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Pregnancy Category: A
Pharmacologic: thyroid preparations
Pharmacologic: thyroid preparations
Thyroid supplementation in hypothyroidism.Treatment or suppression of euthyroid goiters.Diagnostic agent for suppression tests to differentiate mild hyperthyroidism from thyroid gland autonomy.Treatment of myxedema coma (IV formulation).
Replacement of or supplementation to endogenous thyroid hormones.
Principal effect is increasing metabolic rate of body tissues:
- Promote gluconeogenesis,
- Increase utilization and mobilization of glycogen stores,
- Stimulate protein synthesis,
- Promote cell growth and differentiation,
- Aid in the development of the brain and CNS.
Replacement in hypothyroidism to restore normal hormonal balance.
Absorption: Liothyronine is well absorbed.
Distribution: Distributed into most body tissues. Thyroid hormones do not readily cross the placenta; minimal amounts enter breast milk.
Metabolism and Excretion: Metabolized by the liver and other tissues. Thyroid hormone undergoes enterohepatic recirculation and is excreted in the feces via the bile.
Half-life: 1–2 days.
|Liothyronine PO||unknown||24–72 hr||72 hr|
Contraindicated in: Hypersensitivity; Recent MI; Hyperthyroidism.
Use Cautiously in: Cardiovascular disease (initiate therapy with lower doses); Severe renal insufficiency; Uncorrected adrenocortical disorders; Geriatric: ↑sensitivity to thyroid hormones; initial dose should be ↓.
Adverse Reactions/Side EffectsUsually only seen when excessive doses cause iatrogenic hyperthyroidism
Central nervous system
- angina pectoris
- abdominal cramps
- menstrual irregularities
- weight loss
- heat intolerance
- accelerated bone maturation in children
Drug-Drug interactionBile acid sequestrants ↓ absorption of orally administered thyroid preparations.Alters the effectiveness of warfarin (INR will ↑ with thyroid hormone supplementation).May ↑ requirement for insulin or oral hypoglycemic agents in diabetics.Concurrent estrogen therapy may ↑ thyroid replacement requirements.↑ cardiovascular effects with adrenergics (sympathomimetics).
Oral (Adults) Mild hypothyroidism—25 mcg once daily; may ↑ by 12.5–25 mcg/day q 1–2 wk intervals; usual maintenance dose is 25–50 mcg/day. Myxedema—2.5–5 mcg once daily initially; ↑ by 5–10 mcg/day q 1–2 wk up to 25 mcg/day, then ↑ by 12.5–25 mcg/day; usual maintenance dose is 25–50 mcg/day. Simple goiter—5 mcg once daily initially; ↑ by 5–10 mcg/day q 1–2 wk up to 25 mcg/day, then ↑ by 12.5–25 mcg/day q wk until desired effect is obtained; usual maintenance dose is 50–100 mcg/day. T3 suppression test—75–100 mcg daily for 7 days. Radioactive 131I is administered before and after 7-day course.
Oral (Geriatric Patients or Patients with Cardiovascular Disease) 5 mcg /day initially; ↑ by no more than 5 mcg/day q 2 wk.
Intravenous (Adults) Myxedema coma—25–50 mcg initially (if cardiovascular disease is present, initial dose should be 10–20 mcg). Additional doses may be given, to a total of at least 65 mcg/day (not to exceed 100 mcg/day). Doses should be at least 4 hr but not more than 12 hr apart.
Availability (generic available)
Tablets: 5 mcg, 25 mcg, 50 mcg
Injection: 10 mcg/mL
- Assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.
- Children: Monitor height, weight, and psychomotor development.
- Lab Test Considerations: Monitor thyroid function studies prior to and during therapy.
Overdose is manifested as hyperthyroidism (tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, weight loss). Usual treatment is to withhold dose for 2–6 days. Acute overdose is treated by induction of emesis or gastric lavage, followed by activated charcoal. Sympathetic overstimulation may be controlled by antiadrenergic drugs (beta blockers), such as propranolol. Oxygen and supportive measures to control symptoms are also used.
- Monitor blood and urine glucose in diabetic patients. Insulin or oral hypoglycemic dose may need to be increased.
Potential Nursing DiagnosesDeficient knowledge, related to medication regimen (Patient/Family Teaching)
- Oral: Administer as a single dose, preferably before breakfast to prevent insomnia.
- Initial dose is low, especially in geriatric and cardiac patients. Dose is increased gradually, based on thyroid function tests. Side effects occur more rapidly with liothyronine because of its rapid onset of effect.
- For patients with difficulty swallowing, tablets can be crushed and placed in 5–10 mL of water and administered immediately via dropper or spoon; do not store suspension.
- pH: No Data.
- Intravenous: Liothyronine injection is for IV use only. Do not give IM or subcut. Administer doses at least 4 hr and not more than 12 hr apart. Base doses on continuous monitoring of patient and response to therapy.
- Resume PO therapy as soon as patient is stable and able to take PO medication. When switching to PO therapy, discontinue IV liothyronine and initiate PO at low dose, increasing gradually according to patient’s response.
- May be administered undiluted.
- Rate: Administer as a bolus.
- Instruct patient to take medication as directed at the same time each day. Take missed doses as soon as remembered unless almost time for next dose. If more than 2–3 doses are missed, notify health care professional. Do not discontinue without consulting health care professional.
- Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong.
- Advise patient to notify health care professional if headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss >2 lb/wk, or any unusual symptoms occur.
- Caution patient to avoid taking other medications concurrently with thyroid preparations unless instructed by health care professional.
- Instruct patient to inform health care professionals of thyroid therapy.
- Emphasize importance of follow-up exams to monitor effectiveness of therapy. Thyroid function tests are performed at least yearly.
- Pediatric: Discuss with parents the need for routine follow-up studies to ensure correct development. Inform patient that partial hair loss may be experienced by children on thyroid therapy. This is usually temporary.
- Resolution of symptoms of hypothyroidism and normalization of hormone levels.