What you would like to know about hypothyroidism - a lack of thyroid hormones. If free T4 is normal with elevated TSH Reasons for increased TSH when taking l thyroxine

Thyroxine is an iodine-containing hormone produced by the thyroid gland under the influence of the pituitary thyroid-stimulating hormone. There are many known diseases, the development of which leads to disruption of the normal functioning of the thyroid gland and, as a result, to a decrease in the level of thyroid hormones circulating in the blood. Trying to balance the created imbalance, the pituitary gland “spurs” the thyroid gland by increasing thyrotropin (TSH), but the latter is not always able to work productively. This is where an endocrinologist comes to the aid of the body with a “magic” tablet of L-thyroxine. Everything is like in a fairy tale: the symptoms slowly but surely pass, and the doctor acquires an aura of holiness and genius in the patient’s eyes. Do you think this is a happy ending? Often this is almost the case, but sometimes, during a follow-up examination some time after the start of treatment, the patient receives the result of a blood test, in which TSH is still elevated. Why this happens, who is to blame and what to do in such a situation will be discussed below.

For reference:

• The thyroid gland produces hormones that control almost all types of metabolism in the body.
• L-thyroxine is obtained synthetically, an absolute analogue of the natural hormone tetraiodothyronine (also known as T4 or thyroxine).
• The half-life of T4 is almost two weeks, the same figure for TSH is 2 months.
• Women suffer from thyroid diseases several times more often than the male half of the population.

Where does treatment begin?

L-thyroxine therapy is designed to externally compensate for the deficiency of thyroid hormones in the human body. However, everyone is different, and this statement applies perfectly to hormone replacement therapy. To select the required dosage for a particular patient, the endocrinologist evaluates many different indicators: test results, height, weight, age, gender, and so on. However, even with the current development of medicine, the dosage of this medicine requires a long selection and clarification, and sometimes this process drags on for several months.

Due to the fact that thyrotropin reacts slowly to the supply of hormones from the outside, the doctor, having prescribed replacement therapy, prescribes the next appointment for the patient after 2-3 months. By this time, the clinical picture will be clear enough to understand whether this dose is suitable for the person or whether there is a need to increase or decrease it. One of the criteria for assessing the effectiveness of treatment is the TSH level, which was initially elevated, and after therapy should decrease.

Repeat visit to an endocrinologist

Before a second appointment with an endocrinologist, you need to re-donate blood for thyroid hormones and thyroid-stimulating hormone (if it is elevated, the doctor will look into it, but more on that below), and depending on what thyroid disease brought you to the doctor, other indicators may be prescribed blood (thyroglobulin, antibodies to thyroid peroxidase, etc.).

If the TSH results are higher than normal, then you should not panic ahead of time. You just need to see your doctor, who will figure out what is causing the problem.

Why didn't TSH decrease?

The reasons why TSH is elevated and does not decrease while taking L-thyroxine can be divided into two groups:

1. Due to the patient's fault.
2. Due to the medication.

Separately, I highlight the process of dose selection, during which TSH may be higher than normal in several cases:

1. The dosage of levothyroxine prescribed is too small.
2. The body's need for thyroid hormones has increased due to the progression of the underlying thyroid disease.

Let's take the medicine correctly!

Often, as I already mentioned, TSH is elevated, despite the treatment, due to the fault of the patient himself. Levothyroxine, like any other medicinal substance, has its own characteristics of use. Ignoring the instructions for use leads to the fact that it does not have its full effect. Let's discuss the most common patient mistakes that reduce the effectiveness of treatment.

1. Preparations containing thyroxine taken in the morning and in one dose! You should not take them at lunchtime, and certainly not before bed. Replacement therapy should imitate the biological rhythms of hormone release in the human body, and normally the largest amount of it is released into the blood in the morning hours.
2. Levothyroxine should not be taken with or after food. Only 30 minutes before your planned meal! It cannot be well absorbed in the intestines if the gastrointestinal tract is at this time busy digesting the chop just eaten. Almost half of what you take will not be absorbed, which means that the actual amount of medication your body will receive will be half as much as what the endocrinologist expected.
3. The tablets must be taken daily. Any omission reduces the level of hormones in the blood, which as a result does not allow the doctor, even after 3 months, to adequately assess the quality of the selected dosage, since the already mentioned TSH quickly increases, but is slowly eliminated. As a result, TSH will be elevated in the tests, and it will take you and your doctor even longer to select the correct dose that is right for you.
4. Hormone replacement therapy for thyroid diseases is NOT carried out in courses. Those. It is not enough to take the medication for a week or a month, it must be taken constantly. After all, when the thyroid gland is functioning properly, it produces hormones every day; therefore, if it is not functioning, then you do its work yourself by taking your morning pill.

