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INFOMATION:
Levothyroxine (INN, USAN) or L-thyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4), which is naturally secreted by the follicular cells of the thyroid gland. It is used to treat thyroid hormone deficiency, and occasionally to prevent the recurrence of thyroid cancer. Like its naturally secreted counterpart, levothyroxine is a chiral compound in the L-form. The related drug dextrothyroxine (D-thyroxine) was used in the past as a treatment for hypercholesterolemia (elevated cholesterol levels) but was withdrawn due to cardiac side effects.
Medical uses
Levothyroxine is typically used to treat hypothyroidism, and is the treatment of choice for patients with hypothyroidism, who often require lifelong thyroid hormone therapy. It may also be used to treat goiter via its ability to lower thyroid-stimulating hormone (TSH), a hormone that is considered goiter-inducing. Levothyroxine is also used as interventional therapy in patients with nodular thyroid disease or thyroid cancer to suppress thyroid-stimulating hormone (TSH) secretion. In 1992, President George H.W. Bush told television host Larry King that he had been prescribed levothyroxine as part of a treatment regimen for Graves' disease.
Available forms
Levothyroxine for systemic administration is available as an oral tablet, an intramuscular injection, and as a solution for intravenous infusion. Furthermore, levothyroxine is available as both brand-name and generic products. While the United States Food and Drug Administration (FDA) approved the use of generic levothyroxine for brand-name levothyroxine in 2004, the decision was met with disagreement by several medical associations. The American Association of Clinical Endocrinologists, the Endocrine Society, and the American Thyroid Association did not agree with the FDA that brand-name and generic formulations of levothyroxine were bioequivalent. As such, it was recommended that patients be started and kept on either brand-name or generic levothyroxine formulations and not changed back and forth from one to the other. For patients who do switch products, it is recommended that their TSH and free T4 levels be tested after six weeks to check that they are within normal range.
Adverse effects
Dosing, which is generally straight forward, must be controlled to achieve free T4 and free T3 levels within the normal reference range and elimination of hypothyroid and hyperthyroid symptoms. Once patients are stabilized annual or semiannual clinical evaluations and TSH monitoring are appropriate. Long-term suppression of TSH values below normal values will frequently cause cardiac side-effects and contribute to decreases in bone mineral density (low TSH levels are also well known to contribute to osteoporosis).
Patients prescribed too high a dose of levothyroxine may experience effects that mimic hyperthyroidism. Overdose can result in heart palpitations, abdominal pain, nausea, anxiousness, confusion, agitation, insomnia, weight loss, and increased appetite. Allergic reactions to the drug are characterized by symptoms such as difficulty breathing, shortness of breath, or swelling of the face and tongue. Acute overdose may cause fever, hypoglycemia, heart failure, coma and unrecognized adrenal insufficiency.
Acute massive overdose may be life-threatening; treatment should be symptomatic and supportive. Massive overdose can be associated with increased sympathetic activity and thus require treatment with beta-blockers.
The effects of overdosing appear 6 hours to 11 days after ingestion.
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