The use of levothyroxine sodium tablets in special populations

1.

① Women with a history of hypothyroidism or high-risk hypothyroidism should confirm normal thyroid function before pregnancy and early pregnancy , because maternal hypothyroidism may have an adverse effect on the development of the fetal nervous system and lead to premature delivery

② Thyroid function should be assessed immediately after pregnancy.

③During pregnancy, the dose of L-thyroid hormone may need to be increased by up to about 50%.

④The postpartum thyroid hormone dose usually returns to the pre-pregnancy level

 ⑤The dose of thyroid medication during pregnancy may increase, but at the recommended dose, it will not cause teratogenicity and fetal toxicity.

⑥ Excessive use of high-dose levothyroxine may have adverse effects on the fetus or the development of the fetus after birth

⑦At the recommended therapeutic dose, the amount of thyroid hormone secreted into breast milk during breastfeeding is not enough to cause hyperthyroidism in the baby or suppressed TSH secretion

⑧It is not advisable to combine levothyroxine and antithyroid drugs to treat hyperthyroidism during pregnancy .

2.

① from small start-dose ( eg 12.

②If the final maintenance dose given to the patient is lower than the optimal dose for complete replacement therapy, the TSH level cannot be completely corrected

3.

① For newborns and infants with congenital hypothyroidism has been implemented neonatal screening investigation, is from newborns plantar blood test TSH or T plantar blood TSH or detection of T .

② Once the diagnosis is clear, give thyroxine replacement therapy of 10-15g/kg daily for the first three months
.
Thereafter, the dosage should be adjusted according to the individual clinical effect and the level of thyroid hormone and TSH
.

③ In the first year after birth, a higher T4 blood concentration is often needed to make TSH reach a normal level, so the T4 requirement is relatively large
.

③ In the first year after birth, a higher T4 blood concentration is often needed to make TSH reach a normal level, so the T4 requirement is relatively large
.
T4 needs relatively large

④Starting thyroid hormone replacement therapy at an early stage can make the child's IQ reach a normal level, but severe hypothyroidism at the time of diagnosis or inappropriate treatment or treatment delay can cause potential neurological development abnormalities
.

④Starting thyroid hormone replacement therapy at an early stage can make the child's IQ reach a normal level, but severe hypothyroidism at the time of diagnosis or inappropriate treatment or treatment delay can cause potential neurological development abnormalities
.

4.
Subclinical hypothyroidism

4.
Subclinical hypothyroidism 4.
Subclinical hypothyroidism

①There is no globally recognized and recommended treatment for subclinical hypothyroidism
.

①There is no globally recognized and recommended treatment for subclinical hypothyroidism
.

②Levothyroxine therapy is recommended when female patients are pregnant or planning to become pregnant or when the TSH level exceeds 10mIU/L
.
When TSH is less than 10mIU/L, if the patient has subjective symptoms of hypothyroidism, TPO antibody positive, or any evidence of heart disease, treatment should be considered
.

②Levothyroxine therapy is recommended when female patients are pregnant or planning to become pregnant or when the TSH level exceeds 10mIU/L
.
When TSH is less than 10mIU/L, if the patient has subjective symptoms of hypothyroidism, TPO antibody positive, or any evidence of heart disease, treatment should be considered
.
When pregnant or planning to become pregnant, or when the TSH level exceeds 10mIU/L, levothyroxine therapy is recommended

③It is important to confirm that the increase in TSH lasts for more than 3 months before the start of treatment
.
As long as overtreatment can be avoided , there is no risk of correcting a mildly elevated TSH
.

③It is important to confirm that the increase in TSH lasts for more than 3 months before the start of treatment
.
As long as overtreatment can be avoided , there is no risk of correcting a mildly elevated TSH
.
Before starting, confirm that the increase in TSH continues for more than 3 months to avoid overtreatment

④ the treatment of a starting low dose of levothyroxine (25 ~ 50pg / d), the goal is to make the normal TSH
.
If levothyroxine is not given, thyroid function should be monitored annually
.
Adjust the amount of treatment by closely monitoring the TSH level
.

④ the treatment of a starting low dose of levothyroxine (25 ~ 50pg / d), the goal is to make the normal TSH
.
If levothyroxine is not given, thyroid function should be monitored annually
.
Adjust the amount of treatment by closely monitoring the TSH level
.
Start with low-dose levothyroxine (25-50pg/d), the goal is to normalize TSH

5.
Patients after thyroid cancer surgery : taking levothyroxine sodium tablets on the one hand to supplement thyroid hormones to prevent hypothyroidism , and on the other to inhibit TSH to prevent cancer recurrence
.