For reference:

• Only an endocrinologist can take or change the dose of levothyroxine. It is absolutely unacceptable to independently change the amount of the drug.
• Elevated TSH in women taking this medication may occur during pregnancy.

When is the drug to blame?

Let me clarify right away: the essence of the problem is not in the medicine itself, but in its manufacturer. Unfortunately, counterfeits are not uncommon in our pharmaceutical market. That's what we're talking about. Most counterfeit medications are just dummies, so they will not bring the desired effect. TSH has been elevated and remains elevated, even if you take the drug as described earlier. There is only one solution to this unpleasant situation: buying a new package of the drug. It is better if you purchase an analogue of the drug you are taking at another pharmacy. There are several identical versions of levothyroxine produced by different pharmaceutical companies: Eutirox, Bagotyrox, L-thyroxine, Levothyroxine sodium, Eferox.

How do you know that the dose has been chosen correctly?

Firstly, according to self-feelings. Secondly, your endocrinologist will see characteristic changes in laboratory tests. If at the beginning TSH was increased and T4 was decreased, then now both of these indicators should be within the normal range, with minor permissible fluctuations. However, even a correctly selected dose does not cancel scheduled visits to the endocrinologist, at least once every six months.

One tablet of L-Thyroxine can contain from 25 to 200 mcg levothyroxine sodium .

The composition of excipients may vary slightly depending on which pharmaceutical company produced the drug.

Release form

The product is available in tablet form and is supplied to pharmacies in packages No. 25, No. 50 or No. 100.

pharmachologic effect

L-Thyroxine is thyroid stimulant , which is used when hypofunction of the thyroid gland (TG) .

Pharmacodynamics and pharmacokinetics

Levothyroxine sodium , which is part of the tablets, performs the same functions as endogenous ones (produced by the human thyroid gland) And . In the body the substance is biotransformed to liothyronine , which, in turn, penetrating into cells and tissues, affects the mechanisms of development and growth, as well as the course of metabolic processes .

In particular, L-Thyroxine is characterized by the ability to influence the oxidative metabolism occurring in mitochondria and selectively regulate the flow of cations both in the intracellular space and outside the cell.

The effect of a substance depends on its dosage: the use of the drug in small doses provokes an anabolic effect, in higher doses it affects mainly cells and tissues, increasing the latter’s need for oxygen, stimulating oxidative reactions, accelerating the breakdown and metabolism of fats, proteins and carbohydrates , activating functions hearts , vascular system And CNS .

Clinical manifestation of action levothyroxine at observed already in the first 5 days after the start of treatment. Over the next 3-6 months, subject to continuous use of the drug, it decreases or completely disappears.

Levothyroxine taken orally is absorbed primarily in the small intestinal tract. Absorption is largely determined by the galenic form of the drug - max up to 80% when taken on an empty stomach.

The substance binds to plasma proteins almost 100%. This is due to the fact that levothyroxine does not respond to any hemoperfusion , nor hemodialysis . Its half-life is determined by the concentration of thyroid hormones in the patient’s blood: when euthyroid states its duration is 6-7 days, with thyrotoxicosis - 3-4 days, for hypothyroidism - 9-10 days).

About a third of the administered substance accumulates in liver . At the same time, it quickly begins to interact with levothyroxine, which is in.

Levothyroxine is broken down primarily in muscle tissue , liver And brain tissue . Active liothyronine , which is a product of the metabolism of the substance, is excreted in the urine and intestinal contents.

Indications for use

L-Thyroxine is used for maintenance HRT when hypothyroid conditions of various origins , including including primary and secondary hypothyroidism developed after surgery on the thyroid gland, as well as conditions provoked by therapy using radioactive iodine preparations .

It is also considered appropriate to prescribe the drug:

• at hypothyroidism (both congenital and in the case where the pathology is a consequence of lesions hypothalamic-pituitary system );
• for obesity and/or cretinism , which are accompanied by manifestations hypothyroidism ;
• at cerebral-pituitary diseases ;
• as a prophylactic for recurrent nodular goiter after resection of the thyroid gland (if its function is not changed);
• for treatment diffuse euthyroid goiter (L-Thyroxine is used as an independent remedy);
• for treatment euthyroid hyperplasia of the thyroid gland , and Graves' disease after compensation for intoxication has been achieved thyroid hormones with help thyreostatic drugs (as part of complex therapy);
• at Graves' disease And Hashimoto's disease (in complex treatment);
• for the treatment of patients with hormone-dependent well-differentiated malignant neoplasms in the thyroid gland (including papillary or follicular carcinoma );
• for suppressive therapy and HRT in patients with malignant neoplasms in the thyroid gland (including after surgery for thyroid cancer ); as a diagnostic tool when conducting tests thyroid suppression .

