Hypothyroidism: Levothyroxine is indicated for replacement therapy in congenital or acquired hypothyroidism of any etiology.Specific indications include: primary hypothyroidism (thyroid), secondary (pituitary) or tertiary (hypothalamic) hypothyroidism and subclinical hypothyroidism.
Pituitary TSH suppression: In the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto thyroiditis), multinodular goiter and as an adjunct to radioiodine therapy or surgical management well-differentiated thyroid cancer dependent on thyrotropin.
Contraindications: Levothyroxine sodium is contraindicated in patients with subclinical thyrotoxicosis untreated (decreased serum TSH levels with normal T3 and T4) or uncontrolled release of any cause, acute myocardial infarction, uncontrolled adrenal insufficiency, since the Thyroid hormones may trigger acute adrenal crisis by increasing the metabolism of glucocorticoids, and patients with hypersensitivity to the components of the formula.
PRECAUTIONS: The long-term use of levothyroxine has been associated with increased bone resorption, therefore, may decrease bone density, especially in postmenopausal patients receiving higher doses or suppressive levothyroxine.
Levothyroxine should be used with caution in patients with cardiovascular disorders, including angina and hypertension and senescence.
Patients with adrenal insufficiency should be treated with glucocorticoids before initiating therapy with levothyroxine.
Levothyroxine may worsen the symptoms of diabetes mellitus, diabetes insipidus, Addison disease, panhypopituitarism or adrenal insufficiency, so close clinical monitoring is recommended and, if necessary, dose adjustment.
DOSAGE AND ADMINISTRATION: Oral.
The dose is adjusted according to the requirements and response of each patient. Achieve an adequate therapeutic response depends on several factors, including age, weight, cardiovascular status, among other medical conditions, including pregnancy, concomitant medications, and thyroid pathology base.
For the treatment of mild hypothyroidism in adults, the initial oral dose of levothyroxine sodium is 50 mcg per day in one take, increasing from 2 to 4 weeks until the desired dose, but in patients with recent onset of hypothyroidism is indicated initial dose of 100 to 200 mcg per day. The maintenance dose in adults is 100 to 200 mcg per day (1.7 mcg / kg / day), although some patients may require higher doses.
For the management of adult patients with severe hypothyroidism, an initial oral dose of 12.5 - 25 mcg per day in one dose, increasing from 25 to 50 mcg per day in 2 to 4 weeks to get the right answer.
In elderly patients, the initial dose is 25 mcg once a day, increasing at intervals of 6 to 8 weeks to obtain the desired response (the maintenance dose is about 1 mcg / kg / day). In elderly patients with cardiovascular disease are recommended to start with 12.5 mcg once a day.
In children 1 year recommended dose of 25 to 50 mcg in one shot a day a year later, the dose is 3 to 5 mcg / kg / day until the adult dose of 150 micrograms or so.
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