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Hipothyroidism
Thyroxin
T4
Triidothyronin
T3
Hiperthyroidism
Thioamide
Iodide
Ipodate
131i
I-
I-
Io
MIT-DIT-T3-T4
-
- Iodides
Proteolisis
Iodides,
Thioamides
PTU
Metamizol
Peripheral
Tissues
T4 T3
Ipodate,
Beta-blokers
T3
T4 T3
Blood
Levotiroksin:
Tablet 25; 50; 75; 88; 100; 112; 125; 137;
150 ; 175; 200; 300 mcg
Kapsul 13; 25; 50; 75; 88; 100; 112; 125; 137;
150 mcg
Injeksi 100; 200; 500 mcg/vial
Mild Hipotiroid
1.7 mcg/kg or 100-125 mcg PO qDay; not to
exceed 300 mcg/day
>50 years (or <50 yr with CV disease)
Usual initial dose: 25-50 mcg/day
May adjust dose by 12.5-25 mcg q6-8Week
>50 years with CV disease
Usual initial dose: 12.5-25 mcg PO qDay
May adjust dose by 12.5-25 mcg q4-6weeks
until patient becomes euthyroid and serum
TSH concentration normalized; adjustments q68weeks also used
Dose range: 100-125 mcg PO qDay
Severe Hypothyroidism
Initial: 12.5-25 mcg PO qDay
Adjust dose by 25 mcg/day q2-4Week PRN
Subclinical Hypothyroidism
Initial: 1 mcg/kg PO qDay may be adequate
If replacement therapy not initiated, monitor
patient annually for clinical status
Myxedema Coma
200-500 mcg IV once, THEN 100-300 mcg 1
day later PRN; may consider smaller doses in
patients with cardiovascular disease
Liothyronin T3
Hypothyroidism
Initial: 25 mcg PO qDay; may increase by 25
mcg q1-2Weeks; not to exceed 100 mcg/day
Maintenance: 25-75 mcg PO qDay
May use 10-12.5 mcg T3 in combo with T4
(decrease T4 dose by 50 mcg)
Nontoxic Goiter
Initial: 5 mcg PO qDay; may increase by 5-10
mcg q1-2Weeks (5 mcg in elderly)
When reach 25 mcg PO qDay, may increase
by 12.5 mcg or 25 mcg q1-2Weeks
Maintenance: 75 mcg PO qDay
Myxedema
Initial: 5 mcg PO qDay; may increase by 5-10
mcg/day q1-2Weeks
When reach 25 mcg PO qDay, may increase
by 5-25 mcg q1-2Weeks
Maintenance: 50-100 mcg PO qDay
Myxedema Coma
Initial: 25-50 mcg IV
Patients with CVD: 10-20 mcg IV
Doses of at least 65 mcg/day IV associated
with lower mortality
Allow 4-12 hr between doses; not to exceed
12 hours
<1%:
Congestive heart failure, Hypertension,
Twitching, Phlebitis, Angina, Fever
Antithyroid drugs
Propylthiourasil, Methimazole
Propylthiouracil
Mechanism of Action
Inhibits synthesis of thyroid hormone by
blocking oxidation of iodine in thyroid gland;
blocks synthesis of T4 and T3
Pharmacokinetics
Absorption: 75%
Duration: 12-24 hr
Half-life elimination: 1-2 hr, increase in ESRD
Vd: 0.4 L/kg
Protein Bound: 80-85%
Concentration (200-400 mg single dose): 6-9 mcg/mL
Graves Disease
50-150 mg PO q8hr initially
Maintenance: 50 mg PO q8-12hr for up to 1218 months; then taper and discotinue if
euthyroidism restored (TSH) is normal
Renal Impairment
Dose adjustment not necessary