Treatment,+Meds,+and+Nursing+Interventions

Treatment Measures:
==="Overall treatment in a patient with hypothyroidism is restoration of a euthyroid state as safely and rapidly as possible with hormone replacement. In addition, a low-calorie diet is indicated to promote weight loss" (Lewis et al, p.1270).===

Medications:
===-**Levothyroxine (Synthroid**) : drug of choice. “ In young and otherwise healthy patient, the maintenance replacement dose is adjusted according to the patient’s response and lab findings. In the patient without side effects, the dose is increased at 4-6 week intervals. Instruct individuals using levothyroxine to have their serum TSH level checked 4-6 weeks after changing a levothyroxine preparation” (Lewis, et al. P. 1271).===

- Therapeutic action: “Increases the metabolic rate of body tissues, thereby increasing oxygen consumption; respiration and HR; rate of fat, protein, and carb metabolism; and growth and maturation.
===-Indications: Replacement therapy in hypothyroidism, pituitary TSH suppression in tx and prevention of euthyroid goiters, management of thyroid cancer, tx of myxedema coma, to prevent goitrogenesis, hypothyroidism, and thyrotoxicosis during pregnancy (Karch, 2011, p.703).=== ===- Contraindicated with allergy to active or extraneous constituents of drug, untreated thyrotoxicosis, and acute MI uncomplicated by hypothyroidism. Use cautiously with Addison’s disease, lactation, and pt with CAD or angina (Karch p. 703).===

- Pharmacokinetics: Oral has slow onset and peak of 1-3weeks and IV has onset of 6-8 hours and peak of 24-48 hours. (Karch, 2011, p.704)
===- Adverse Effects: tremors, headache, nervousness, insomnia, palpitations, tachycardia, angina, cardiac arrest, allergic skin reaction, diarrhea, N/V, esophageal atresia, gagging, choking (Karch, 2011, p.704).=== ===-Interventions: Closely monitor at beginning of therapy, take with full glass of water, do not mix IV doses to other IV fluids, administer oral daily dose before breakfast with full glass of water (Karch, 2011, p. 704).===

**Liotrix**
===Same info as levothyroxine, but “is a synthetic mix of T3 and T4 and has a fast onset of action with peak of 2-3 days instead of peak of 1-3 weeks. May be used in acutely ill patients with hypothyroidism” (Lewis, et al, p.1270).===