Hypothyroidism treatment

I Contraindications Hypersensitivity to tablet components, such as tartrazine allergy to aspirin lactose intolerance Ml and thyrotoxicosis uncomplicated by hypothyroidism treatment of obesity... 

Thyroid-stimulating hormone can be used clinically to test thyroid function but has not found practical apphcation in the treatment of human thyroid insufficiency. Direct replacement therapy with thyroid hormone is easy and effective, owing to a simple molecular stmcture. TSH has been used in the veterinary treatment of hypothyroidism, and preparations of TSH ate produced by Cooper Animal Health, Inc. and Armour Pharmaceuticals. 

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Myxedema and goiter are the main conditions for which thyroid preparations are indicated. The treatment of cretinism is difficult because it is recognized only at or after birth. Even if this disease could be diagnosed m utero, thyroid hormones do not readily cross the placental barrier. In addition, the fetus, as does a premature infant, rapidly deactivates the thyroid hormones. The halogen-free analogue DlMlT [26384-44-7] (3), which is resistant to fetal deiodinases, may prove useful for fetal hypothyroidism (cretinism). 

Lithium. In the lithium carbonate treatment of certain psychotic states, a low incidence (3.6%) of hypothyroidism and goiter production have been observed as side effects (6,36) (see Psychopharmacologicalagents). It has been proposed that the mechanism of this action is the inhibition of adenyl cyclase. Lithium salts have not found general acceptance in the treatment of hyperthyroidism (see Lithiumand lithium compounds). 

Ms. Hartman, age 47 years, has been prescribed leuothyroxine (Synthroid) for hypothyroidism. Develop a teaching plan for Ms. Hartman that would provide her with the knowledge she needs to maintain a therapeutic treatment regimen. 

Clofibrate causes a necrotizing myopathy, particularly in patients with renal failure, nephrotic syndrome or hypothyroidism. The myopathy is painful and myokymia of unknown origin is sometimes present. The mechanism of damage is not known, but p-chlorophenol is a major metabolite of clofibrate and p-chlorophe-nol is a particularly potent uncoupler of cellular oxidative phosphorylation and disrupts the fluidity of lipid membranes. Muscle damage is repaired rapidly on the cessation of treatment. 

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

Identify the typical signs and symptoms of hypothyroidism and the consequences of inadequate treatment. 

Describe the clinical use of levothyroxine in the treatment of hypothyroidism, including initial dose and dose titration, and patient monitoring. 

There are three major goals in the treatment of hypothyroidism replace the missing hormones, relieve symptoms, and achieve a stable biochemical euthyroid state. 

Despite the availability of a wide array of thyroid hormone products, it is clear that synthetic levothyroxine (LT4) is the treatment of choice for almost all patients with hypothyroidism. LT4 mimics the normal physiology of the thyroid gland, which secretes mostly T4 as a prohormone. As needed, based on metabolic demands, peripheral tissues convert thyroxine (T4)... 

Liothyronine (Cytomel ) SyntheticT3 5, 25, and 50 meg tablets 15 meg Rarely needed in treatment of hypothyroidism rapid absorption and pharmacologic effect increased toxicity versus LT4 no outcome benefit to combining with LT4... 

LT4 is indicated for patients with overt hypothyroidism.22 However, the need for treatment is controversial in patients with mild or subclinical disease (TSH less than 10 milli-units/L). There are no large clinical trials that show an outcome benefit with treating these patients, and the therapeutic decision must be individualized.1,23 Many patients with subclinical hypothyroidism do, in fact, have subtle symptoms that improve with LT4 replacement. If the patient s serum cholesterol is elevated,24 or if serum anti-TPOAbs are present, many clinicians recommend LT4 therapy. 

Congenital hypothyroidism is still seen in the United States, and all newborns in the United States undergo screening with a TSH level. As soon as the hypothyroid state is identified, the newborn should receive the full LT4 replacement dose. The replacement dose of LT4 in children is age-dependent. In newborns, the usual dose is 10 to 17 mcg/kg per day. LT4 tablets may be crushed and mixed with breast milk or formula. Serum FT4 levels (target 1.6-2.2 ng/dL or 20.59-28.31 pmol/L) are used for dose titration in infants because the TSH level may not respond to treatment as it does in older children and adults. By 6 months of age, the required dose is reduced to 5 to 7 mcg/kg per day, and from ages 1 to 10 years, the dose is 3 to 6 mcg/kg per day. After age 12, adult doses can be given. 