In addition, thyroxine is often used in bodybuilding as a means of losing weight.

Contraindications

L-Thyroxine is contraindicated for use in:

• hypersensitivity to the drug;
• acute;
• acute inflammatory lesions of the heart muscle ;
• untreated thyrotoxicosis ;
• untreated hypocorticism ;
• hereditary galactosemia , lactase deficiency , malabsorption syndrome .

The drug should be used with caution in patients with diseases of the heart and blood vessels (including including , myocardial infarction in the anamnesis, arterial hypertension ), long-term severe form hypothyroidism , .

The presence of any of the above diseases in the patient is a prerequisite for changing the dose.

Side effects of L-Thyroxine

Correct use of the drug under the supervision of a physician is not accompanied by side effects. In hypersensitive individuals, treatment with levothyroxine may be accompanied by allergic reactions .

Other side effects are usually caused by an overdose of L-Thyroxine. Extremely rarely, they can be triggered by taking the medicine in an incorrectly selected dose, as well as by increasing the dose too quickly (especially in the initial stages of treatment).

Side effects of L-Thyroxine are most often expressed as:

• feelings worries , headaches , insomnia , pseudotumor cerebri;
• arrhythmias (including atrial fibrillation), tachycardia , angina pectoris , heartbeat , extrasystoles ;
• vomiting and;
• skin rashes, skin itching , ;
• pathologies of the menstrual cycle ;
• , hyperthermia, feeling hot, weight loss, increased weakness, muscle cramps .

The appearance of the above symptoms is a reason to reduce the dose of L-Thyroxine or stop treatment with the drug for several days.

Cases of sudden death have been recorded due to cardiac disorders in patients using levothyroxine in high doses for a long time.

After the disappearance of side effects, therapy is continued, carefully selecting the optimal dose. Whenever allergic reactions (bronchospasm , laryngeal edema and - in some cases -) the use of the drug is stopped.

L-Thyroxine: instructions for use

The daily dose of the drug is determined individually depending on the indications. The tablets are taken on an empty stomach with a small amount of liquid (without chewing), at least half an hour before meals.

Patients under 55 years of age with healthy heart and blood vessels during replacement therapy are advised to take the drug at a dose of 1.6 to 1.8 mcg/kg. Persons who have been diagnosed with certain heart/vascular diseases , as well as for patients over 55 years of age, the dose is reduced to 0.9 mcg/kg.

For persons whose body mass index exceeds 30 kg/sq.m, the calculation is made based on “ ideal weight”.

At the initial stages of treatment hypothyroidism The dosage regimen for different patient groups is as follows:

• 75-100 mcg/day/100-150 mcg/day. - respectively, for women and men, provided that their heart and vascular system are functioning normally.
• 25 mcg/day. - persons over 55 years of age, as well as persons diagnosed with cardiovascular diseases. After two months, the dose is increased to 50 mcg. The dose should be adjusted by increasing it by 25 mcg every next 2 months until the indicators normalize thyrotropin in blood. If cardiac or vascular symptoms occur or worsen, a change in treatment regimen is required. heart/vascular diseases .

In accordance with the instructions for use of levothyroxine sodium, patients with congenital hypothyroidism the dose should be calculated depending on age.

For children from birth to six months, the daily dose varies from 25 to 50 mcg, which corresponds to 10-15 mcg/kg/day. when converted to body weight. Children from six months to one year are prescribed 50-75 mcg/day, children from one to five years old - from 75 to 100 mcg/day, children over 6 years old - from 100 to 150 mcg/day, adolescents over 12 years old - from 100 to 200 mcg/day.

The instructions for L-Thyroxine indicate that infants and children under 36 months of age should be given the daily dose in one dose, half an hour before the first feeding. Immediately before administration, the L-Thyroxine tablet is placed in water and dissolved until a thin suspension is formed.

At hypothyroidism El-Thyroxine is usually taken throughout life. At thyrotoxicosis after it is reached euthyroid state , levothyroxine sodium is prescribed to be taken in combination with antithyroid drugs . The duration of treatment is determined by the doctor in each specific case.

Regimen for taking L-Thyroxine for weight loss

In order to lose extra pounds, the drug should be taken at a dose of 50 mcg/day, dividing the indicated dose into 2 doses (both doses should be taken in the first half of the day).

