Thyroid Disease Treatments- MPR

Thyroid Disease Treatments

Thyroid Disease Treatments
Generic	Brand	Strength	Form	Dose
HYPOTHYROIDISM
levothyroxine	—	100mcg, 200mcg, 500mcg	pwd for IV inj after reconstitution	Adults: Myxedema coma: individualize. Initially 300–500mcg IV once, then 50–100mcg IV once daily; switch to oral form and dose as soon as feasible. Elderly, underlying CVD: may need lower doses. Children: Not established.
	—	25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg	tabs	Adults: Maintenance: 100–200mcg daily. Children: <6mos: 8–10mcg/kg/day. 6mos–1yr: 6–8mcg/kg/day. 1–5yrs: 5–6mcg/kg/day. 6–12yrs: 4–5mcg/kg/day.
	Levoxyl^*†	25mcg, 50mcg (dye-free), 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg	scored tabs	Adults: Primary hypothyroidism: 1.6mcg/kg once daily; titrate in increments of 12.5–25mcg every 4–6wks until euthyroid and serum TSH normalized. Elderly or underlying CVD: initially 12.5–25mcg once daily; titrate every 6–8wks until euthyroid and serum TSH normalized. Usual max 200mcg/day. Severe hypothyroidism: initially 12.5–25mcg once daily; titrate in increments of 12.5–25mcg every 2–4wks until euthyroid and serum TSH normalized. Secondary or tertiary hypothyroidism, pregnancy: see full labeling. Children: Congenital or acquired hypothyroidism: 0–3mos: 10–15mcg/kg/day; 3–6mos: 8–10mcg/kg/day; 6–12mos: 6–8mcg/kg/day; 1–5yrs: 5–6mcg/kg/day; 6–12yrs: 4–5mcg/kg/day; >12yrs (growth and puberty incomplete): 2–3mcg/kg/day; (growth and puberty complete): 1.6mcg/kg/day. Newborns at risk for cardiac failure: initiate at lower dose; increase dose every 4–6wks as needed. Risk for hyperactivity: initially ¼ full replacement dose; increase by ¼ dose weekly until full dose reached.
	Synthroid^*†	25mcg, 50mcg (dye-free), 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg	scored tabs
	Thyquidity*	20mcg/mL	oral soln
	Tirosint-Sol*	13mcg/mL, 25mcg/mL, 37.5mcg/mL, 44mcg/mL, 50mcg/mL, 62.5mcg/mL, 75mcg/mL, 88mcg/mL, 100mcg/mL, 112mcg/mL, 125mcg/mL, 137mcg/mL, 150mcg/mL, 175mcg/mL, 200mcg/mL	oral soln
	Unithroid^*†	25mcg, 50mcg (dye-free), 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcg	scored tabs
liothyronine	—	10mcg/mL	soln for IV inj	Adults: Myxedema coma, precoma: initially 25–50mcg; CVD: initially 10–20mcg. Usual range: 65–100mcg daily. Change to oral therapy as soon as possible: start tabs at low dose and increase gradually; discontinue IV gradually. Give with glucocorticoids. Allow 4–12hrs between doses. Children: Not established.
liothyronine	Cytomel	5mcg, 25mcg, 50mcg	tabs	Adults: Hypothyroidism: initially 25mcg daily; may increase by up to 25mcg every 1–2wks; usual maintenance 25–75mcg daily. Myxedema, simple goiter: initially 5mcg daily; may increase by 5–10mcg daily every 1–2wks to 25mcg daily, then may increase by 5–25mcg every 1–2wks (myxedema) or by 12.5 or 25mcg daily every 1–2wks (simple goiter). Maintenance: myxedema: 50–100mcg/day; simple goiter: 75mcg/day. Children: Initially 5mcg daily; may increase by 5mcg daily every 3–4 days. Cretinism: maintenance dose: <1yr: 20mcg/day. 1–3yrs: 50mcg/day. >3yrs: as adult.
thyroid	Armour Thyroid	15mg (¼ grain), 30mg (½ grain), 60mg (1 grain), 90mg (1 + ½ grain), 120mg (2 grains), 180mg (3 grains)+, 240mg (4 grains), 300mg (5 grains)	tabs	Adults: Initially 30mg daily (long-standing myxedema: initially 15mg daily); increase by 15mg every 2–3wks; usual maintenance: 60–120mg daily. Children: <6mos: 4.8–6mg/kg/day. 6–12mos: 3.6–4.8mg/kg/day; 1–5yrs: 3–3.6mg/kg/day; 6–12yrs: 2.4–3mg/kg/day; ≥12yrs: 1.2–1.8mg/kg/day.
HYPERTHYROIDISM
methimazole	—	5mg, 10mg	scored tabs	Adults: Initially 15–60mg daily in 3 divided doses, depending on severity of disease. Maintenance: 5–15mg daily. Children: Initially 0.4mg/kg daily in 3 divided doses. Maintenance: ½ initial dose.
propylthiouracil	—	50mg	scored tabs	Adults: Give in 3 equally divided doses every 8hrs. Initially 300mg/day. Severe conditions: initially 400mg/day; max 900mg/day. Maintenance: 100–150mg/day. Children: <6yrs: not recommended. Give in 3 equally divided doses every 8hrs. ≥6yrs: initially 50mg/day; may upward titrate based on response, TSH, and free T4 levels.
THYROID EYE DISEASE
teprotumumab-trbw	Tepezza	500mg/vial	lyophilized pwd for IV infusion after reconstitution	Adults: Initially 10mg/kg followed by 20mg/kg every 3wks for 7 additional infusions. Infuse 1st two infusions over 90mins; if tolerated, may reduce subsequent infusions to 60mins. Children: Not established.
NOTES
Key: + = scored; CVD = cardiovascular disease * Take in AM on empty stomach, ½ to 1hr before breakfast. † May crush tabs and mix in 5–10mL water. Not an inclusive list of medications or dosing details. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 12/2023)

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