5, 5, postoperative thyroid cancer patients after thyroid cancer : : taking levothyroxine sodium tablets in one hand, thyroid hormone supplements to prevent hypothyroidism , the other is to suppress TSH, prevent cancer recurrence
.
On the one hand, supplement thyroid hormone to prevent hypothyroidism

6.
Mucoedema coma

6.
Mucoedema coma 6.
Mucoedema coma

①There is still a mortality rate of 20%-40% under intensive treatment, and the outcome depends on the level of T4 and TSH
.
The patient's hypothermia can reach 23°C
.
The patient may have poor compliance or may not have been diagnosed
.
Mucoedema coma mostly occurs in the elderly , usually due to factors such as drugs (especially sedatives, anesthetics and antidepressants), pneumonia, congestive heart failure, myocardial infarction, gastrointestinal hemorrhage or cerebrovascular accident, sepsis and other factors Aggravate
.
Exposure to cold is also a risk factor
.
Hypnea leading to hypoxia and hypercapnia, hypoglycemia and dilutional hyponatremia are also related to the occurrence of mucoedema coma
.

①There is still a mortality rate of 20%-40% under intensive treatment, and the outcome depends on the level of T4 and TSH
.
The patient's hypothermia can reach 23°C
.
The patient may have poor compliance or may not have been diagnosed
.
Mucoedema coma mostly occurs in the elderly , usually due to factors such as drugs (especially sedatives, anesthetics and antidepressants), pneumonia, congestive heart failure, myocardial infarction, gastrointestinal hemorrhage or cerebrovascular accident, sepsis and other factors Aggravate
.
Exposure to cold is also a risk factor
.
Hypnea leading to hypoxia and hypercapnia, hypoglycemia and dilutional hyponatremia are also related to the occurrence of mucoedema coma
.
Mostly occurs when the elderly are exposed to cold

②Initially, levothyroxine 500ug can be injected intravenously alone as a loading dose
.
Although levothyroxine is not strictly necessary for the next few days, it is usually given continuously at a dose of 50-100ug/d
.
If there is no suitable intravenous preparation, the same initial dose of levothyroxine can be given through a nasogastric tube (but absorption may be limited)
.
Another alternative is to give liothyronine (T3) intravenously or nasogastric tube, 10-25ug every 8-12h
.
And there is an excess of liothyronine induced arrhythmias possible
.
Another option is to combine levothyroxine (200ug) and liothyronine (25ug) as a single-dose initial intravenous bolus, followed by daily levothyroxine (50-100ug/d) and liothyronine (10ug every 8h)
.

②Initially, levothyroxine 500ug can be injected intravenously alone as a loading dose
.
Although levothyroxine is not strictly necessary for the next few days, it is usually given continuously at a dose of 50-100ug/d
.
If there is no suitable intravenous preparation, the same initial dose of levothyroxine can be given through a nasogastric tube (but absorption may be limited)
.
Another alternative is to give liothyronine (T3) intravenously or nasogastric tube, 10-25ug every 8-12h
.
And there is an excess of liothyronine induced arrhythmias possible
.
Another option is to combine levothyroxine (200ug) and liothyronine (25ug) as a single-dose initial intravenous bolus, followed by daily levothyroxine (50-100ug/d) and liothyronine (10ug every 8h)
.
A single intravenous bolus of levothyroxine 500ug as a loading dose of liothyronine (T3) induces arrhythmia

③ Supportive treatment should correct metabolic disorders and keep warm
.
Parenteral hydrocortisone (50 mg every 6h) should be given because the adrenal reserves are impaired in severe hypothyroidism
.
At the same time correct other causes, including early application of broad-spectrum antibiotics to fight infections, improve ventilation, and intravenous infusion of hypertonic saline or glucose for patients with hyponatremia and hypoglycemia
.
Hypotonic fluid should be avoided because it may aggravate secondary renal insufficiency and water retention due to inappropriate secretion of vasopressin
.

③ Supportive treatment should correct metabolic disorders and keep warm
.
Parenteral hydrocortisone (50 mg every 6h) should be given because the adrenal reserves are impaired in severe hypothyroidism
.
At the same time correct other causes, including early application of broad-spectrum antibiotics to fight infections, improve ventilation, and intravenous infusion of hypertonic saline or glucose for patients with hyponatremia and hypoglycemia
.
Hypotonic fluid should be avoided because it may aggravate secondary renal insufficiency and water retention due to inappropriate secretion of vasopressin
.
Correct metabolic disorders and keep warm

④The metabolism of most drugs is impaired, so sedatives should be avoided or the dose should be reduced
.
If possible, blood concentration should be monitored to guide drug dosage
.

④The metabolism of most drugs is impaired, so sedatives should be avoided or the dose should be reduced
.
If possible, blood concentration should be monitored to guide drug dosage
.
Avoid sedatives or reduce the dose

 

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