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RxPrep
Hypothyroid
| Question | Answer |
|---|---|
| Normal free T4 range? | 0.9–2.3 ng/dL |
| Normal TSH range? | 0.3–3 mIU/L |
| Primary hypothyroidism labs? | Low free T4 + high TSH |
| Primary monitoring test? | TSH |
| 1st line for hypothyroidism? | T4 (levothyroxine) |
| Why levothyroxine preferred? | Stable levels, predictable |
| When use liothyronine (T3)? | Rarely; not generally recommended |
| When used desiccated thyroid? | Not recommended |
| Levothyroxine brand names? | Synthroid, Levoxyl, Unithroid, Euthyrox, Tirosint |
| Box warning for levothyroxine? | Not for weight loss |
| CI in levothyroxine? | Uncorrected adrenal insufficiency |
| ADRs of levothyroxine? | No ADRs unless overdosed, then can experience hyperthyroid symptoms |
| In what conditions would we use different levothyroxine dosing for hypothyoidism? | Lower dose in CAD Higher dose in pregnancy (30-50%) |
| Levothyroxine monitoring? | TSH every 4–6 weeks |
| How to take levothyroxine? | Empty stomach, 60 minutes before breakfast. Must be taken at the same time each day |
| Alternative timing for levo? | Can take at bedtime, >3 hours after last meal |
| IV:PO ratio of levo? | 0.75mcg IV = 1mcg oral |
| When use IV levothyroxine? | Myxedema coma |
| Liothyronine brand? | Cytomel, Triostat |
| Liothyronine issue? | Short half-life, flucuating T3 levels |
| What is Liotrix? | Thyrolar, mix of t3 and t4 (1:4 ratio), not recommended |
| Desiccated thyroid brands? | Armour, Nature-Throid, Westhroid |
| Issue with desiccated thyroid? | Unpredictable potency |
| Levothyroxine binds with what materials/minerals? | Levothyroxine binding interactions? |
| Levo binds with what other drugs? | Cholestyramine, sucralfate, sevelamer, separate by 4 hours |
| Separate levothyroxine from binders? | 4 hours |
| How does estrogen affect thyroid levels? | ↓ thyroid hormone levels |
| SSRIs effect? | ↓ thyroid hormone |
| Hepatic inducer (like rifampin) effect on levo? | ↓ thyroid hormone |
| Which drugs decrease thyroid levels? | Estrogens, SSRIs, inducers |
| Which drugs decrease conversion of T4 to T3? | Betablockers, amiodarone, and steroids |
| What effect dose levo have on warfarin? | ↑ INR |
| Levothyroxine effect on theophylline? | ↓ levels |
| How do we dose levo for FULL replacement (for patients with no thyroid)? | 1.6 mcg/kg/day |
| Start lower dose in CAD? | 12.5–25 mcg daily |
| Older adults dose? | 20–25% lower |
| Excess levothyroxine symptoms? | Palpitations, tachycardia, weight loss, sweating, arrhythmias |
| Monitoring for levo? | Check TSH in 4-6 weeks after starting, then yearly once stable |
| When is FT4 monitoring needed? | In central hypothyroidism |
Created by:
cdaughtry