Below each person’s neck, there is a pair of butterfly-like endocrine organs: thyroid gland.
The function of thyroid gland is very important to the growth and development of human beings. The reduction of thyroid hormone secreted by thyroid gland or the problem of tissue utilization will lead to hypothyroidism, or hypothyroidism for short.
Compared with hyperthyroidism, its treatment is very simple. According to the principle of “what is missing and what is missing” and “how much is missing and what is missing”, as long as the appropriate dose of levothyroxine tablets (LT4) is supplemented, there is almost no difference between hypothyroidism patients and healthy people.
Simple to simple, hypothyroidism treatment still has many common misunderstandings and precautions. The following knowledge, you deserve to have.
1. Is hypothyroidism LT4?
The common trade names of levothyroxine tablets (LT4) are: Youjiale, Jiaheng, Retix, etc. Because of its advantages of definite long-term curative effect, few side effects, easy dosage adjustment, good intestinal absorption, long serum half-life, low drug cost, etc., it has defeated other similar drugs and has become the best choice for hypothyroidism treatment.
However, there are still a few patients who do not respond well to LT4. Therefore, drugs such as dry thyroid tablets (T4+T3) and T3 have not completely withdrawn from the historical stage, and more clinical studies are needed to scientifically evaluate different treatment schemes.
2. What is the best time to eat?
Food may affect the absorption of LT4. In order to ensure the best use of drugs, it is recommended to take drugs immediately after getting up, or 3 hours or more before going to bed and after dinner.
Do you have to take medicine every day?
It is recommended to take the medicine regularly every day, but for hypothyroidism patients with poor compliance, due to the long half-life of the medicine, it is possible to consider taking the medicine twice a week at a dose of LT4 weeks or twice a week at a dose of half a week each time.
4. How much is the best dose?
The dose of LT4 should be determined according to the patient’s weight, pregnancy status, hypothyroidism etiology, serum thyrotropin (TSH) value, age, clinical symptoms and other aspects to determine the best individualized dose.
Generally speaking, the daily dose of LT4 for patients with thyroid loss is about 1.6 g/kg, and [body weight per kilogram] here refers to the ideal body weight of the patient rather than the actual body weight.
- If the patient’s serum TSH level is significantly increased, a complete replacement dose should be used. If TSH is only slightly higher and TSH < 10 mU/L, a lower initial dose should be used, recommending 25 ~ 50 g; The initial dose for the elderly, patients with coronary heart disease and other people should be lower, and even if the dose is insufficient, it needs to be slowly increased. For hypothyroidism patients after isotope therapy, the initial dose can be slightly higher and the dosage rate should be faster.
5. Does what need to adjust LT4 dose?
Except for some special circumstances, for most hypothyroidism patients, serum TSH level is the reference scale for LT4 dose adjustment.
It is generally recommended to stabilize the TSH value within 0.5 ~ 3.5 mU/L, and the target for over 70 years old can be relaxed to 4 ~ 6 mU/L.
After 4 ~ 6 weeks of LT4 treatment, the dose of LT4 should be increased or decreased according to the level of TSH. After that, the dose should be measured and adjusted circularly every 4 ~ 6 weeks until TSH reaches the standard, the detection frequency can be reduced to once every 4 ~ 6 months, and then gradually reduced to once a year.
For hypothyroidism patients with aging, pregnancy or large changes in body weight, the reexamination frequency should be appropriately increased.
In case of obvious hyperthyroidism, hypothyroidism or physical discomfort, reexamination is required in advance.
6. How when LT4 is excessive?
When LT4 is used too much, [iatrogenic thyrotoxicosis] will occur, inducing atrial fibrillation, osteoporosis and other diseases, which must be avoided, especially for the elderly and postmenopausal women, TSH should not be less than 0.1 mU/L.
7. Can LT4 be taken with other drugs?
Some drugs, such as calcium carbonate, ferrous sulfate, sucralfate, orlistat, coleenamine, etc., may affect the absorption of LT4. Therefore, when it is necessary to apply these drugs, it is recommended to take LT4 at intervals of 4 hours.
For more drug consultation, please see this article > > Youjiale, how to eat best? < <, or download Dr. Clove App and directly consult pharmacists.
8. What other factors will affect drug absorption?
In addition to the above drugs, factors affecting LT4 absorption include gastrointestinal diseases and surgery, high dietary fiber foods, pregnancy, heart failure, etc.
This suggests that if the actual demand for LT4 by hypothyroidism patients is obviously inconsistent with the expected value of doctors, these factors need to be analyzed and the LT4 dose should be reevaluated after appropriate intervention is made.
9. Is there any difference in the efficacy of LT4 of different brands?
There is no particular difference between different brands of LT4. However, for the weak, pregnant, young children and thyroid cancer patients, it is still necessary to avoid switching between different brands, and slight changes in dosage may adversely affect this sensitive group of people.
10. Is there any difference in the treatment of hypothyroidism during pregnancy in what?
It is suggested that hypothyroidism patients should control TSH to < 2.5 mIU/L before starting pregnancy. After pregnancy, the drug dose should be increased by 25% ~ 30% from the original level. The simplest adjustment method is to take an extra dose of two days per week.
The target values of TSH are different in different stages of pregnancy, so LT4 dose should be adjusted in time:
- 0.1 ~ 2.5 mIU/L in early pregnancy; 0.2 ~ 3.0 mIU/L in the second trimester of pregnancy; 0.3 ~ 3.0 mIU/L in the second and third trimester of pregnancy.
11. How to treat hypothyroidism in infants?
For infants with definite diagnosis of hypothyroidism, they should receive LT4 treatment as soon as possible, with the initial dose of 10 ~ 15 g/kg per day, and strive to make the serum thyroxine close to normal within 2 ~ 4 weeks. The treatment goal is to maintain the thyroxine value at the upper and middle levels of the reference range and the TSH value at the lower and middle levels of the reference range.
12. Does subclinical hypothyroidism need treatment?
The so-called subclinical hypothyroidism means that the serum TSH level is higher than the normal upper limit, while the FT4 level remains normal. If the anti-thyroid antibody is positive, the greater the serum TSH value, the higher the possibility of subclinical hypothyroidism progressing to dominant hypothyroidism.
Specific Treatment Suggestions for Subclinical Hypothyroidism;
- When TSH level is 5 ~ 10 mIU/L, treatment is generally not recommended. LT4 should be given when TSH > 10 mIU/L and signs and symptoms are consistent with primary thyroid diseases.
Conclusion
Compared with other diseases, the treatment of hypothyroidism can really be called [simple], basically realizing the excellent situation of [one drug for one disease]. However, when we enlarge our perspective and dig deeply, we find that there are still too many problems worthy of attention and attention to be optimized.
Medicine is never a [simple] thing from the moment the patient picks up the tablet.