Thyroid hormone drugs are indicated:As replacement or supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis.This category includes cretinism, myxedema and ordinary hypothyroidism in patients of any age (pediatric patients, adults, the elderly), or state (including pregnancy); primary hypothyroidism resulting from functional deficiency, primary atrophy, partial or total absence of thyroid gland, or the effects of surgery, radiation, or drugs, with or without the presence of goiter; and secondary (pituitary) or tertiary (hypothalamic) hypothyroidism (see WARNINGS).As pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto’s) and multinodular goiter.As diagnostic agents in suppression tests to differentiate suspected mild hyperthyroidism or thyroid gland autonomy.Cytomel (liothyronine sodium) Tablets can be used in patients allergic to desiccated thyroid or thyroid extract derived from pork or beef.
Thyroid hormone preparations are generally contraindicated in patients with diagnosed but as yet uncorrected adrenal cortical insufficiency, untreated thyrotoxicosis and apparent hypersensitivity to any of their active or extraneous constituents.There is no well-documented evidence from the literature, however, of true allergic or idiosyncratic reactions to thyroid hormone.
The use of thyroid hormones in the therapy of obesity, alone or combined with other drugs, is unjustified and has been shown to be ineffective.
Neither is their use justified for the treatment of male or female infertility unless this condition is accompanied by hypothyroidism.Thyroid hormones should be used with great caution in a number of circumstances where the integrity of the cardiovascular system, particularly the coronary arteries, is suspected. These include patients with angina pectoris or the elderly, in whom there is a greater likelihood of occult cardiac disease.
In these patients, liothyronine sodium therapy should be initiated with low doses, with due consideration for its relatively rapid onset of action.
Starting dosage of Cytomel (liothyronine sodium) Tablets is 5 mcg daily, and should be increased by no more than 5 mcg increments at 2-week intervals.
When, in such patients, a euthyroid state can only be reached at the expense of an aggravation of the cardiovascular disease, thyroid hormone dosage should be reduced.Morphologic hypogonadism and nephrosis should be ruled out before the drug is administered. If hypopituitarism is present, the adrenal deficiency must be corrected prior to starting the drug.
Myxedematous patients are very sensitive to thyroid; dosage should be started at a very low level and increased gradually.Severe and prolonged hypothyroidism can lead to a decreased level of adrenocortical activity commensurate with the lowered metabolic state.
When thyroid-replacement therapy is administered, the metabolism increases at a greater rate than adrenocortical activity.
This can precipitate adrenocortical insufficiency.
Therefore, in severe and prolonged hypothyroidism, supplemental adrenocortical steroids may be necessary.In rare instances the administration of thyroid hormone may precipitate a hyperthyroid state or may aggravate existing hyperthyroidism.