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Drugs in Hypothyroidism and Management of Hypothyroidism and Myxedema Coma
Drugs Used in Hypothyroidism
1. Levothyroxine (T4)
- Levothyroxine is the synthetic form of T4, the main thyroid hormone.
- It is the first-line treatment for hypothyroidism, providing the body with the thyroid hormone it lacks.
- Once administered, Levothyroxine is converted into its active form, T3, in the liver and kidneys.
- T3 binds to thyroid hormone receptors in cells, increasing metabolism, protein synthesis, and regulating cardiovascular and developmental processes.
- Administered orally, typically taken on an empty stomach.
- Dosage is individualized based on factors like weight, age, and the severity of hypothyroidism.
2. Liothyronine (T3)
- Liothyronine is the synthetic form of T3, a more potent form of thyroid hormone.
- It is used less commonly but may be combined with Levothyroxine for patients who do not respond to T4 alone.
3. Desiccated Thyroid Extract
- This is a natural thyroid hormone derived from pig thyroid glands.
- It contains both T4 and T3 but is less commonly used due to concerns about inconsistency in hormone content.
Management of Myxedema Coma
1. Intravenous Levothyroxine
- IV Levothyroxine is given for rapid replenishment of thyroid hormones.
- Typical initial dose is 200-400 mcg, followed by a maintenance dose.
- It is crucial for critically ill patients as it bypasses the gastrointestinal system.
2. Supportive Care
- Mechanical ventilation may be required if respiratory depression occurs.
- IV fluids are essential for correcting dehydration and electrolyte imbalances.
- Glucocorticoids, such as hydrocortisone, are given to address adrenal insufficiency.
3. Other Medications
- Gradual warming of the patient is essential to avoid complications from hypothermia.
- Broad-spectrum antibiotics are given if infection is suspected as a precipitating factor.
