PHAR 451 Lecture Notes - Lecture 6: Liothyronine, Hypothyroidism, Sucralfate
10 Dec 2016
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Hypothyroidism: rationalize a diagnosis of hypothyroidism on the basis of signs and symptoms combined with lab tests, design, implement and monitor an effective pharmacotherapeutic plan for managing primary hypothyroidism. Identify and manage common drug related-causes of hypothyroidism. Synthetic l-thyroxine (t4) (synthroid, eltroxin, gen-levothyroxine, soloxine, euthyrox, nv-thyro, levo-t) T4/t3 combinations (thyrolar, liotrix) - n/a in canada. T3+t4 replacement not superior to t4 alone on body weight, lipids, symptoms, cognition, qol. Absorbed fine at anytime best at night. Can titrate dosing depending on time of day drug is taken. Re-measure tsh (+/- t3/ft4) 3-6 weeks after dose change. Once on appropriate dose, measure tsh annually or when presenting with sx. No clinical advantage (qol, sx, cognition) to aiming for the low half of normal tsh range vs the upper half. Propranolol, atenolol, alprenolol, ptu, dexamethasone, prednisone, iopanoic acid, amiodarone. Tsh <0. 1 3. 6 times increase in hip fracture risk and 4. 5 increase in vertebral fracture risk vs normal.
