Treatment with the thyroid hormone – is it a challenge?
Journal Title: Postępy Nauk Medycznych - Year 2015, Vol 28, Issue 12
Abstract
Levothyroxine (L-T4) represents the first-line treatment in patients with primary andcentral hypothyroidism in different periods of life. Although the normal thyroid glandsecretes both thyroxine and triiodothyro nine, currently, only L-T4 is recommended asa replacement therapy for hypothyroidism. Triiodothyro nine is reserved as a secondline drug with specific indications such as myxoedema coma or as short-term therapyin patients with thyroid cancer when L-T4 therapy is withdrawn. The goal of replacementtherapy is to restore biochemical and clinical euthyroidism. TSH is a convenienttest to diagnose and monitor hypothyroidism, except some condictions: centraldisease, drugs (glucorticoids, dopaminergic agents), heterophilic TSH-antibodies,early phases of pregnancy, adrenal insufficiency (may raise TSH). The dose of L-T4depends on the cause and severity of hypothyroidism, patient age and sex, BMI, andconcomitant diseases. L-T4 should be taken 30 to 60 minutes before breakfast or atbedtime 4 hours after the last meal. Noncompliant patients may recive their full weeklydose once weekly or half the dose twice weekly. In cases of malabsorption it canbe injected weekly intramuscularly. Intravenous daily application may be consideredwhen oral administration cannot be used in patients with severe hypothyroidism. TheL-T4 absorption test, based on the administration of a single large dose of 1000 µgof T4, with thyroid function tests at 2, 4, and 6 hours, is the primary method for distinguishingbetween non-compliance and true malabsorption. Switches between levothyroxineproducts could potentially result in variations in the administered dose andshould generally be avoided.
Authors and Affiliations
Helena Jastrzębska
Keywords
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