Review of the therapeutic points of hypothyroidism and how to follow the patientt

Review of the therapeutic points of hypothyroidism and how to follow the patientt

Treating hypothyroidism, as seemingly easy and safe as it may seem, is associated with complications (especially in infants and pregnant women) that require more precision.

The most important drug used is the synthetic compounds of thyroxine or T4, also known as levothyroxine.

When it comes to taking levothyroxine pills, you need to be very careful and follow these tips:

1- It should be eaten every day at a certain time and on an empty stomach.

2- Do not eat anything until 0.5 hours later.

So it's best to set it up in the morning before breakfast.


It should be noted that adjusting the dose of levothyroxine sometimes takes months so that we can find the dose you need, and it should be taken for life.

In healthy young people, doctors usually start with a "complete replacement dose" of T4 (a dose that is supposed to completely restore thyroid function).

The full replacement dose is calculated based on body weight and for most people is between 50 and 200 micrograms (micrograms) per day.

In the elderly or people with coronary artery disease, starting thyroid replacement therapy is usually 25 to 50 micrograms per day, and the dose is gradually increased over time.

Two weeks after the dose of levothyroxine is changed, the symptoms of dementia go away, but it takes about 6 weeks for TSH levels to stabilize.

Therefore, after changing the dose of levothyroxine, the TSH will be checked 6 weeks later, and this process will be repeated until your TSH level is within the normal range and the clinical symptoms disappear.

When the optimal dose of T4 is obtained, TSH levels are measured each year or more to make sure the treatment is adequate.

When a person starts taking thyroid hormone replacement medications, the goals of treatment are very simple. They are:

Thyroid hormone levels, in particular, normalize thyroxine (T4) and thyroid-stimulating hormone (TSH) levels.

Symptoms of hypothyroidism, such as constipation, fatigue, hair loss, and cold intolerance, go away.

Stopping and reversing any effects that hypothyroidism may have on various organic systems (eg, high cholesterol levels) can be improved.

Decreased goiter size if Hashimoto's disease is present.

Treatment of hypothyroidism in infants

In a baby with congenital hypothyroidism, the goal is to get the thyroid level back to normal, fast and safe. The faster the thyroid level normalizes, the more often the baby's cognitive and motor development is normalized.

Levothyroxine is a treatment for congenital hypothyroidism.


Management

Often, liquid form of levothyroxine is given to infants.

It is not important to combine levothyroxine with infant formula or any type of iron or calcium preparation.

Just know that soy, calcium and iron can all reduce a baby's ability to absorb medication properly.

If levothyroxine tablets are given to a baby, parents should mix levothyroxine tablets with breast milk, formula, or baby water.

Children with congenital hypothyroidism are regularly evaluated, often every few months for at least the first three years of life.

According to the European Association of Endocrine Children, in cases of congenital hypothyroidism, blood tests for serum T4 or free T4 and TSH should be performed as follows:

- Every one to three months during the first 12 months of life

- Every one to four months between 1 and 3 years

- Every six to 12 months until growth is complete

- Every two weeks after starting T4 treatment and every two weeks until TSH levels return to normal

- Four to six weeks after each dose change

At frequent intervals when compliance is questioned or abnormal results are obtained.

Congenital or lifelong hypothyroidism can be confirmed by imaging and ultrasound studies that show that there is a forgotten thyroid or misplaced thyroid or a defect in the ability to synthesize or secrete thyroid hormone.

If permanent hypothyroidism does not develop, treatment with levothyroxine may be stopped for one month at age 3 and the child tested again. If the surface remains normal, transient hypothyroidism is assumed. If the level is abnormal, permanent hypothyroidism is assumed.

However, children with congenital hypothyroidism who are taking the drug should continue their thyroid evaluation and reproduction period because they are at high risk for thyroid problems throughout their lives.

Treatment of hypothyroidism during pregnancy

In order to protect your pregnancy and your baby's health, it is important for a woman to have enough thyroid hormone during pregnancy.

before pregnancy
According to the American Thyroid Association's guidelines, the alternative dose of thyroid hormone (levothyroxine) for a woman with hypothyroidism should be adjusted early so that her TSH level is less than 2.5 mIU / L before childbirth.

During pregnancy

The range of traditional reference used by physicians to diagnose and treat gestational hypothyroidism is significantly narrower.

TSH levels should be maintained at specific quarterly levels:

First trimester: between 0.15 and 3.9 mL / L

Second trimester: between 0.3 to 4.1 mL / L

Third trimester: between 0.4 to 4.1 mL / L

Drug Interactions:

1- Co-administration with corticotropin changes thyroid status. Changing the amount of levothyroxine may also necessitate a change in the dose of corticotropin.

2- Concomitant use with anticoagulants may alter the effect of recent drugs. If the dose of levothyroxine is increased, the dose of anticoagulant may be reduced.

Concomitant use with tricyclic antidepressants or sympathomimetic drugs may increase the effects of all of these drugs and lead to coronary heart disease or cardiac arrhythmias.

4. Concomitant use of oral medications that lower blood sugar or insulin may alter the dose.

Beta-receptor blockers may reduce the conversion of levothyroxine to levothyronine.

6. Cholestyramine may delay the absorption of levothyroxine.

7- Estrogens increase the dose of thyroxine by increasing the serum concentration of globulin bound to thyroxine. Check the drug concentration 12 weeks later and adjust the dose accordingly.

8. Drugs that induce liver enzymes (such as phenytoin) may increase the hepatic metabolism of levothyroxine and the dose of levothyroxine.

9 - The drug reduces the effectiveness of treatment of digitalis glycosides. Monitor the serum level of digoxin and adjust the dose accordingly.

10. Concomitant use of the drug with Somaterm causes the bone epiphysis to close quickly. Do not use in children at the same time.

11- Theophylline clearance is reduced in patients with hypothyroidism and returns to normal with euthyroidism.