Title: Treatment of Severe Hypothyroidism<br/>Author: Michael Bond<br/><a href='http://umem.org/profiles/faculty/78/'>[Click to email author]</a><hr/><p>
        <u><strong>Treatment of Severe Hypothyroidism</strong></u></p>
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        We do not see patient's with severe hypothyroidism often, but it is important that they be treated aggressively. Some treatment pearls are</p>
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                <strong>Rule out aggravating cause</strong> (i.e.: infection [UTI, pneumonia], myocardial infarction)</li>
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                <strong>Start IV levothyroxine dosing</strong>
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                                <strong>Initial dose 400-500 mcg. </strong><em>This is a large dose but it only saturates the thyroid receptors and will not cause a rebound hyperthyroidism state.</em></li>
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                                Daily dose 100 mcg/day</li>
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                <strong>Consider starting Dexamethasone/hydrocortisone</strong>
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                                Patients may also have adrenal insufficiency from primary pituitary failure or may have secondary adrenal suppression due to the severe hypothyroidism.  If dexamethasone/hydrocortisone is not provided they may develop severe adrenal insufficiency once you kick start their metabolism.</li>
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