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Hypothyroidism
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Moreover, no studies exist in which levothyroxine administration has been shown to improve these effects. On the contrary, there are at least two large RCTs showing no benefit from screening and treating isolated hypothyroxinemia in pregnancy. In a RCT, levothyroxine supplementation given to asymptomatic women screened and identified to have a free T4 below the 2.5th percentile was associated with a similar IQ and cognitive outcomes in their children at 3 years of age, compared to placebo [26]. In another RCT, levothyroxine supplementation given to asymptomatic women screened and identified to have a normal TSH (0.08–3.99 mU/mL) and a low free T4 (<0.86 ng/dL) was associated with a similar IQ and cognitive outcomes in their children at 5 years of age, compared to placebo [54]. Therefore, there is evidence that screening and treating for hypothyroxinemia in pregnancy is unnecessary, as it is not associated with any maternal or child benefits [23].
Endocrine Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Thyroid-hormone replacement with levothyroxine is indicated for patients with TSH > 10 mU/l. For patients aged >65 years or with known cardiac disease, tachyarrhythmias or multiple comorbidities, the starting dose of levothyroxine is 25–50 μg daily. For all others, levothyroxine should be started 1.67 μg/kg/day, using ideal body weight; it should be taken on an empty stomach. The goal is to normalise TSH. Tests should be repeated 6–8 weeks after initiation and/or any dose adjustments.
Late Effects of Treatment for Childhood Brain and Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Ralph Salloum, Katherine Baum, Melissa Gerstle, Helen Spoudeas, Susan R. Rose
Early treatment of mild hypothyroidism might improve growth velocity and quality of life (QoL).46,47 In patients who also have ACTHD, cortisol replacement should be initiated before beginning thyroid therapy, as thyroid therapy accelerates cortisol clearance, and can precipitate an adrenal crisis. The initial thyroid dose is 5–10 μg/kg daily for patients <3 years old, or 3 μg/kg daily for children and adolescents (about 100 μg/m2).45 Average thyroid dose in adults is 112 μg daily. Levels should be measured after 4 weeks on a new or adjusted dose, due to the long half-life of levothyroxine (5–6 days). In primary hypothyroidism, the treatment goal is TSH of 0.5–2.0 mU/L. In central hypothyroidism, monitoring TSH is not helpful and the treatment goal is free T4 in the mid-normal to upper-normal range.50
Practical guidance for use of oral semaglutide in primary care: a narrative review
Published in Postgraduate Medicine, 2020
Javier Morales, Jay H. Shubrook, Neil Skolnik
Levothyroxine is a commonly used oral medication with similarities in dosing conditions to oral semaglutide [65]. In a drug–interaction study, levothyroxine (600 µg) exposure was increased by 33% when co-administered with oral semaglutide 14 mg at steady state [12,60]. Monitoring of thyroid parameters should, therefore, be considered when treating patients with oral semaglutide in combination with levothyroxine [65]. Prescribing information states that levothyroxine should be administered in the morning on an empty stomach [65] with recommendations suggesting that it can be taken at bedtime, at least 3 hours after the evening meal as an alternative [66]. None of the studies investigating bedtime dosing of levothyroxine included dosing of oral semaglutide; however, morning dosing of oral semaglutide and evening dosing of levothyroxine could be considered, and is aligned with current evidence [12,67,68].
Integrating oral semaglutide into clinical practice in primary care: for whom, when, and how?
Published in Postgraduate Medicine, 2020
Stephen A. Brunton, Ofri Mosenzon, Eugene E. Wright Jr
When oral semaglutide is administered concomitantly with medications that have narrow therapeutic windows or that require clinical monitoring, increased clinical/laboratory monitoring should be considered [9]. An example of such an agent is levothyroxine, which is used as a thyroid hormone replacement therapy and is recommended to be taken on an empty stomach before breakfast [81]. When a single dose of levothyroxine 600 µg was co-administered with oral semaglutide at steady-state in a study in healthy volunteers, thyroxine exposure increased by 33%, potentially due to a delay in gastric emptying caused by oral semaglutide [9,73]. Patients taking concomitant levothyroxine should therefore be advised to comply with the dosing conditions for oral semaglutide [9]. In line with current medical guidance, close monitoring of thyroxine parameters should be considered and patients could consider taking levothyroxine at least 3 hours after the last meal of the day instead of in the morning [73,74].
A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment
Published in International Journal of Hyperthermia, 2018
Hao Jin, Jinrui Fan, Kun Liao, Zhuocheng He, Wei Li, Min Cui
One study has shown that about 10–70% of adults worldwide can be found to have thyroid nodules under US examination and iodine deficiency is a risk factor [1]. Most thyroid nodules are benign according to current research [2]. Large thyroid nodules can compress the trachea and esophagus, leading to a series of symptoms around the neck, such as cosmetic issues, pain, difficulty swallowing [3] and serious respiratory problems which can even threaten the life of patients [4]. For thyroid goiter treatment, conventional thyroidectomy will leave a permanent scar on the neck, and certain complications may set in, such as injury of recurrent laryngeal, parathyroid gland damage and secondary hemorrhage [4]. Some patients who received conventional bilateral thyroidectomy need to take levothyroxine after the operation for the rest of their lives to prevent hypothyroidism. In some rare cases, long-term and large-dose levothyroxine may lead to an adverse effect such as reduction of bone density [5].