Levothyroxine Therapy in Patients with Thyroid Disease

@article{Mandel1993LevothyroxineTI,
  title={Levothyroxine Therapy in Patients with Thyroid Disease},
  author={Susan J. Mandel and Gregory A. Brent and P. R. Larsen},
  journal={Annals of Internal Medicine},
  year={1993},
  volume={119},
  pages={492-502}
}
Levothyroxine is one of the 13 most commonly prescribed medications in the United States, with more than 15 million prescriptions filled annually [1]. It is given as either physiologic replacement therapy in patients with hypothyroidism or as interventional therapy to suppress thyroid-stimulating hormone (TSH) secretion in patients with nodular thyroid disease or thyroid cancer. Overt hypothyroidism occurs in 1.5% to 2% of women and in 0.2% of men [2], and its incidence increases with age… 

Variations in adequate levothyroxine replacement therapy in patients with different causes of hypothyroidism.

  • M. B. GordonM. Gordon
  • Medicine, Biology
    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
  • 1999
The levothyroxine replacement dose varies with the cause of the hypothyroidism, and a normal thyrotropin level and clinical euthyroidism in patients with primary hyp Timothyroidism and a serum free thyroxine index in the upper half of the normal range in conjunction with clinical euthYroidism is defined.

Management of thyroxine therapy during pregnancy.

  • M. Kaplan
  • Medicine, Biology
    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
  • 1996
The increment in T4 dose needed to normalize an increased TSH level in women taking T4 can be estimated from the serum TSH concentration during pregnancy, and the optimal schedule is uncertain.

Evaluation of the adequacy of levothyroxine replacement therapy in patients with central hypothyroidism.

The results indicate that the diagnosis of CH is reached at best by measuring TSH and FT4 concentrations, and both FT4 and FT3 serum levels together with some biochemical indexes of thyroid hormone action are all necessary to a more accurate disclosure of over- or undertreated patients.

Prevalence of Iatrogenic Hyperthyroidism in a Community Hospital

The frequent use of levothyroxine suggests that TSH suppression could represent a serious public health concern, particularly for postmenopausal women and patients with heart disease.

Management of Hypothyroidism in Adults

A small subgroup of patients well controlled on levothyroxine monotherapy with TSH in euthyroid range still complain of persistent symptoms suggesting that a combination of thyroxine and triiodothyronine may improve the quality of life in such patients.

Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis.

In patients with hypothyroidism and gastrointestinal pathology, vitamin C improves the abnormalities in serum free T4, T3, and TSH concentrations, and this approach is helpful in the management of these patients.

Thyroxine replacement: a clinical endocrinologist’s viewpoint

Despite the availability of thyroid hormone replacement for more than a century, there are still substantial challenges in practice and opportunities to improve treatment outcomes.

Delayed intestinal absorption of levothyroxine.

Full suppression or normalization of TSH is obtained by postponing breakfast for at least 60 min after T4 ingestion by patients in whom TSH-suppressive or replacement L-T4 therapy failed to suppress or normalize serum TSH.

Misuse of levothyroxine and the rate of achieving target thyroid-stimulating hormone in levothyroxine treatment

Investigating the misuse of levothyroxine treatment in patients with hypothyroidism found that taking the medication on a full stomach or in the evening, occasional use of medication, storing the medicine in the refrigerator, and the use of additional medications were the major factors for insufficient TSH levels.

Medication use in the hypothyroid patient.

...

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This study demonstrates that obtaining routine thyroid hormone indexes prior to initiation of replacement levothyroxine therapy may be reliable predictors of the final lev Timothyroxine dose; serum thyroid-stimulating hormone concentration being the best index.

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...