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*For medical professionals to read and refer
to, there are problems with 7 prescriptions, do you see?
Hypothyroidism (referred to as hypothyroidism) is a disease
that is caused by a decrease in the synthesis and secretion of thyroid hormones, or insufficient physiological effects.
L-thyromorphine sodium is a drug that mainly treats hypothyroidism in clinical practice, what problems do clinicians often have when prescribing?
Prescription 1: Patient, female, 64 years old, diagnosed goiter, prescribed levothyroxine sodium 100 μg once
daily.
Prescription 2: Patient, male, 12 years old, first visit, diagnosed hypothyroidism, prescribed levothyroxine sodium 100 μg once
daily.
Prescription 3: Patient male, 36 years old, diagnosed hypothyroidism, prescribed levothyroxine sodium 50 μg twice
daily.
Prescription 4: Female, 32 years old, diagnosed hypothyroidism, prescribed levothyroxine sodium 100 μg once daily, taken
after breakfast.
Prescription 5: Patient male, 40 years old, diagnosed with obesity, BMI 30kg/m2, prescribed levothyroxine sodium 100 μg once
daily.
Prescription 6: Patient female, 55 years old, diagnosed hypothyroidism, pulmonary embolism, prescribed levothyroxine sodium 100 μg once daily oral, warfarin sodium tablets 2.
5 mg once daily oral
.
Prescription 7 prescription: the patient is female, 27 years old, 8 weeks pregnant, diagnosed with hyperthyroidism and goiter, prescribe propylthiouracil tablets 50mg three times daily orally; Levothyroxine sodium 100 μg once daily is taken orally
.
Guidelines for the diagnosis and treatment of hypothyroidism in adults (2017)[J].
Chinese Journal of Endocrinology and Metabolism, 2017, 33(2): 167-180 [3] National Pharmacopoeia Commission.
Clinical Medication Instructions for the Pharmacopoeia of the People's Republic of China: Chemical Drugs and Biological Products Volume.
2010 Edition
In order to understand the reading habits and interests of fans and users of each channel, provide more interesting, useful and attitude content, medical endocrinology channels welcome everyone to use their fingers to complete the following research It only takes a minute!
Where to see more endocrine drug knowledge? Come to the "doctor's station" and take a look 👇
to, there are problems with 7 prescriptions, do you see?
Hypothyroidism (referred to as hypothyroidism) is a disease
that is caused by a decrease in the synthesis and secretion of thyroid hormones, or insufficient physiological effects.
L-thyromorphine sodium is a drug that mainly treats hypothyroidism in clinical practice, what problems do clinicians often have when prescribing?
1
Prescription 1: Patient, female, 64 years old, diagnosed goiter, prescribed levothyroxine sodium 100 μg once
daily.
Click on the space to see the answer
Analysis: Indications are not suitable
.
Levothyroxine sodium is synthetic tetraiodothyronine (T4), which is mainly used to supplement thyroid hormones
.
Indications include treatment of non-toxic goiter (normal thyroid function); Take after goiter removal to prevent recurrence of goiter; Replacement therapy for hypothyroidism; Adjuvant therapy with antithyroid therapy for hyperthyroidism; Suppressive therapy after surgery for thyroid cancer; Thyroid suppression experiments
.
Only the diagnosis of goiter is made, and levothyroxine sodium is not appropriate
.
2
Prescription 2: Patient, male, 12 years old, first visit, diagnosed hypothyroidism, prescribed levothyroxine sodium 100 μg once
daily.
Click on the space to see the answer
Analysis: The dosage is not suitable
.
The amount of levothyroxine sodium needs to be individualized and needs to be determined
by multiple factors such as the severity of the patient's condition, age, and weight.
For children diagnosed with hypothyroidism, the initial dose is generally 12.
5 to 50 micrograms/day, and the maintenance dose is given at a body surface area of 100-150 micrograms/m2
.
The patient is a pediatric and at first presentation is given a dose of 100 micrograms/day too large
.
3
Prescription 3: Patient male, 36 years old, diagnosed hypothyroidism, prescribed levothyroxine sodium 50 μg twice
daily.
Click on the space to see the answer
Analysis: The frequency of medication is not appropriate
.
The average half-life of levothyroxine sodium is 7 days
.
For patients with hypothyroidism, the half-life can reach 9-10 days, so it can
be given once a day.
4
Prescription 4: Female, 32 years old, diagnosed hypothyroidism, prescribed levothyroxine sodium 100 μg once daily, taken
after breakfast.
Click on the space to see the answer
Analysis: The administration time is not appropriate
.
The absorption site of levothyroxine sodium is mainly in the small intestine, and taking it with food may affect its absorption, so taking it on an empty stomach can make the drug reach the small intestine as soon as possible and better exert the therapeutic effect, so it is recommended to take
it half an hour to an hour before breakfast.
5
Prescription 5: Patient male, 40 years old, diagnosed with obesity, BMI 30kg/m2, prescribed levothyroxine sodium 100 μg once
daily.
Click on the space to see the answer
Analysis: There are no indications for medication
.
Levothyroxine sodium will increase the body's metabolism, and the body's consumption will increase, resulting in weight loss, but the drug has no indications for weight loss, and it is not scientific
to lose weight.
In general, the commonly used amount of levothyroxine sodium can not effectively reduce weight, but also cause some symptoms of hyperthyroidism, manifested as flushing, fever, insomnia, sweating, increased appetite, weight loss, etc.
, excessive use may be life-threatening
.
6
Prescription 6: Patient female, 55 years old, diagnosed hypothyroidism, pulmonary embolism, prescribed levothyroxine sodium 100 μg once daily oral, warfarin sodium tablets 2.
5 mg once daily oral
.
Click on the space to see the answer
Analysis: There are drug interactions
.
Levothyroxine sodium may cause increased anticoagulation of warfarin, causing bleeding, and the international normalized ratio (INR) should be monitored and the warfarin dose
adjusted.
In addition, at least 2 hours apart when combined with sucralfate and at least 4 hours
when combined with orlistat, sevelamer, cholestyramine, calcium carbonate, etc.
7
Prescription 7 prescription: the patient is female, 27 years old, 8 weeks pregnant, diagnosed with hyperthyroidism and goiter, prescribe propylthiouracil tablets 50mg three times daily orally; Levothyroxine sodium 100 μg once daily is taken orally
.
Click on the space to see the answer
Analysis: Special population medication is not suitable
.
Patients with exophthalmos and goiter, long-term use of antithyroid drugs, can cause thyroid enlargement, congestion and other conditions, combined with levothyroxine sodium, reduce thyroid stimulation, to relieve exophthalmos, goiter
.
Some patients with hyperthyroidism combine levothyroxine sodium for a short time to better adjust the dosage
of antithyroid drugs.
However, for the safety of pregnant women and fetuses, pregnant women should minimize the dose of the drug, and the combination of levothyroxine sodium
is not recommended.
References:
[1] Levothyroxine sodium drug insert [2] Endocrinology Branch of Chinese Medical Association.Guidelines for the diagnosis and treatment of hypothyroidism in adults (2017)[J].
Chinese Journal of Endocrinology and Metabolism, 2017, 33(2): 167-180 [3] National Pharmacopoeia Commission.
Clinical Medication Instructions for the Pharmacopoeia of the People's Republic of China: Chemical Drugs and Biological Products Volume.
2010 Edition
In order to understand the reading habits and interests of fans and users of each channel, provide more interesting, useful and attitude content, medical endocrinology channels welcome everyone to use their fingers to complete the following research It only takes a minute!
Where to see more endocrine drug knowledge? Come to the "doctor's station" and take a look 👇
