Replacement therapy and complementary therapy in hypothyroidism with various etiologies. Prevention of recurrence of the thyroid will after surgical treatment in patients with normal thyroid function (euthyreosis). Treatment of the inert will. Helpful in the treatment of hyperthyroidism in Graves-Basedow disease in combination with thyrostatic agents after obtaining euthyroidism. Replacement and suppressive therapy of thyroid malignant tumors, especially after thyroidectomy. Suppressive test in the diagnosis of hyperthyroidism.
Composition:
1 tabl contains 50 μg, 75 μg, 100 μg, 125 μg or 150 μg of levothyroxine sodium.
Action:
Synthetic levothyroxine works identically to the naturally occurring hormone produced in the thyroid gland. After partial conversion to liotyronine, mainly in the liver and kidneys, and penetration into the body cells, thyroid hormones stimulate the growth, growth and metabolism of the body. Following oral administration, fasting, levothyroxine is absorbed in the small intestine by 80%. The percentage of absorbed dose depends on the galenical form. Maximum serum concentration is reached about 6 hours after administration. After oral administration, the therapeutic effect develops within 3 to 5 days. Levothyroxine binds 99% of plasma proteins. Levothyroxine is degraded mainly in the liver, kidneys, brain and muscles. Due to the strong binding to plasma proteins, during hemodialysis, it is removed from the body in small amounts.
Contraindications:
Hypersensitivity to the active substance - levothyroxine - or to any of the excipients. Hyperthyroidism, regardless of etiology. The only exception is the therapy supporting thyroid hyperthyroidism after reaching euthyreosis; however, it should be remembered that concomitant use of levothyroxine and thyrostatic medication is contraindicated in pregnant women.
Precautions:
Before starting thyroid hormone therapy, the following diseases should be excluded or ameliorated: coronary insufficiency, heart failure, arrhythmias (tachyarrhythmias) - a dose should be carefully adjusted or increased to avoid iatrogenic hyperthyroidism; more frequent monitoring of thyroid hormone concentrations may be necessary; hypothyroidism, adrenal insufficiency - in the case of secondary hypothyroidism, simultaneous adrenal insufficiency should be ruled out, if adrenal insufficiency is confirmed, Hydrocortisone should be used first, in women with hypothyroidism, in postmenopausal period, with an increased roar of osteoporosis, more often control thyroid function to avoid too high levels of serum levothyroxine; anatomic nodules - if there is a suspicion of autonomic thyroid nodules, a TRH test or suppressive scintigraphy should be performed.
Pregnancy and lactation:
The thyroid hormone treatment, which has been initiated earlier, should be continued, especially during pregnancy and lactation. Concomitant use of levothyroxine with thyreostatic medicinal products during pregnancy is contraindicated. Thyrostatic drugs, unlike levothyroxine, can penetrate the placenta barrier in doses that affect the fetus. The concomitant use of levothyroxine requires higher doses of thyrostatic medication, which may cause the development of fetal hypothyroidism. For this reason, in the case of hyperthyroidism during pregnancy, only treatment with low doses of thyrostatic drugs is allowed. Due to the increased concentration of estrogens in the blood, during pregnancy, in women with hypothyroidism, the need for levothyroxine may increase. Therefore, thyroid function should be monitored during and after pregnancy and, if necessary, adjusted. Avoid carrying out a suppressive test in pregnant women. The amount of thyroid hormones secreted in breast milk, even when treated with high doses of levothyroxine, is not a sufficient dose to develop hyperthyroidism or inhibit secretion of TSH in a child.
Side effects:
During the properly conducted and controlled use of the drug, the occurrence of side effects is unlikely. If the dose is very rarely tolerated or if the overdose occurs, especially if the dose is increased too rapidly at the beginning of treatment, tachycardia, arrhythmias, tremors, coronary pain, agitation, insomnia, conductivity, weight loss, diarrhea may occur. . If these symptoms occur, the daily dose should be reduced or discontinued for several days. After the symptoms have resolved, the treatment can be resumed carefully by setting the dosage. In addition, hypersensitivity reactions may occur: urticaria, bronchospasm and laryngeal edema; In isolated cases, anaphylactic shock was observed. In such cases, the drug should be discontinued.
Dosage:
Orally. The individual daily dose should be determined on the basis of a medical examination and the results of laboratory tests.Hypothyroidism. Adults: starting dose - 25-50 μg daily, maintenance dose - 100-200 μg daily (the dose should be increased by 25-50 μg in 2-4 week intervals). Children: initial dose 12.5-50 μg daily, initial dose (newborns) 25-50 μg daily; Maintenance dose (the maintenance dose, used over a longer period of time, is determined, among others, based on the age and weight of the child): 0-6 months: 25-50 μg per day (10-15 μg / kg / day); 6-24 months: 50-75 μg daily (8-10 μg / kg / day); 2-10 years: 75-125 μg per day (4-6 μg / kg / day); 10-16 years: 100-200 μg per day (3-4 μg / kg / day); > 16 years: 100 -200 μg daily (2-3 μg / kg / day). In the case of congenital hyperthyroidism, the initiation of treatment as soon as possible is crucial for achieving normal psychomotor development. Standard values of T4 concentration should be achieved during the first 3 to 4 years of life. During the first 6 months of life, the T4 concentration, as a control parameter, is more measurable than TSH levels. Despite adequate T4 delivery, normalization of TSH concentration may last, in individual cases, up to 2 years.Prophylaxis of relapse will75-200 μg daily.I prefer indifferent75-200 μg daily.Therapy supporting thyroid hyperthyroidism50-100 μg daily.After thyroid replacement surgery due to malignant thyroid cancer150-300 μg daily.Suppressive test in the diagnosis of hyperthyroidism200 μg daily (for 14 days until the scintigrator). In elderly patients, patients with coronary heart disease and patients with long or severe hypothyroidism, treatment should begin with a low initial dose, which should then be increased slowly at large intervals, while monitoring the level of thyroid hormones. Small initial doses are also sufficient for low body weight and high nodular goiter. The total daily dose should be taken in the morning, on an empty stomach, at least 1/2 hour before breakfast, with a sufficient amount of water. Infants should receive a daily dose at least 1/2 hour before the first feeding. The tablets should be dissolved in a small amount of water, and the resulting suspension should be given with the appropriate amount of fluids. Table. they must be dissolved immediately before administration. In the case of hypothyroidism and thyroid removal surgery due to malignant thyroid cancer, the treatment usually lasts throughout life; in the case of the inert will and prophylaxis of relapse, the will lasts for several months or years and even for the rest of their lives; in supportive therapy for hyperthyroidism, the duration of treatment depends on the length of thyrostatic treatment.
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