Therapy is supplemented with the use β-blockers, the dose of which is adjusted depending on the pulse rate.

Subsequently, the dose of levothyroxine is gradually increased to 150-300 mcg/day, dividing it into 3 doses until 18:00. At the same time, the daily dose is increased β-blocker . It is recommended to select it individually, so that the resting heart rate does not exceed 70 beats per minute, but at the same time is greater than 60 beats per minute.

The appearance of pronounced side effects is a prerequisite for reducing the dose of the drug.

The duration of the course is from 4 to 7 weeks. The medication should be stopped gradually, reducing the dose every 14 days until complete discontinuation.

If during use there is diarrhea , the course is supplemented with a prescription, which is taken 1 or 2 capsules per day.

Between courses of taking levothyroxine, intervals of at least 3-4 weeks should be maintained.

Overdose

Symptoms of overdose are:

• increased heart rate and pulse;
• increased anxiety;
• feeling of heat;
• hyperthermia ;
• hyperhidrosis (excessive sweating);
• insomnia;
• arrhythmia ;
• increased frequency of attacks angina pectoris ;
• weight loss;
• anxiety;
• tremor ;
• diarrhea ;
• vomit;
• muscle weakness and convulsions ;
• pseudotumor cerebri;
• menstrual cycle irregularities .

Treatment involves stopping taking L-Thyroxine and conducting follow-up examinations.

With the development of severe tachycardia to reduce its severity, the patient is prescribed β - adrenergic blockers . Due to the fact that the thyroid function is completely suppressed, use thyreostatic drugs not advisable.

When taking levothyroxine in extreme doses (during a suicide attempt), it is effective to plasmapheresis .

Interaction

The use of levothyroxine reduces the effectiveness antidiabetic drugs . At the beginning of treatment with the drug, as well as each time the dose is changed, monitoring should be carried out more frequently. blood glucose level .

Levothyroxine potentiates effects anticoagulants (in particular, the coumarin series), thereby increasing risk of cerebral hemorrhage (dorsal or head), as well as gastrointestinal intestinal bleeding (especially in older people).

Therefore, if it is necessary to take these drugs in combination, it is recommended to carry out regular blood clotting tests and, if appropriate, reduce the dose anticoagulants.

The effect of levothyroxine may be impaired when taken concomitantly with protease inhibitors. In this regard, it is necessary to constantly monitor the concentration of thyroid hormones. In some situations, it may be necessary to review the dose of L-Thyroxine.

Cholestyramine And colestipol slow down the absorption of levothyroxine, so L-Thyroxine must be taken at least 4-5 hours before taking these medications.

Drugs containing aluminum or iron may reduce the severity of the effects of levothyroxine, so take L-Thyroxine at least 2 hours before taking them.

The absorption of levothyroxine is reduced when taken in combination with lanthanum carbonate or sevelamer , therefore, it should be taken one hour before or three hours after using these remedies.

When taking drugs in combination, monitoring the level of thyroid hormones is necessary at the initial and final stages of their simultaneous use. The dose of levothyroxine may need to be adjusted.

The effectiveness of the drug decreases when taken simultaneously with tyrosine kinase inhibitors, therefore, changes in thyroid function should be kept under control during the initial and final stages of the simultaneous use of these drugs.

Proguanil/chloroquine And reduce the effectiveness of the drug and provoke an increase plasma concentration of thyrotropin .

Drug-induced enzymes (eg. carbamazepine or barbiturates ) may increase the concentration of levothyroxine.

Women taking hormonal contraceptives , which contains estrogenic component , as well as for women taking postmenopausal age hormone replacement drugs , the dose of levothyroxine may need to be increased.

Thyroxine and L-Thyroxine

Which is better: Eutirox or L-Thyroxine?

The drugs are generics, that is, they have the same indications for use, the same range of contraindications and are dosed similarly.

Difference Euthyroxa and L-Thyroxine is that it contains Euthyroxa Levothyroxine sodium is present in slightly different concentrations than in L-Thyroxine.

Combination with alcohol

A single intake of a small dose of alcohol that is not too strong, as a rule, does not provoke any negative consequences for the body, therefore the instructions for the drug do not categorically prohibit such a combination.

However, it is permissible only for patients with healthy heart and blood vessels.

Drinking alcohol during treatment with L-Thyroxine often provokes a number of undesirable reactions from the central nervous system and liver, which in turn can affect the effectiveness of treatment.

