New formulations of levothyroxine may benefit select patients

NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. You may be sensitive or allergic to the dyes or fillers and binders – known as excipients — found in most levothyroxine tablets. It is important that you tell your doctor about all the medicines you take including prescription and over-the-counter medicines, vitamins, and herbal supplements. TIROSINT may affect the way other medicines work, and other medicines may affect how TIROSINT works. Ask your doctor or pharmacist for a list of medicines that may interact with TIROSINT.

Absorption

• In patients on a stable and appropriate replacement dosage, evaluate clinical and biochemical response every 6 to 12 months and whenever there is a change in the patient’s clinical status.
• T4 absorption is increased by fasting, and decreased in malabsorption syndromes and by certain foods such as soybean infant formula.
• SYNTHROID is indicated in adult and pediatric patients, including neonates, as a replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism.
• Due to the long half-life of levothyroxine, the peak therapeutic effect at a given dose of levothyroxine sodium may not be attained for 4-6 weeks.
• Published studies report that levothyroxine is present in human milk following the administration of oral levothyroxine.
• The synthetic T4 in SYNTHROID is identical to that produced naturally by the human thyroid gland.

Studies in women taking levothyroxine sodium during pregnancy have not shown an increased risk of congenital abnormalities. SYNTHROID should not be discontinued during pregnancy and hypothyroidism diagnosed during pregnancy should be promptly treated. The therapeutic effects of digitalis glycosides may be reduced by levothyroxine. Serum digitalis glycoside levels may be decreased when a hypothyroid patient becomes euthyroid, necessitating an increase in the dose of digitalis glycosides (see Table 2). Thyroid hormones regulate multiple metabolic processes and play an essential role in normal growth and development, and normal maturation of the central nervous system and bone.

How to Increase Free T3 Without Thyroid Medication

Plasmapheresis, charcoal hemoperfusion and exchange transfusion have been reserved for cases in which continued clinical deterioration occurs despite conventional therapy. Because T4 is highly protein bound, very little drug will be removed by dialysis. Thyroid hormones, including EUTHYROX, should not be used either alone or in combination with other drugs for the treatment of obesity or weight loss. In patients with normal thyroid levels, doses of EUTHYROX used daily for hormone replacement are not helpful for weight loss. Larger doses may result in serious or even life-threatening events, especially when used in combination with certain other drugs used to reduce appetite.

Savvy thyroid patients have known about this issue for a long time which is why thyroid medications like Tirosint, Tirosint-Sol, and WP thyroid (even though it’s not currently available) have become so popular among thyroid groups. Larger doses may produce serious or even life threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects. Thyroid hormones, including TIROSINT, either alone or with other therapeutic agents, should not be used for the treatment of obesity or for weight loss. The information provided on this website is for educational and informational purposes only, and not a substitute for professional medical advice, diagnosis, or treatment.

Administration of sertraline in patients stabilized on SYNTHROID may result in increased SYNTHROID requirements. Therefore, a decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the SYNTHROID dose is increased. Closely monitor coagulation tests to permit appropriate and timely dosage adjustments. Addition of levothyroxine therapy in patients with diabetes mellitus may worsen glycemic control and result in increased antidiabetic agent or insulin requirements. Carefully monitor glycemic control after starting, changing, or discontinuing SYNTHROID see Drug Interactions (7.2). Monitor for cardiac arrhythmias during surgical procedures in patients with coronary artery disease receiving suppressive SYNTHROID therapy.

• Inadequate levothyroxine dosage will produce or fail to ameliorate the signs and symptoms of hypothyroidism.
• The metabolic actions of thyroid hormones include augmentation of cellular respiration and thermogenesis, as well as metabolism of proteins, carbohydrates and lipids.
• Never disregard professional medical advice or delay in seeking it because of something you have learned from this video or site.
• Overtreatment may result in craniosynostosis in infants and premature closure of the epiphyses in children with resultant compromised adult height.
• Levothyroxine, at doses individualized according to patient response, is effective as replacement or supplemental therapy in hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis.

For patients who have recently initiated levothyroxine therapy and whose serum TSH has normalized or in patients who have had their dosage or brand of levothyroxine changed, the serum TSH concentration should be measured after 8-12 weeks. When the optimum replacement dose has been attained, clinical (physical examination) and biochemical monitoring may be performed every 6-12 months, depending on the clinical situation, and whenever there is a change in the patient’s status. It is recommended that a physical examination and a serum TSH measurement be performed at least annually in patients receiving SYNTHROID (see WARNINGS, PRECAUTIONS, and DOSAGE AND ADMINISTRATION). Missing doses and failing to take levothyroxine as recommended are common reasons for difficulty in treating hypothyroidism. However, erratic absorption of levothyroxine in the gut can make treatment of hypothyroidism difficult.

• SYNTHROID is not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis.
• The therapeutic effects of digitalis glycosides may be reduced by levothyroxine.
• One of the biggest problems with these ingredients, though, is that they can actually limit the absorption of the medication.
• SYNTHROID (levothyroxine sodium tablets, USP) are round, color coded, scored and debossed with “SYNTHROID” on one side and potency on the other side.
• Absorption of orally administered T4 from the gastrointestinal (GI) tract ranges from 40% to 80%.
• We often take these binders and fillers for granted because their dose is so small but the reality is that they can and do make a difference.

These include urticaria, pruritus, skin rash, flushing, angioedema, various gastrointestinal symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness, and wheezing. Since some more severely affected children may become clinically hypothyroid when treatment is discontinued for 30 days, an alternate approach is to reduce the replacement dose of levothyroxine by half during the 30-day trial period. If, after 30 days, the serum TSH is elevated above 20 mU/L, the diagnosis of permanent hypothyroidism is confirmed, and full replacement therapy should be resumed. However, if the serum TSH has not risen to greater than 20 mU/L, levothyroxine treatment should be discontinued for another 30-day trial period followed by repeat serum T4 and TSH testing.

Thyroid hormones do not readily cross the placental barrier (see PRECAUTIONS – Pregnancy). Many drugs and physiologic conditions affect the binding of thyroid hormones to serum proteins see Drug Interactions (7). Thyroid hormones do not readily cross the placental barrier see Use in Specific Populations (8.1). In adult patients with primary hypothyroidism, monitor serum TSH levels after an interval of 6 to 8 weeks after any change in dosage. In patients on a stable and appropriate replacement dosage, evaluate clinical and biochemical response every 6 to 12 months and whenever synthroid success there is a change in the patient’s clinical status.

Myxedema coma is a life-threatening emergency characterized by poor circulation and hypometabolism and may result in unpredictable absorption of levothyroxine sodium from the gastrointestinal tract. Use of oral thyroid hormone drug products is not recommended to treat myxedema coma. Administer thyroid hormone products formulated for intravenous administration to treat myxedema coma. For secondary or tertiary hypothyroidism, serum TSH is not a reliable measure of SYNTHROID dosage adequacy and should not be used to monitor therapy. Use the serum free-T4 level to titrate SYNTHROID dosing until the patient is clinically euthyroid and the serum free-T4 level is restored to the upper half of the normal range see Dosage and Administration (2.3). Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products.

One potential solution to this problem is what I call the 50 mcg levothyroxine medication hack (it also works for Synthroid as well). We often take these binders and fillers for granted because their dose is so small but the reality is that they can and do make a difference. If you still have fatigue, depression, weight gain, cold hands/feet, hair loss, etc. while taking your medication then you may be reacting to the ingredients we’ve discussed above.