Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Levothyroxine is a synthetic
(man-made) version of the principle thyroid hormone, thyroxine (T4) that is made
and released by the thyroid gland. Thyroid hormone increases the metabolic rate
of cells of all tissues in the body. In the fetus and newborn, thyroid hormone
is important for the growth and development of all tissues including bones and
the brain. In adults, thyroid hormone helps to maintain brain function, food
metabolism, and body temperature, among other effects.
GENERIC AVAILABLE: Yes. Generic and branded tablets of levothyroxine may
differ:
in the amount of levothyroxine they contain,
the absorption of the
levothyroxine into the body, and
the distribution of levothyroxine throughout
the body.
This means that ingestion of 1 mg of generic levothyroxine may not
have the same effect on the body as 1 mg of another generic or branded
levothyroxine. Practically speaking, this means that when changing between
levothyroxine manufactured by different pharmaceutical companies, a change in
dose may be necessary to maintain the desired effect, or to prevent toxicity.
PRESCRIPTION: Yes.
PREPARATIONS: Tablets: 0.025, 0.05, 0.075, 0.088, 0.1, 0.112, 0.125, 0.137,
0.15, 0.175, 0.2, and 0.3 mg. Powder for intravenous injection: 200 mcg and 500
mcg per vial.
STORAGE: Levothyroxine tablets and dry powder should be kept at room
temperature, 15-30°C (59-86°F) in a light-resistant, tight container.
Powdered levothyroxine for intravenous injection should be used immediately
once mixed with a liquid.
PRESCRIBED FOR: Levothyroxine is approved to treat hypothyroidism and to
suppress thyroid hormone release in the management of cancerous
thyroid nodules
and growth of goiters. In addition, Synthroid, Levoxyl and Levothroid also are
prescribed with anti-thyroid drugs, for example methimazole (Tapazole), to
manage thyrotoxicosis (high thyroid hormone levels due to over-activity of the
thyroid gland). Thyrotoxicosis may result in the growth of goiters and/or
hypothyroidism.
DOSING: For adult hypothyroidism levothyroxine is started at 12.5-125 mcg/day
administered orally. Starting doses and dose changes may differ with individual
patients based upon age, the presence of cardiovascular disease, the development
of tolerance (reduced effectiveness with continued use), side effects to the
medication, and blood levels of thyroid hormone. It may take one to three weeks
after initiating therapy with levothyroxine or changing the dose before effects
are seen. The goal of replacement therapy is to maintain a normal blood
thyroxine level.
DRUG INTERACTIONS: Initiation or discontinuation of therapy with
levothyroxine in diabetic patients may create a need for an increase or decrease
in the required dose of insulin and/or antidiabetic drug,
[for example, glyburide
(Micronase)].
Levothyroxine may increase the effect of blood thinners such as warfarin
(Coumadin). Therefore, monitoring of blood clotting is necessary, and a decrease
in the dose of warfarin may be necessary.
Intravenous administration of epinephrine to patients with coronary artery
disease may lead to complications ranging from difficulty in breathing to a
heart attack. These complications may occur more frequently among patients also
taking levothyroxine. Therefore, careful observation is needed when intravenous
epinephrine is given to patients receiving levothyroxine who also have coronary
artery disease.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include: fatigue, weight gain, cold intolerance, excessive sleepiness, dry or coarse hair, difficulty swallowing, a lump in the front of the throat, and many more. Treatment is usually hypothyroid medication.
Thyroid nodules are the most common endocrine problem in the United States. The term "thyroid nodule" refers to any abnormal growth that forms a lump in the thyroid gland. The vast majority of thyroid nodules are benign.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Hypothyroidism during pregnancy can be treated with synthetic thyroid hormones to maintain the proper thyroid hormone balance. Hypothyroidism symptoms include fatigue, weight gain, lethargy, and constipation. Treatment of hypothyroidism in pregnant women is important, because inadequate levels of thyroid hormones may affect the fetus, and child during growth and development.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
Pendred syndrome, a genetic disorder that causes hearing loss. Generally, the hearing loss is affected in early childhood. Pendred syndrome also affects other parts fo the body (for example, the thyroid gland). Treatment is generally cochlear ear implants.
Thyroiditis (thy-roi-DY-tiss) is inflammation, or swelling, of the thyroid.
There are several types of thyroiditis, one of which is Hashimoto's thyroiditis.
What are other types and symptoms of thyroiditis?
Postpartum thyroiditis
Like Hashimoto's thyroiditis, postpartum thyroiditis seems to be caused by a
problem with the immune system. In the United States, postpartum thyroiditis
occurs in about 5 to 10 percent of women. The first phase starts 1 to 4 months
after giving birth. In this phase, you may get symptoms of hyperthyroidism
because the damaged thyroid is leaking thyroid hormones out into the
bloodstream. The second phase starts about 4 to 8 months after delivery. In this
phase, you may get symptoms of hypothyroidism because, by this time, the thyroid
has lost most of its hormones. Not everyone with postpartum thyroiditis goes
through both phases. In most women who ha...
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