50 and older įor older people (over 50 years old) and people with known or suspected ischemic heart disease, levothyroxine therapy should not be initiated at the full replacement dose. Poor compliance in taking the medicine is the most common cause of elevated TSH levels in people receiving appropriate doses of levothyroxine. Doses of levothyroxine that normalize serum TSH may not normalize abnormal levels of LDL cholesterol and total cholesterol. A study in 2015 showed greater efficacy of levothyroxine when taken at bedtime. For patients with trouble taking levothyroxine in the morning, bedtime dosing is effective, as well. As such, thyroid replacement therapy is usually taken 30 minutes prior to eating in the morning. Levothyroxine is taken on an empty stomach about half an hour to an hour before meals. Annual or semiannual clinical evaluations and TSH monitoring are appropriate after dosing has been established. Other predictors of the required dosage are sex, body mass index, deiodinase activity (SPINA-GD), and etiology of hypothyroidism. ĭosages vary according to the age groups and the individual condition of the person, body weight, and compliance to the medication and diet. As it is a medical emergency with a high mortality rate, it should be treated in the intensive-care unit with thyroid hormone replacement and aggressive management of individual organ system complications. It is also used to treat myxedema coma, which is a severe form of hypothyroidism characterized by mental status changes and hypothermia. Oral dosing for patients with subclinical hypothyroidism is 1 μg/kg/day. As such, treatment should be taken into account for patients with initial TSH levels above 10 mIU/L, people with elevated thyroid peroxidase antibody titers, people with symptoms of hypothyroidism and TSH levels of 5–10 mIU/L, and women who are pregnant or want to become pregnant. One benefit of treating this population with levothyroxine therapy is preventing development of hypothyroidism. Such people may be asymptomatic and whether they should be treated is controversial. Levothyroxine is also used to treat subclinical hypothyroidism, which is defined by an elevated TSH level and a normal-range free T 4 level without symptoms. Furthermore, reviewing their medications and possible dietary supplements is important, as several medications can affect thyroid hormone levels. In these people, further laboratory and clinical evaluation is warranted, as they may have another cause for their symptoms. A subset of people with hypothyroidism treated with an appropriate dose of levothyroxine will describe continuing symptoms despite TSH levels in the normal range. Levothyroxine is also used as interventional therapy in people with nodular thyroid disease or thyroid cancer to suppress TSH secretion. It may also be used to treat goiter via its ability to lower thyroid-stimulating hormone (TSH), which is considered goiter-inducing. Levothyroxine is typically used to treat hypothyroidism, and is the treatment of choice for people with hypothyroidism who often require lifelong thyroid hormone therapy. In 2019, it was the second most commonly prescribed medication in the United States, with more than 102 million prescriptions. Levothyroxine is available as a generic medication. It is on the World Health Organization's List of Essential Medicines. Much of the effect of levothyroxine is following its conversion to triiodothyronine (T 3). Dosing should be based on regular measurements of thyroid-stimulating hormone (TSH) and T 4 levels in the blood. Use during pregnancy has been found to be safe. Use is not recommended in people who have had a recent heart attack. Side effects from excessive doses include weight loss, trouble tolerating heat, sweating, anxiety, trouble sleeping, tremor, and fast heart rate. Maximum effect from a specific dose can take up to six weeks to occur. Levothyroxine is taken by mouth or given by intravenous injection. It may also be used to treat and prevent certain types of thyroid tumors. It is used to treat thyroid hormone deficiency (hypothyroidism), including Hashimoto's disease and a severe form known as myxedema coma. Levothyroxine, also known as L-thyroxine, is a manufactured form of the thyroid hormone thyroxine (T 4).
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