L-Thyroxine for weight loss

According to its effectiveness thyroxine significantly superior to most fat burning products (including pharmacological ones). According to the instructions, it speeds up , increases calorie expenditure, enhances heat production, stimulates the central nervous system, suppresses appetite, reduces the need for sleep and increases physical performance.

In this regard, there are many positive reviews about the use of levothyroxine sodium for weight loss. However, those who want to lose excess weight should remember that the drug increases heart muscle contraction frequency , causes a feeling of anxiety and excitement, thereby having a negative effect on the heart.

To prevent the development of side effects, experienced bodybuilders advise using el-thyroxine for weight loss in combination with antagonists (blockers) β-adrenergic receptors . This allows you to normalize your heart rate and reduce the severity of some other side effects that accompany taking thyroxine.

The advantages of L-Thyroxine for weight loss are the high efficiency and availability of this drug, the disadvantage is a large number of side effects. Despite the fact that many of them can be eliminated or even prevented, it is recommended to consult a specialist before using the drug in order to lose extra pounds.

Use during pregnancy

Treatment with thyroid hormones should be carried out consistently, especially during pregnancy and lactation. Despite the fact that L-Thyroxine is used quite widely during pregnancy, there is no exact data on its safety for the developing fetus.

The amount of thyroid hormones penetrating into breast milk (even if therapy is carried out using high doses of the drug) is insufficient to provoke in an infant inhibition of thyrotropin secretion or development thyrotoxicosis .

Name: Elena, Kharkov.

Question: I am 57 years old. TSH - 6.3. Antibodies to TPO - 205.4. I took L-thyroxine at 50, but what to do now with such indicators?

Answer:

Your TSH readings have a very slight deviation from the norm.

Thyroid-stimulating hormone is produced by the pituitary gland, its task is, in turn, to promote the synthesis of thyroxine (T3) and triiodothyronine (T4).

Doctor's explanations about T3, T4, TSH, AT TPO

This process is important for normal metabolism, the production of proteins and energy resources. Therefore, for a complete picture, it would be necessary to know the parameters of these two hormones at the moment.

If the levels of T3 and T4 are normal, most likely, we will be talking about subclinical hypothyroidism, and with it the symptoms are weak or absent.

As for the analysis of AT to TPO, it depends on how the testing was carried out.

If this was an ELISA technique, the normal value in women over 50 years of age should not exceed 50 IU/ml.

With immunoluminescent analysis, the value can reach up to 100 IU/ml.

You have exceeded the limit. This effect appears when the antibodies of the immune system, as a result of various factors, begin to perceive thyroid enzymes as foreign and dangerous and try to fight them.

In women during menopause and menopause, this phenomenon is not uncommon, and the reason for this is hormonal changes.

is a drug whose main active ingredient (levothyroxine) performs the same functions as T3 and T4.

The activity of this element depends on the prescribed dose - in small quantities it provides an anabolic effect.

At higher levels, it stimulates metabolism, stimulates oxidative reactions, and accelerates the breakdown of fats, proteins and carbohydrates.

The question is how long have you been taking the drug, and what were your readings before taking it?

Typically, your doctor will adjust your dosage every two months until your levels return to normal.

L-thyroxine is a pharmacological drug, an analogue of thyroid hormones. It is prescribed to patients with reduced function of this organ to compensate and stabilize hormonal levels. An overdose of L-thyroxine can occur in patients if they do not comply with the treatment regimen prescribed by the doctor.. To avoid symptoms of overdose, it is necessary to accurately calculate the amount of the substance taken, taking into account the weight, age and degree of pathology of the patient. Increasing the dosage for therapeutic purposes in persons taking the drug for the first time leads to the development of signs of intoxication.

The drug contains the substance levothyroxine. In its action it is similar to human thyroid hormones, which are produced by the thyroid gland. They regulate cell growth and development, differentiate tissues, and participate in metabolic processes.

The drug is prescribed for hypothyroidism, patients after surgical removal of the thyroid gland, after treatment with radioactive iodine.

L-thyroxine, depending on the dose, has different effects on the human body. Lack of thyroxine enhances the anabolic effect (increases protein synthesis, promotes muscle tissue growth). Its presence activates the cardiovascular system and stimulates nervous activity. The substance is capable of accelerating the breakdown of proteins, fats and carbohydrates, thereby causing an increased need for oxygen in cells.

Overdose symptoms

Taking L-thyroxine in doses exceeding the norm leads to disruption of physiological processes in the body, failure of organs and systems. With an excess amount of thyroid-stimulating hormone (TSH) the synthesis of biologically active substances sharply increases in the body, metabolic processes are accelerated.

