throughout life will affect the dose of levothyroxine required to maintain euthyroidism. Furthermore, dose adjustments may need to be made in patients with concomitant medical conditions, in patients taking certain medications, as well as in elderly patients. Patients who have undergone any weight or hormonal changes may require dose adjustments, and the majority of pregnant women require increased doses of levothyroxine.
