Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Thyroid hormone is administered to supplement or replace endogenous production.

Class Summary

Thyroid hormone influences growth and maturation of tissues. It is involved in normal growth, metabolism, and development. Levothyroxine (LT4) is generally considered to be the treatment of choice for patients with hypothyroidism.

Levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid, Tirosint, Thyquidity)

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Liothyronine (Cytomel, Triostat)

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Liothyronine (LT3) is a synthetic form of the natural thyroid hormone (T3) converted from T4. It is not intended for use as sole maintenance therapy, but in rare cases it can be used together with LT4 in small doses (5-15 µg/day).The recommended ratio of T4 to T3 is 10-14:1. T3 has a short duration of activity (half-life, 12-24 hours), which allows quick dosage adjustments in the event of overdosage.

Theoretically, LT3 may be preferred when gastrointestinal (GI) absorption is impaired (95% of this hormone is absorbed, compared with 50-80% of T4) or if peripheral conversion is impaired. Dosage recommendations are for short-term use in special circumstances (eg, myxedema coma), under the guidance of an endocrinologist. Dosage should be determined in consultation with an endocrinologist.

Dosage recommendations are for short-term use in special circumstances (see above) with the guidance of an endocrinologist.

Thyroid desiccated (Armour Thyroid, Nature-Throid, Westhroid)

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Desiccated thyroid is derived from extracts of bovine or porcine thyroid glands. Some manufacturers standardize their formulations on the basis of bioassays, whereas others use iodine content.

Desiccated thyroid is referred to as natural thyroid and generally contains T3 and T4 in a 1:4 ratio. It is made in a range of strengths, with tablets including 1/8, 1/4, 1/2, 1, 2, 3, 4, or 5 grains. One grain (60 mg) contains about 38 µg of T4 and 9 µg of T3. Because these preparations contain variable quantities of T3, they should not be prescribed for patients with known or suspected cardiac disease and are generally avoided. They also are not preferred in pregnancy, because they produce relatively lower T4 levels.

Questions

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The hypothalamic-pituitary-thyroid axis. Levels of circulating thyroid hormones are regulated by a complex feedback system involving the hypothalamus and pituitary gland.

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Author

Philip R Orlander, MD, FACP Professor, Department of Internal Medicine, Director, Division of Endocrinology, Diabetes and Metabolism, Associate Dean for Educational Programs, Vice-Chair of Medicine for Education, Edward Randall III Chair in Internal Medicine, Program Director, Endocrinology, Diabetes and Metabolism Fellowship Program, University of Texas Health Science Center at Houston, McGovern Medical School

Philip R Orlander, MD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, Endocrine Society, Harris County Medical Society, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jeena M Varghese, MD Assistant Professor, Department of Internal Medicine, Division of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center

Jeena M Varghese, MD is a member of the following medical societies: Endocrine Society, Harris County Medical Society, Texas Medical Association

Disclosure: Nothing to disclose.

Sapna Naik, MD Assistant Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, UTHealth, University of Texas Health Science Center at Houston, McGovern Medical School; Attending Physician, Department of Gastroenterology, Memorial Hermann Hospital – Texas Medical Center, and Lyndon B Johnson General Hospital

Sapna Naik, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for Physician Leadership, American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society, International Society for Clinical Densitometry, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Lance M Freeman, MD Fellow, Division of Endocrinology, University of Texas Health Science Center at Houston

Disclosure: Nothing to disclose.

Acknowledgements

Anu Bhalla Davis, MD Assistant Professor, Department of Internal Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Texas Medical School at Houston