Thyroxine primarily affects the cardiovascular system. The following symptoms are observed:

• Increased heart rate;
• Tachycardia (rapid heartbeat);
• Atrial fibrillation (irregular heart rhythm);
• Thromboembolism (blockage of blood vessels with blood clots);
• Angina attack.

• Myocardial infarction, including microinfarctions;
• Angina;
• Atherosclerosis;
• Coronary heart disease (CHD);
• Coronary circulatory insufficiency;
• Severe form of hypertension;
• Organic lesions of the heart structures (pericarditis, myocarditis).

Symptoms of mild overdose

Depending on the age and general condition of the person, the first signs of intoxication may appear in the coming hours after taking the medicine or in a few days.

Manifestations:

1. Digestive system ─ disorders of digestion and absorption of food, diarrhea, aching pain in the intestines, heaviness in the epigastric region, loss of appetite;
2. Cardiovascular system ─ frequent heartbeat and pulse;
3. Nervous system ─ sleep disturbance, increased sweating, feeling tired;
4. Psyche ─ motor restlessness, speech agitation, feelings of anxiety and fear, tremor of the limbs (trembling);
5. Slight increase in body temperature;
6. Allergic reactions.

These signs are also characteristic of chronic poisoning.

Symptoms of chronic overdose

Chronic poisoning develops in people who are forced to take the hormone for a long time. Symptoms are similar in appearance to thyrotoxicosis.

Clinical manifestations:

• Weight loss with normal appetite and calorie intake;
• Metabolic disorders;
• Vomiting and abdominal pain;
• Frequent urination;
• High systolic and low diastolic pressure;
• Nervous excitability, sudden mood changes;
• Memory impairment, voice timbre;
• Difficulty swallowing;

Symptoms of acute overdose

Acute poisoning of the body occurs when thyroxine is taken in large quantities, when the substance acts as a poison for the body.

Symptoms appear on the first day. A person feels severe pain in the heart area, hot flashes. Against the background of nervous excitement, severe muscle weakness is felt. The use of high doses of thyroxine leads to respiratory, renal failure, and myocardial infarction.

The most serious side effect of an overdose of thyroxine is a thyrotoxic crisis, which is characterized by a rapid increase in all signs of thyrotoxicosis. Mental disorders are observed in the form of impaired consciousness ─ delirium, insanity. A person may be in a semi-fainting state, which leads to the development of coma.

Symptoms of the onset of thyrotoxic crisis:

• Temperature rises to 40-41°;
• Vomiting and diarrhea;
• Apathy and prostration;
• Increased blood pressure;
• The amount of urine excreted decreases, leading to anuria.

The condition is aggravated by the acute process of liver atrophy. Excitement is replaced by stupor, then loss of consciousness followed by a transition to coma.

The lethal dose of El-thyroxine has not been established. The body’s reaction to a particular amount of a substance depends on the person’s body weight and the physical strength of the body.

Overdose of L-thyroxine in pregnant women and children

Pregnancy is not an obstacle to taking the hormone thyroxine. The drug does not affect the embryo in the first trimester of pregnancy and does not cause gene mutations. Even when the mother takes large doses, the child is not subject to any influence, since this is prevented by the placental barrier. The hormone in breast milk is contained in small doses, and it is not enough to lead to any physiological disorders in the child.

In children, taking the medicine may cause tremors in the limbs. Prescribing should be cautious if the child suffers from epilepsy or is prone to seizures. In this case, thyroxine will intensify the symptoms and worsen the general condition.

Diagnostics

To recognize an overdose and determine the severity of poisoning, carry out tests to assess the production of thyroid-stimulating hormone. With a high level of the hormone thyroxine in the blood, there is a discrepancy between the serum concentration of hormones and clinical manifestations.

A venous blood sample of 5 ml is taken from the victim to test for thyroid hormones (TSH, T3, T4). In this case, the results will always show increased thyroxine (T4) and triiodothyronine (T3), as well as decreased thyroid-stimulating hormone.

Medical assistance in case of drug overdose

What should I do if my condition begins to noticeably worsen after taking the medicine? If a person feels unwell, weak or any other symptoms that have not previously appeared, you should consult a doctor. If you feel satisfactory, you should come to the clinic for an appointment or call a doctor at home. If the condition worsens sharply, you should immediately call an ambulance.

In what cases is there a need for urgent medical intervention:

• A child, an elderly person, a pregnant woman were injured;
• Severe pain in the heart, irregular heart rhythm;
• High blood pressure;
• Profuse diarrhea mixed with blood;
• Neurological pathology ─ paresis, paralysis, convulsions;
• A depressed state in which a person does not respond to external stimuli;
• Unconscious state.