American Association of Clinical Endocrinologists Thyroid Task Force. Evaluation and Treatment of Hyperthyroidism and Hypothyroidism, 2002 www.aace.com/clin/guidelines/hypo hyper.pdf accessed October 30,2005. 

Children treated with GH replacement therapy rarely experience significant adverse effects, whereas adults are more susceptible to dose-related adverse effects. Treatment with GH may mask underlying hypothyroidism. GH-induced symptoms, such as edema, arthralgia, myalgia, and carpal tunnel syndrome, are common and necessitate dose reductions in up to 40% of adults. Benign increases in intracranial pressure may occur with GH therapy and generally are reversible with discontinuation of treatment. Often, GH therapy can be restarted with smaller doses without symptom recurrence. 

The answer is d. (Hardman, pp 1398-MOO.) Methimazole is classified as a thioamide and is used in the treatment of hyperthyroidism It prevents the organification of F by blocking the oxidation of F to active I and also inhibits coupling of iodotyrosines. Excessive treatment with this drug may induce hypothyroidism. Some other adverse reactions reported for... 

Complications of surgery include persistent or recurrent hyperthyroidism (0.6% to 18%), hypothyroidism (up to about 49%), hypoparathyroidism (up to 4%), and vocal cord abnormalities (up to 5%). The frequent occurrence of hypothyroidism requires periodic follow-up for identification and treatment. 

The treatment goals for hypothyroidism are to normalize thyroid hormone concentrations in tissue, provide symptomatic relief, prevent neurologic deficits in newborns and children, and reverse the biochemical abnormalities of hypothyroidism. 

BrtVHaWBa Thyroid Preparations Used in the Treatment of Hypothyroidism ... 

Patients with subclinical hypothyroidism and marked elevations in TSH (greater than 10 miUi-intemational units per liter [mlU/L]) and high titers of TSAb or prior treatment with sodium iodide 131 may benefit from treatment with levothyroxine. 

The disorder is not caused by a medical condition (eg., hypothyroidism) or substance-induced disorder (eg., antidepressant treatment, medications, electroconvulsive therapy). 

Other causes include magnesium-containing antacids in patients with renal insufficiency, enteral or parenteral nutrition in patients with multiorgan system failure, magnesium for treatment of eclampsia, lithium therapy, hypothyroidism, and Addison s disease. 

Quigley s group in Cork, Ireland, have concluded that normal aging is associated with changes in motility but the pattern is varied and no clear clinical consequence can be identified (67). More important in their view are the pathophysiological influences, including depression (and treatment with anti-cholinergics and opiates), hypothyroidism, and chronic renal failure. 

During treatment of hyperthyroidism, Lp(a), as well as LDL cholesterol and apolipoprotein B, increases, indicating an effect of thyroid hormone on receptor activity and on protein synthesis. The opposite effect is observed in treatment of hypothyroidism (B27, E9, K16). 

A number of medical conditions are associated with high rates of depression (see Table 3.4). In some instances, the distinction between MDD and depression due to a general medical condition is largely academic with little bearing on treatment selection. For example, pancreatic cancer may induce depression directly through the release of tumor-secreted substances however, depression in the pancreatic cancer patient is treated with conventional antidepressant medications. In other cases, the diagnostic distinction bears important treatment implications. One commonly cited example is depression occurring in association with hypothyroidism. Patients with depression and hypothyroidism do not respond to antidepressant treatment alone but require a thyroid hormone supplement. 

Despite these clues, a definitive diagnosis often cannot be made. In that case, a prudent course is to treat what would be treatable. The initial evaluation should carefully look for treatable medical causes of dementia or depression. These include vitamin deficiency and hypothyroidism among others. If no medical causes are found, then treatment for depression should be started. If the patient is depressed and suffering from a pseudodementia, the patient can expect full recovery of memory as the depression resolves. But if the patient has a progressive dementia such as Alzheimer s disease, then treatment for depression has done no harm and may still provide some benefit. 

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