1 tablet of the drug contains:
Levothyroxine sodium - 25, 50 or 100 μg;
Excipients, including lactose.
Levothyroxine, which is part of the drug, is similar in action to endogenous human thyroid hormones. In the body, levothyroxine is metabolized to liothyronine, which, getting into the cells and tissues, is able to regulate the development and growth of cells, affect the metabolism. In particular, the drug can affect oxidative metabolism in mitochondria and selectively regulate the flow of cations inside and outside the cell. In addition, the effect of levothyroxine depends on its dosage, so, in small doses, it is able to exert an anabolic effect, in the middle it affects mainly cells and tissues. The drug increases the tissue's need for oxygen, stimulates oxidative reactions, accelerates the breakdown and metabolism of proteins, fats and carbohydrates, activates the functions of the cardiovascular system, has a stimulating effect on the central nervous system.
In large doses, the drug inhibits the production of thyrotropin-releasing factor by the hypothalamus, thus reducing the production of thyroid-stimulating hormone by the pituitary gland.
Clinical manifestation of the drug in hypothyroidism is observed already at 3-5 days after the start of therapy. For 3-6 months, subject to continuous therapy with levothyroxine, diffuse goiter decreases or disappears completely.
After oral administration, the adsorption from the gastrointestinal tract is up to 80%, the maximum concentration in the blood plasma is reached within 6 hours. The half-life of levothyroxine depends on the amount of thyroid hormones in the blood, so, in hypothyroid states, the half-life is 10 days. In euthyroid states, 6-7 days, and in hyperthyroid conditions, up to 4 days. After administration, levothyroxine is metabolized to active liothyronine in the liver and kidneys. Levothyroxine is excreted in bile.
Indications for use
The drug is used for replacement therapy for hypothyroidism of various etiologies, including primary and secondary hypothyroidism after surgical interventions on the thyroid gland and after a course of therapy with radioactive iodine.
As a replacement therapy for congenital and acquired hypothyroidism. With myxedema, cretinism, obesity with manifestations of hypothyroidism. With cerebral-pituitary diseases.
For prophylaxis in case of recurrent nodular goiter after resection in case of undisturbed thyroid function.
In monotherapy of diffuse euthyroid goiter. When euthyroid hyperplasia of the thyroid gland. In combination therapy of diffuse toxic goiter after thyrotoxicosis compensation with thyrostatic drugs.
In the complex treatment of Graves disease and autoimmune thyroiditis Hashimoto.
For the treatment of hormone-dependent highly differentiated malignant tumors of the thyroid gland, including follicular or papillary carcinomas.
The drug is also used for replacement and suppressive therapy for malignant tumors of the thyroid gland, including after surgical interventions for cancer of the thyroid gland.
As a diagnostic tool in thyroid suppression tests.
Mode of application
Take the entire dose of the drug at a time, preferably in the morning, on an empty stomach 30 minutes before a meal, drinking plenty of water. Infants tablet crushed and dissolved in a small amount of water, the resulting suspension is given 30 minutes before the first morning feeding, it is necessary to prepare the suspension immediately before ingestion.
The dose of the drug is selected individually, taking into account the weight, age, severity and nature of the disease, laboratory indicators characterizing the functional state of the thyroid gland.
Typically, the initial dose for adults with hypothyroidism and euthyroid goiter is 25-100 μg per day, then the dose is gradually increased every 2-3 weeks by 25-50 μg until the maintenance dose is reached. For children, the initial dose of 12.5-50 μg per day, the achievement of a maintenance dose is the same as for adults.
In severe hypothyroidism or in the case of hypothyroidism, which has long existed, the initial dose is reduced and the dose is increased more slowly.
For malignant tumors of the thyroid gland, after surgery, 150-300 μg per day is prescribed.
In hypothyroidism, caused by the removal of part or all of the thyroid gland, levothyroxine is taken throughout life.
For the diagnosis by the method of suppression scintigram, levothyroxine is prescribed at a dose of 200 µg per day for 14 days, or 3 mg 1 time per week before re-testing.
If the recommended dosage of the drug is observed, side effects are extremely rare, but their manifestations are possible as an increase in body weight due to increased appetite under the action of the drug, in addition, hair loss and kidney damage are possible. Children suffering from epilepsy or prone to convulsive seizures may experience a worsening course of these diseases.
When taking excessive doses or increasing the dose too quickly during therapy, manifestations of hyperthyroidism are possible. In particular, the development of tachycardia, arrhythmias, disturbances in sleep and wakefulness, tremor of the limbs, causeless anxiety and feelings of anxiety are possible. In addition, possible strokes, hyperhidrosis, diarrhea, vomiting, weight loss.
