Levothyroxine myxedema coma

In myxedema coma or stupor, without concomitant severe heart disease, 200 to 500 meg of levothyroxine for injection may be administered IV as a solution containing 100 mcg/mL. Do not add to other IV fluids. Although the patient may show evidence of increased responsivity within 6 to 8 hours, full therapeutic effect may not be evident until the following day. An additional 100 to 300 meg or more may be given on the second day if evidence of significant and progressive improvements has not occurred. Maintain continued daily administration of lesser amounts parenterally until the patient is fully capable of accepting a daily oral dose. 

Herpes simplex virus encephalitis after myxedema coma has been described in an 81-year-old man treated with hydrocortisone (100 mg 8-hourly) and levothyroxine (328). In renal transplantation, two cases of death from Herpes simplex as a result of glucocorticoid treatment are on record (SED-8, 827 SEDA-17, 449). 

Levothyroxine is indicated in the treatment of hypothyroidism (0.05 mg initially) of myxedema coma (0.4 mg IV initially) of thyroid-stimulating hormone (TSH) suppression in thyroid cancer of euthyroid and nodules goiter and of thyroid suppression therapy (2.6 mcg/kg/day for 7 to 10 days). Levothyroxine increases the metabolic rate of tissue. It affects protein and carbohydrate metabolism, promotes gluconeogenesis, increases the utilization and mobilization of glycogen stores, stimulates protein synthesis, and regulates cell growth and differentiation. The orally administered... 

Liotrix (T4 T3) (e.g.. Euthyroid) Replaces T4 and T3 When conversion of T4 to T3 is abnormally low (myxedema coma), liotrix may be more useful than levothyroxine. ... 

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