There is no specific antidote to L-thyroxine. Therefore, help lies in eliminating the symptoms of poisoning. Depending on the severity of intoxication, a person can be treated at home or in a hospital, in the endocrine department.

Symptomatic drug therapy:

1. To restore heart rhythm, adrenergic blockers are prescribed (increase sympathetic tone);
2. For nervous disorders ─ sedatives;
3. For high blood pressure - antihypertensive drugs;
4. To reduce temperature ─ antipyretics.

Neuroleptics should absolutely not be used as sedatives. They will intensify the symptoms of thyrotoxicosis and increase the risk of developing arrhythmia. To suppress the effect of large doses of thyroxine, glucocorticosteroids are prescribed.

In severe cases, hemosorption is performed - purification of the blood from poison and toxic substances. This procedure is used in patients in the stage of unconsciousness or coma. The blood passes through a special apparatus, where it reacts with the sorbent and is thus purified.

Another blood purification procedure is plasmaphoresis. The victim is connected to a special apparatus, and a certain volume of blood is pumped through it. In this case, plasma containing a large amount of thyroxine is separated, and the remaining components are returned to the bloodstream.

Emergency care for acute overdose of thyroxine at home

It is advisable to carry out urgent assistance only if symptoms arose immediately after taking the drug, as well as in the case of rapid detection of suicide, when a person took a large dose once.

Resuscitation measures should be carried out if no more than 30-40 minutes have passed since the use of the substance:

1. Perform gastric lavage. Allow the victim to drink 3-4 glasses of water in a short time interval. Then induce artificial vomiting. To do this, press on the root of the tongue with two fingers;
2. Take any of the sorbents that are in your home medicine cabinet ─ activated carbon, Polysorb, Enterosgel, Polyphepan;
3. Take a saline laxative ─ sodium chlorine, magnesium sulfate, saline solution (a tablespoon of salt in half a glass of water). Such solutions retain water in the intestines and increase its volume. As a result, its contents soften, after which they are quickly and easily removed from the body.

Consequences and complications of thyroxine overdose

Common complications include:

• Angina;
• Bronchial spasm;
• Decreased production of pituitary hormones, which regulate the functioning of the thyroid gland;
• Hyperthyroidism;
• Osteoporosis.

Less commonly encountered are serious allergic manifestations: angioedema, bronchial asthma, lupus erythematosus.

To avoid a possible overdose, you should follow the treatment regimen. If the first signs of intoxication appear, the doctor is obliged to examine the patient and reduce the single dose of the drug.

Thyroid-stimulating hormone (TSH), synthesized by the pituitary gland, is a catalyst for the production of free hormones by the thyroid gland - triiodothyronine (T3) and thyroxine (T4).

These substances are energy sources for the metabolism of fats, proteins and glucosides in the human body, and are also responsible for the full functioning of the genitourinary and cardiovascular systems, and the digestive tract. In addition, they have an impact on the individual’s psyche. In this case, stimulation of the production of T3 and T4 occurs according to the feedback principle - with an increase in hormonal synthesis by the thyroid gland, the reproduction of thyroid-stimulating hormone is suppressed. Therefore, in modern medicine, determining the TSH norm is carried out in conjunction with thyroid hormone tests.

If the production of these three substances is unbalanced, the following painful conditions are possible:

• Hypothyroidism refers to a decreased level of free hormones T3 and T4;
• an increased level of thyroid hormone synthesis is called hyperthyroidism;
• thyrotoxicosis is the excessive synthesis of thyroid hormones, which causes “intoxication” of the human body.

Preparation and performance of TSH analysis

Monitoring the level of thyroid-stimulating hormone synthesis is mandatory for all patients suffering from thyroid diseases, as well as during the initial diagnosis of various endocrine diseases. As a result of the analysis, the TSH norm, or its deficiency and excess concentration is established. American doctors believe that women who have reached the age of fifty should definitely take a TSH test, regardless of the presence of endocrine diseases.

Before conducting a biological study, it is necessary to stop smoking, take iodine-containing drugs, and limit excessive physical overload for one to two days. The patient should refrain from taking hormonal drugs. A blood test is taken in the morning, on an empty stomach. When determining the dynamics of hormone levels, tests spread over the days of the week are taken at the same time of day.

Normal thyroid-stimulating hormone levels

According to various medical standards, male and female TSH norms differ. Its normal concentration will be determined by an endocrinologist and depends on the patient’s age, individual characteristics of the body and the presence of various somatic diseases and psycho-emotional defects. In a healthy individual, the maximum level of synthesis occurs in the early morning.

