QuestionSBA
QuestionChoice
25micrograms of liothyronine is bioquivalent to 100micrograms of levothyroxine sodium. As he is thyroid function is poorly controlled with this dose of thyroid replacement, changing it to another form that is of similar bioequivalence would not be beneficial for him
34503
d
Change to liothyronine sodium 25 micrograms PO daily
QuestionChoice
His thyroid function test, particularly the high TSH is suggestive of poor thyroid control. Continueing him on the similar dose of thyroid replacement will not be help his thyroid function
34504
e
Continue levothyroxine sodium 100 micrograms PO daily
QuestionChoice
High TSH and low total T4 level indicate inadequate replacement of levothyroxine and hence should be uptitrated. The increase in dose should be done in steps of 25-50 micrograms every 3-4 weeks
34500
a
Increase levothyroxine sodium to 125 micrograms PO daily
QuestionChoice
His thyroid function test suggest inadequate replacement and hence his medication should be increased and not decreased
34501
b
Decrease levothyroxine sodium to 75 micrograms PO daily
QuestionChoice
The recommended increment in levothyroxine is a gradual increment of 25-50 micrograms every 3-4 weeks
34502
c
Increase levothyroxine sodium to 175 micrograms PO daily
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2843
Levothyroxine titration
Topic
75
GP
6911
Case Presentation:




A 56-year-old man presents to his GP for review of his medication. PMH Hypothyroidism for 3 years. DH Levothyroxine sodium 100 micrograms PO daily.


 **Investigations**
TSH 10 mU/L (0.4-5.0)


Total T4 0.5 nmol/L (1.1-3)


Question:
Select the most appropriate decision option with regard to the levothyroxine sodium prescription based on these data.
a