Early diagnosis can be a major step forward in the treatment of hypothyroidism. In the next section we will discuss the treatment of hypothyroidism.
Treatment
Historically, hypothyroidism is the first endocrine disorder to be treated by supplementation of the deficient hormone.
- It was treated with animal thyroid extracts in the past
- This was followed by development of purified thyroid hormone preparations.
Available thyroid hormone preparations are
- Thyroxine sodium (T4)
- Tri-iodothyronine (T3)
- Combination of synthetic T3 and T4
- Thyroid USP (desiccated animal thyroid containing T3 and T4 in the form of thyroglobulin)
The mostly widely used and preferred preparation is synthetic T4, thyroxine sodium.
Goal of treatment
To normalise the thyroid hormone status in peripheral tissues.
Initiation of therapy
Initial dosage may be based on
- Age of patient
- Severity and duration of hypothyroidism
- Presence of associated disorders like ischaemic heart disease, adrenal insufficiency paediatric hypothyroidism
- The dosage of thyroxine sodium for paediatric hypothyroidism varies with age and body weight. Thyroxine should be given at a dose that maintains the serum total T4 or free T4 concentrations in the upper half of the normal range and serum TSH in the normal range.
- Thyroxine sodium therapy is usually initiated at the full replacement dose. Infants and neonates with very low or undetectable serum T4 levels
( < 5 mcg/ dL) should start at the higher end of the dosage range (e.g. 50 mcg daily).
A lower starting dosage (e. g. 25 mcg daily) should be considered for neonates at risk of cardiac failure, increasing every few days until a full maintenance dose is reached.
- In children with severe, long-standing hypothyroidism, thyroxine sodium should be initiated gradually, with an initial dose of 25 mcg for two weeks, and then increasing the dose by 25 mcg every 2 to 4 weeks until the desired dose
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