thyroid

BEERS REMS

Thyroid supplementation in hypothyroidism.
Treatment or suppression of euthyroid goiters and thyroid cancer.
Diagnostic agent for suppression tests to differentiate mild hyperthyroidism from thyroid gland autonomy.

Action ⬆ ⬇

Replacement of or supplementation to endogenous thyroid hormones.
Principal effect is increasing metabolic rate of body tissues:
- Promote gluconeogenesis,
- Increase utilization and mobilization of glycogen stores,
- Stimulate protein synthesis,
- Promote cell growth and differentiation,
- Aid in the development of the brain and CNS.
Contains T₃ (triiodothyronine) and T₄ (thyroxine) activity.

Therapeutic effects:

Replacement in deficiency states with restoration of normal hormonal balance.

Pharmacokinetics ⬆ ⬇

Absorption: Levothyroxine is variably (50–80%) absorbed from the GI tract. Liothyronine is well absorbed.

Distribution: Distributed into most body tissues.

Metabolism/Excretion: Metabolized by the liver and other tissues. Thyroid hormone undergoes enterohepatic recirculation and is excreted in the feces via the bile.

Half-Life: T₃ (liothyronine): 1–2 days; T₄ (thyroxine): 6–7 days.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
Levothyroxine PO	unknown	1–3 wk	1–3 wk
Liothyronine PO	unknown	24–72 hr	72 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Recent MI;
Hyperthyroidism.

Use Cautiously in:

Cardiovascular disease (initiate therapy with lower doses);
Severe renal insufficiency;
Uncorrected adrenocortical disorders;
Geri: Appears on Beers list. risk of cardiac adverse effects in older adults. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Usually only seen when excessive doses cause iatrogenic hyperthyroidism

CV: arrhythmias, angina pectoris, tachycardia

GI: abdominal cramps, diarrhea, vomiting

Derm: hyperhidrosis

Endo: hyperthyroidism, menstrual irregularities

Metab: heat intolerance, weight loss

MS: accelerated bone maturation in children

Neuro: headache, insomnia, irritability

Interactions ⬆ ⬇

Drug-drug:

Bile acid sequestrants↓ absorption of orally administered thyroid preparations.
Alters the effectiveness of warfarin ; INR will ↑ with thyroid hormone supplementation.
May ↑ requirement for insulin or oral hypoglycemic agents in diabetics.
Concurrent estrogen therapy may ↑ thyroid replacement requirements.
↑cardiovascular effects with adrenergics (sympathomimetics).

Foods or supplements containing high amounts of calcium, iron, magnesium, or zinc may bind thyroid hormones and prevent complete absorption.

Route/Dosage ⬆ ⬇

Each 1 grain = 60 mg and is equivalent to approximately 100 mcg of levothyroxine (T₄) or 25 mcg of liothyronine (T₃)

Hypothyroidism

PO (Adults and Children ): Armour Thyroid: 30 mg once daily (15 mg once daily if long-standing myxedema or cardiovascular disease); ↑ by 15 mg/day every 2–3 wk (usual maintenance dose = 60–120 mg/day). Adthyza: 32.5 mg once daily (16.25 mg once daily if long-standing myxedema or cardiovascular disease); ↑ by 16.25 mg/day every 2–3 wk (usual maintenance dose = 65–130 mg/day).

Availability ⬆ ⬇

Tablets (Armour Thyroid): 15 mg; 30 mg; 60 mg; 90 mg; 120 mg; 180 mg; 240 mg; 300 mg
Tablets (Adthyza): 16.25 mg; 32.5 mg; 65 mg; 97.5 mg; 130 mg

Assessment ⬆ ⬇

Assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.
Pedi: Monitor height, weight, and psychomotor development.

Lab Test Considerations:

Monitor thyroid function studies prior to and during therapy.
- Monitor blood and urine glucose in diabetic patients. Insulin or oral hypoglycemic dose may need to be increased.

Toxicity and Overdose:

Overdose is manifested as hyperthyroidism (tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, weight loss). Usual treatment is to withhold dose for 2–6 days. Acute overdose is treated by induction of emesis or gastric lavage, followed by activated charcoal. Sympathetic overstimulation may be controlled by antiadrenergic drugs (beta blockers), such as propranolol. Oxygen and supportive measures to control symptoms such as fever are also used.

Implementation ⬆ ⬇

Administer as a single dose, preferably before breakfast to prevent insomnia.
- Initial dose is low, especially in older adults and patients with cardiovascular disease. Dose is increased gradually, based on thyroid function tests.
- For patients with difficulty swallowing, tablets can be crushed and placed in 5–10 mL of water and administered immediately via dropper or spoon; do not store suspension.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed at the same time each day. Take missed doses as soon as remembered unless almost time for next dose. If more than 2–3 doses are missed, notify health care professional. Do not discontinue without consulting health care professional.
- Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong.
- Advise patient to notify health care professional if headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss >2 lb/wk, or any unusual symptoms occur.
- Caution patient to avoid taking other medications concurrently with thyroid preparations unless instructed by health care professional.
- Instruct patient to inform health care professionals of thyroid therapy.
- Emphasize importance of follow-up exams to monitor effectiveness of therapy. Thyroid function tests are performed at least yearly.
Pedi: Discuss with parents the need for routine follow-up studies to ensure correct development. Inform patient that partial hair loss may be experienced by children on thyroid therapy. This is usually temporary.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