• 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.

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.

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.

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).

Drug-Food:

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

• 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;

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).

Adthyza, Armour Thyroid

• 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.

• Replacement in deficiency states with restoration of normal hormonal balance.

Therapeutic Classification: hormones

Pharmacologic Classification: thyroid preparations

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.

• 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.

THYE-royd