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[Up] [Hypothyroidism classification] [Risk factors] [Clinical features] [End organ impact] [Associated illnesses] [Diagnosis] [Treatment] [Dose titration] [Drug interactions] [Monitoring & follow up] [Myxedema coma]

 

 

 

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Historically, hypothyroidism is the first endocrine disorder to be treated by supplementation of the deficient hormone.

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It was treated with animal thyroid extracts in the past.

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This was followed by development of purified thyroid hormone preparations.

 

 Available thyroid hormone preparations are.

  1. Thyroxine Sodium (T4 )

  2. Triiodothyronine (T3 )

  3. Combination of synthetic T3 and T 4

  4. Thyroid USP (desiccated animal thyroid containingT3 and T4 in the form of thyroglobulin)

 

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The mostly widely used and preferred preparation is synthetic T 4, thyroxine sodium .

 

 Goal of treatment

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To normalize the thyroid hormone status in peripheral tissues.

 

 Initiation of Therapy

 Initial dosage may be based on

  • Age of patient,

  • Severity and duration of hypothyroidism.

  • Presence of associated disorders like ischaemic heart disease, adrenal insufficiency

 

 Pediatric hypothyroidism .

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The dosage of Thyroxine sodium for pediatric hypothyroidism varies with age and body weight

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Thyroxine should be given at a dose that maintains the serum total T4 or free T4 concentrations in the upper half of the normal range and serum TSH in the normal range.

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Thyroxine sodium therapy is usually initiated at the full replacement dose.

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Infants and neonates with very low or undetectable serum T4 levels ( < 5 mcg/ dL) should start at the higher end of the dosage range ( e.g.50 mcg daily)

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A lower starting dosage ( e. g. 25 mcg daily) should be considered for neonates at risk of cardiac failure, increasing every few days until a full maintenance dose is reached.

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In children with severe, long-standing hypothyroidism, Thyroxine sodium should be initiated gradually, with an initial dose of 25 mcg for two weeks, and then increasing the dose by 25 mcg every 2 to 4 weeks until the desired dose based on serum T 4 and TSH levels is achieved.

 

 

                         Age

          Daily dose

  per Kg body weight +

0-3 months

3-6 months

6-12 months

1-5 years

6-12 years

> 12 years

Growth and puberty complete

10-15 mcg

  8-10 mcg

  6-8 mcg

  5-6 mcg

  4-5 mcg

  2-3 mcg

  1.6 mcg

 

+ To be adjusted on the basis of the clinical response and laboratory test.

 

 Adults

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Young, healthy adults with no cardiac / respiratory disease are started with 1.6 mcg/kg/day of thyroxine sodium administered once daily.

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In elderly patients or in younger patients with cardiovascular disease, dose required is lower than the usual adult dose. i.e. < lmcg/kg/day, administered once a day.

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To start with in elderly patients 12.5 to 50 mcg of thyroxine sodium are given daily and increment of 12.5 to 25 mcg are made at 3-6 week intervals if required.

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Women who are maintained on thyroxine sodium during pregnancy may require increased doses.

 

 Treatment of sub clinical hypothyroidism

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Treatment of sub clinical hypothyroidism, when indicated may require lower than usual replacement doses; (lmcg/kg/day).

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Patients for whom treatment is not initiated should be monitored yearly for changes in clinical status, TSH and thyroid antibodies.

 

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In patients with associated adrenal insufficiency, low does of thyroxine sodium are started only after initial treatment with glucocorticoids.

 

 

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