It is rarely possible the development of atopic dermatitis.
In the event of side effects, it is necessary to reduce the therapeutic dose or stop taking the drug until they disappear and resume treatment with a slightly lower single dose of the drug.
- Individual hypersensitivity to the drug.
- Thyrotoxicosis of various etiologies, which has not been cured.
- Heart rhythm disorders.
- Ischemic heart disease, angina pectoris, insufficiency of the coronary circulation, atherosclerosis, acute myocardial infarction.
- Organic lesions of the heart, including myocarditis, pericarditis.
- Severe hypertension and heart failure.
- Adrenal insufficiency, Addison's disease.
- Age over 65 years.
These contraindications relate to the use of the drug for suppressive, mono - and combination therapy of diseases and do not apply to replacement therapy.
For substitution therapy with a drug, only individual hypersensitivity is contraindicated; in other cases, after consultation with your doctor, the drug can be used.
The preparation contains lactose, which should be considered when prescribing L-thyroxine in patients with lactase deficiency.
The drug has no embryotoxic, teratogenic and mutagenic effects. Bad penetrates the placental barrier. In small doses, penetrates into breast milk, even during therapy with large doses. In the second and third trimester of pregnancy, the need for thyroid hormones increases, so you must inform the doctor about pregnancy for the possible correction of doses of the drug.
The use of the drug in combination with thyreostatics during pregnancy and lactation is not recommended, because as a result, the child may develop hypothyroidism, only levothyroxine monotherapy is indicated.
The drug reduces the effect of insulin and oral antidiabetic agents, so when prescribing levothyroxine to patients with diabetes, it is necessary to control blood sugar levels and, if necessary, adjust the dose of insulin or oral antidiabetic agents.
At the same time taking the drug reduces the effect of cardiac glycosides.
The drug enhances the pharmacological effect of antidepressants.
Levothyroxine is able to increase the prothrombin time when taken together with anticoagulants, this interaction is especially strong with coumarin derivatives.
Estrogens reduce the effectiveness of levothyroxine.
Enveloping agents, in particular aluminum hydroxide and magnesium hydroxide, as well as calcium carbonate, colestipol, sucralfate and cholestyramine reduce the absorption of levothyroxine from the gastrointestinal tract, therefore, with the simultaneous appointment of these funds with levothyroxine, it is necessary to take a break between doses of 4-5 hours.
Clofibrate, dicumarol, salicylic acid derivatives, large doses of furosemide increase the content of levothyroxine in the blood, increase the risk of arrhythmias.
Anabolic hormones can alter the degree of binding of levothyroxine to plasma proteins. Simultaneous use of asparaginase and tamoxifen with levothyroxine has the same effect.
Chloroquine increases the intensity of levothyroxine in the liver.
Levodopa, dopamine, diazepam, carbamazepine, aminosalicylic acid, amiodarone, aminoglutetimid, metoclopramide, somastatin, lovastatin and antithyroid drugs alter the level of thyroid hormones in the body, their influence extends to the endogenous hormones and the hormones introduced into the body by the organism in the body, and its effect extends to the organism in the body, and the hormones that are administered to the body in the body also affect the body, introduced into the body, and the effects on the body are also endogenous, and the hormones that are administered to the body in the body are also influenced by the body’s endogenous hormones and by thyroid hormones.
Sertraline reduces the effectiveness of levothyroxine in patients with hypothyroidism.
When taking ritonavir, the body's need for levothyroxine increases.
Manifestations of overdose may appear immediately after administration or after a few days. An overdose of the drug causes symptoms of thyrotoxicosis, in severe cases up to a thyrotoxic crisis. Characterized by palpitations, diarrhea, epigastric pain, tachycardia, angina attacks. Also characterized by manifestations of heart failure, tremor, violations of sleep and wakefulness, fever, heat intolerance, increased sweating, irritability. Laboratory indices of free thyroxin index and T3 and T4 levels are increasing. There may be a decrease in body weight.
Treatment is the abolition of the drug. In acute overdose, intramuscular administration of glucocorticosteroids (prednisone, hydrocortisone, dexamethasone) or administration of B-blockers is indicated. In critical cases with levothyroxine poisoning, plasmapheresis is indicated.
Tablets of 25, 50 or 100mkg 50 tablets in a blister, 1 or 2 blisters in a carton.
The drug should be stored in a dry dark place at a temperature of 15-25 degrees Celsius.
Shelf life - 3 years.
Levothyroxine sodium, Eutirox, Eferox, Bagotirox.
