Thyroid Drugs Nursing Considerations & Management

Pregnant and lactating females need to discuss the dose and use of this medication with their caregivers. This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. Notify your doctor if you experience serious side effects of Synthroid including rapid heartbeat, fluttering in your chest, or chest pain.

SPECIAL CONSIDERATIONS FOR HYPOTHYROID MEDICATIONS

Triiodothyronine(T3) and L-thyroxine (T4) diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. If cardiac symptoms develop or worsen, reduce the SYNTHROID dose or withhold for one week and restart at a lower dose. The peak therapeutic effect of a given dose of SYNTHROID may not be attained for 4 to 6 weeks. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use levothyroxine only for the indication prescribed. This is given as an injection into a vein by a healthcare provider and should only be used to treat myxedema coma.

• Reduce the SYNTHROID dosage or discontinue temporarily if signs or symptoms of overdosage occur.
• Use this section to review the cases of Steve, Jennifer, and Diana to see how to effectively manage their hypothyroidism with SYNTHROID (levothyroxine sodium).
• Measure and evaluate unbound (free) hormone and/or determine the free-T4 index (FT4I) in this circumstance.
• Carefully monitor glycemic control, especially when thyroid therapy is started, changed, or discontinued see WARNINGS AND PRECAUTIONS.
• Synthroid is also used in patients who need surgery and radioiodine therapy to manage a type of thyroid cancer called well-differentiated thyroid cancer.

Euthyrox (levothyroxine) is used to treat hypothyroidism and to treat or prevent goiter. It’s very important to remind the patients, in addition to these factors, that they need to check their pills on a consistent basis. Look to see if the tablets have Synthroid embossed on them to ensure they’re getting the right product.

DISCUSS THE FOLLOWING WITH PATIENTS

Carefully monitor glycemic control after starting, changing, or discontinuing SYNTHROID see Drug Interactions (7.2). Levothyroxine is generally continued for life in these patients see WARNINGS AND PRECAUTIONS. Carefully monitor glycemic control after starting, changing, or discontinuing SYNTHROID see DRUG INTERACTIONS. Assess the adequacy of therapy by periodic assessment of laboratory tests and clinical evaluation. Persistent clinical and laboratory evidence of hypothyroidism despite an apparent adequate replacement dose of SYNTHROID may be evidence of inadequate absorption, poor compliance, drug interactions, or a combination of these factors.

Initiate SYNTHROID therapy in this population at lower doses than those recommended in younger individuals or in patients without cardiac disease see DOSAGE AND ADMINISTRATION and Use In Specific Populations. For adult patients with primary hypothyroidism, titrate until the patient is clinically euthyroid and the serum TSH returns to normal see Dosage and Administration (2.3). For adult patients with primary hypothyroidism, titrate until the patient is clinically euthyroid and the serum TSH returns to normal see Recommended Dosage And Titration. Synthroid is prescribed in tablets that range from 25 to 300 mcg in strength and is usually taken once a day with a full glass of water (about 8 ounces) 30 to 60 minutes before breakfast for best adsorption into the body. Children can take the medicine if the tablet is crushed and put into about 1 to 2 teaspoons of water; do not store or delay giving this crushed pill suspension. Doctors often may have to slowly increase the dose; patients should not increase or decrease this medication themselves.

2 Antidiabetic Therapy

SYNTHROID may reduce the therapeutic synthroid dyes effects of digitalis glycosides. Serum digitalis glycoside levels may decrease when a hypothyroid patient becomes euthyroid, necessitating an increase in the dose of digitalis glycosides. Levothyroxine is used in adults and children to treat hypothyroidism (underactive thyroid – a condition where the thyroid gland does not produce enough thyroid hormone). Some patients with hypothyroidism can be challenging to treat and require special consideration. Use this section to review the cases of Steve, Jennifer, and Diana to see how to effectively manage their hypothyroidism with SYNTHROID (levothyroxine sodium).

Family history is very important when talking to these patients because there is a strong predisposition amongst family members in the primary setting to have another family member with hypothyroidism. One of the difficulties of the diagnosis of hypothyroidism is that the signs and symptoms are non-specific to the disease. So, in order to diagnose the disease accurately, given the non-specific symptoms, you must use the TSH level as a screening tool to assist in the family history and signs and symptoms that you have come across. Levothyroxine is the most commonly used treatment in this setting. Pseudotumor cerebri and slipped capital femoral epiphysis have been reported in pediatric patients receiving levothyroxine therapy.

• Do not administer in foods that decrease absorption of SYNTHROID, such as soybean-based infant formula see DRUG INTERACTIONS.
• The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
• Persistent clinical and laboratory evidence of hypothyroidism despite an apparent adequate replacement dose of SYNTHROID may be evidence of inadequate absorption, poor compliance, drug interactions, or a combination of these factors.

Drug Interactions

Consider the potential for food or drug interactions and adjust the administration or dosage of SYNTHROID as needed see DOSAGE AND ADMINISTRATION, DRUG INTERACTIONS and CLINICAL PHARMACOLOGY. Do not administer in foods that decrease absorption of SYNTHROID, such as soybean-based infant formula see DRUG INTERACTIONS. Monitor for cardiac arrhythmias during surgical procedures in patients with coronary artery disease receiving suppressive SYNTHROID therapy.

So, my job as a thyroid specialist in these patients is to make sure my patient is treated and gets to a point of consistency, because it is a lifelong course of medication. Do not store the crushed tablet/water mixture and do not administer it mixed with foods that decrease absorption of levothyroxine, such as soybean-based infant formula. Synthroid is also used in patients who need surgery and radioiodine therapy to manage a type of thyroid cancer called well-differentiated thyroid cancer. Consumption of certain foods may affect SYNTHROID absorption thereby necessitating adjustments in dosing see DOSAGE AND ADMINISTRATION. Many drugs can inhibit Synthroid’s adsorption by the body; other medications may increase or decrease its effectiveness once it is adsorbed. Providing a complete list of medications to the doctor will help with getting the correct dose established for each individual patient.

Another group is those that have underlying cardiac disease or are at risk for atrial fibrillation. And a third is those that have severe, long-standing hypothyroidism. Overtreatment or undertreatment with levothyroxine may have negative effects on different systems throughout the human body.