Know your thyroid: 11 things every woman should know
The thyroid gland is a small but extremely important gland in the body, the health of which must be carefully monitored. The publication Woman’s Day tells what and why every woman should know about her thyroid gland.
Problems with the thyroid gland can seriously affect the overall health of a person; moreover, they are difficult to determine - they are often identical to the symptoms of depression or menopause. Approximately every eighth woman in her life is faced with thyroid problems, and 60 percent of people do not even realize that they have them.
Thyroid - energy source
Iron in the form of a butterfly, which is located in the neck, is often considered the cause of many diseases, and here's why. Thyroid hormones affect almost all processes and organs of the body.
Women are more likely to suffer from thyroid problems
About 10% of women suffer from certain forms of hypothyroidism, in which the thyroid gland cannot produce enough thyroid hormones for the smooth functioning of the body. Women are 8 times more likely than men to be at risk, especially after 60 years. Less common is hyperthyroidism, which produces too many of these hormones.
Often, the symptoms are barely noticeable at first, but destructive later
When the thyroid gland slows down its work, you slow down yourself - your metabolism slows down, you do not have enough energy, you often feel cold, and you feel weak, your pulse slows down and there are difficulties with concentration. Hypothyroidism causes an increased risk of type 2 diabetes and infertility. Exactly the opposite effect has hyperthyroidism, which accelerates the reaction in the body.
Hormonal changes are confused with thyroid problems
With age, the risk of thyroid problems only increases and the premenopause period begins at about 40 years. Since premenopause and hypothyroidism have many identical symptoms, for example, fatigue, irregular periods and weight gain, women find it difficult to understand what exactly is the cause. Here are some signs that the cause is in the thyroid gland: there were cases of thyroid disease in your family (ask your mother or relatives), you have an autoimmune disease, such as type 1 diabetes or celiac disease. Autoimmune inflammation (when your immune system attacks the thyroid gland) is the most common cause of hypothyroidism.
Prescriptions from doctors may vary
First it is important to determine the level of your thyroid-stimulating hormones (TSH) using a blood test. If the level is elevated or does not correspond to the norm, then it is possible that your thyroid gland does not cope and the body releases more TSH in order to “spur” it. Of course, the norm also varies. Many experts believe that the rate of TSH ranges from 0.4 to 4.0 mU / l, so if your results are within the normal range, the doctor is unlikely to prescribe a treatment for you. Other experts and adherents of an integrated approach believe that treatment is necessary if your tests are technically normal (from 2.5 to 4 mU / l). For a more complete picture, your doctor may order a T3 and / or T4 hormone level check.
Thyroid gland can be cured
In the United States, Levothyroxine (artificial T4) is most often prescribed for the thyroid gland — this is not a very expensive drug and most patients experience improvements over the course of a month. However, if it really works for you, then you may have to take it all your life. That is why experts prescribe medications only if they are sure that you have a thyroid disease.
Other problems are often blamed on the thyroid gland
What just do not explain the problems with the thyroid gland - weight gain, fatigue, reduced libido and not always so. That is why doctors should check everything - test results, symptoms, risk factors, heredity - in context, and not as separate problems.
It is important to tell the doctor honestly and in detail about symptoms, complaints, habits. With the help of tests, you can identify other problems that are disguised as hypothyroidism - for example, fatigue can be caused by a lack of vitamins. You may also be referred to an endocrinologist.
Do not forget to check the thyroid gland
This is especially important for pregnant women, since thyroid hormones are important for the development of the fetus. It should also be checked more often for those who have had cases of thyroid or autoimmune diseases in the family.
Your food helps the thyroid gland
Eat often and in small portions - this can normalize the level of T3, increasing the level of insulin, which helps the body burn through T4 to T3.
Eat foods with selenium
One study found that selenium can prevent thyroid damage in people with autoimmune thyroiditis, which leads to hypothyroidism. The recommended dose of selenium for women is 55µg per day - this mineral is found in seafood, Brazil nuts and eggs.
Do you doubt? Consult a doctor
If it seems to you that something is wrong with your body, it is better to trust your inner voice than later regret the lost time and opportunities.
Endemic goiter: symptoms, diagnosis, treatment
An increase in the thyroid gland caused by iodine deficiency in the body is an endemic goiter.
Endemic goiter is an enlargement of the thyroid gland caused by iodine deficiency in the body. The normal volume of the gland does not exceed 20 cm3 in women and 25 cm3 in men. With goiter it is larger than these sizes.
Endemic goiter is:
- euthyroid - when the thyroid gland is enlarged, but the level of hormones is maintained within the normal range,
- hypothyroid - in combination with hypothyroidism, reduced thyroid function,
- hyperthyroid - in combination with an increased work of the thyroid gland (it is quite rare).
There are also:
- diffuse goiter - a uniformly enlarged thyroid gland,
- nodular goiter - the presence in the mass of the gland nodes more dense tissue,
- mixed goiter, when, along with a diffuse increase, individual nodes are palpable in the thyroid gland.
Localization goiter can be unilateral and bilateral.
Symptoms of endemic goiter depend on the function of the thyroid gland. Most often, patients complain of sensations such as:
- low physical endurance,
- discomfort in the heart,
These symptoms can occur even at an early stage of the disease. With further growth of the thyroid gland appear:
- feeling of squeezing in the neck,
- difficulty swallowing and breathing
- dry cough,
- asthma attacks.
Endemic goiter is the most common form of goiter. Women get it 3-4 times more often than men. This is due to the increased need of the female body in thyroid hormones during puberty, pregnancy and breastfeeding.
On a note
Iodine deficiency can occur due to:
- low iodine in the environment and drinking water. These regions include the middle belt of Russia, including Moscow, the Urals, the Caucasus, the Altai ...
- unbalanced nutrition - rare eating fish, meat, sea kale, shrimp, dairy products, oatmeal and buckwheat ...
- systematic use of certain drugs that block the absorption of iodine;
- hereditary predisposition to the development of goiter with a genetic defect in the production of thyroid hormones.
Facts and Figures
About 200 million people in the world suffer from endemic goiter. WHO calls endemic goiter "one of the most common human disasters."
90% of all cases of goiter in Russia and the CIS countries are caused by iodine deficiency.
The incidence of endemic goiter in children over the past 10 years has increased by 6%, today it makes up about 25% of all children's endocrinological diseases.
Endemic goiter can cause complications. These include:
- the so-called "goitre heart" - a condition in which the vessels that leave the heart are compressed, this condition can lead to an expansion of the right side of the heart;
- compression of the esophagus and trachea;
- hemorrhage in the thickness of the thyroid gland;
- inflammation of the thyroid gland;
- malignant degeneration of the thyroid gland.
An instrumental method for the diagnosis of endemic goiter is ultrasound. Through this study, the form of the disease is established: diffuse or nodular endemic goiter.
In the presence of nodes, sonoelastography can be prescribed - a study that allows to determine the density and elasticity of the nodules, which suggests the benign or malignant nature of the disease. For the same purpose, a biopsy of the thyroid gland may be additionally performed.
To clarify the diagnosis also check the level of hormones TSH, T3, T4. In patients with this type of disease, the balance of thyroid hormones is usually disturbed. Indicators of iodine excretion in the urine, as a rule, are reduced.
With a slight increase in the gland, often several courses of potassium iodide and diet therapy with foods rich in iodine are sufficient.
Treatment of endemic goiter complicated by hypothyroidism involves hormone replacement therapy.
The treatment of a nodular endemic goiter at an advanced stage of the disease is predominantly surgical. In the postoperative period, the patient is given hormone replacement therapy.
From folk remedies, we can recommend the powder from seaweed leaves. It is taken on 1 teaspoon at night with water. The course of treatment is 20-30 days.
Effective prevention of the development of endemic goiter is the regular consumption of edible iodized salt. It is important to add salt to the food after it has been prepared, since the trace elements of iodine are destroyed during heating.
Reducing the likelihood of endemic goiter also allows regular consumption of seafood, walnuts, persimmon. In the diet must be present dishes from fish and other products rich in iodine.
Memo to the patient
Recommended diet to prevent the development of endemic goiter:
- seafood - shrimp, squid, mussels;
- sea kale and other seaweed;
- boiled sea fish 2-3 times a week;
- fermented milk drinks, especially those containing bifidobacteria and acidophilic bacteria, 1-2 cups a day;
- medium-fat cottage cheese up to 3 times a week;
- nuts of all kinds up to 50 g per day;
- seeds of all kinds;
- dried fruits - raisins, dried apricots, dried apricots, figs, prunes, apples, pears;
- berries - cranberries, cranberries, bilberries, strawberries, gooseberries, black currants, viburnum, mountain ash red;
- vegetables - carrots, cabbage, beets, raw pumpkin;
- greens - garlic, onion, celery, horseradish;
- fresh juices of vegetables, fruits, berries;
- freshly squeezed juices of wild plants - dandelion, snyti, nettle, sap from birch leaves, linden;
- drinks from hips, hawthorn, dandelion root, green tea;
- mineral water, spring water;
- honey 30-50 g, as well as bee products.