When conducting a blood test, the level of the hormone is very important in women over 40 years of age, as well as in those representatives of the fair sex who are preparing to become mothers. At the same time, TSH analysis is often performed in pregnant women in the absence of complaints about their health. Deviation of the hormone level from the norm can harm the embryo and cause congenital diseases in the child.

Elevated TSH levels

TSH analysis allows you to determine the dysfunction of the thyroid gland when the concentration of free hormones T3 and T4 in the blood serum is abnormal. Typically, thyroid-stimulating hormone is elevated if the following functional disorders are present in the human body:

• dysfunction of the adrenal glands,
• severe psychological trauma,
• malignant and benign neoplasms of the pituitary gland,
• severe gestosis,
• syndrome of atypical TSH secretion.

In addition, thyroid-stimulating hormone may be elevated due to heavy physical activity and drug therapy using:

• neuroleptics,
• iodine-containing drugs,
• beta blockers.

TSH in the blood may be elevated due to hemodialysis, lead intoxication, and may also occur after surgical treatment of the gallbladder. If a blood test shows an excess above normal, then treatment must be started as quickly as possible, otherwise the patient may develop hypothyroidism.

TSH is often elevated during pregnancy, which is not always considered a pathology or abnormality.

Low TSH level

A decrease in TSH concentration below normal can be caused by:

• dysfunction of the pituitary gland,
• self-medication with hormonal drugs,
• stress,
• benign tumors in the thyroid gland,
• postpartum degradation of pituitary cells in women (Sheehan syndrome),
• Plummer's disease.

Most often, hormonal deficiency is caused by goiter of toxic etiology or excessive intake of hormonal medications that affect the function of the thyroid gland. Often, TSH deficiency is caused by dietary starvation and changes in the patient’s psycho-emotional state due to stress. In addition, a decrease in TSH below normal may be a consequence of cancer or acute inflammation of the thyroid gland, injury to the pituitary gland, which reduces normal hormone production.

TSH level during pregnancy

During pregnancy, the level of thyroid-stimulating hormone can be in the range of 0.2-3.5 mU/l. Such a high range of indicators is explained by different methods of analysis and different chemicals used in its implementation. Control of hormonal levels is especially important until the 10th week, when the thyroid gland of the embryo is not yet formed and all the hormones necessary for the development of the fetus come from the mother’s internal secretion organs.

A pregnant woman's TSH level may change throughout the pregnancy. However, it depends on the physical condition of the woman and, compared to the norm, can be increased or slightly decreased. However, it should be noted that a significant deviation in concentration from the norm can harm not only the fetus, but also complicate the course of immensity in the woman herself. The lowest level of thyroid-stimulating hormone is at 10-12 weeks. However, there are often cases when its level is reduced not only in the second, but also in the third trimester.

Typically, a decrease in TSH levels is observed in 25.0% -30.0% of pregnant women carrying one child and in 100.0% of cases of multiple pregnancies. In about 10.0% of women in labor, the production of thyroid-stimulating hormone is suppressed, but the concentration of free T4 is increased. The norm is determined by the observing physician, who may decide to prescribe additional studies using echography or fine-needle biopsy of the thyroid gland.

In case of elevated TSH levels in the early stages of fetal development, drug therapy with L-thyroxine (L-Thyroxin) may be prescribed.

Equally important is monitoring TSH levels when planning pregnancy. If the hormonal balance is disturbed, this can lead to dysfunction of the thyroid gland, which has an extremely negative effect on the development of the fetus. With increased production of thyroid-stimulating hormone, the synthesis of free hormone T4 is suppressed, which affects the intellectual development of the child. If the expectant mother is diagnosed with hypothyroidism, then drug treatment with L-thyroxine is carried out. Moreover, adjustments to the dosage of the drug are carried out throughout the entire pregnancy, after passing the appropriate tests.

Symptoms of hormonal imbalance

Both high and low levels of thyroid-stimulating hormone are accompanied by a deterioration in the patient’s physical condition and, in some cases, can cause serious harm to human health.

A high TSH level is accompanied by the following symptoms:

• decreased physical activity, along with general weakness and fatigue,
• apathy, increased irritability,
• mental retardation along with slow thinking,
• sleep disturbance, expressed by nighttime insomnia and daytime sleepiness,
• paleness of the skin and its swelling,
• obesity, which is quite difficult to correct,
• disruption of the gastrointestinal tract (nausea, constipation),
• pregnant women experience a thickening of the neck,
• decrease in body temperature,
• loss of appetite.

When TSH is below normal, the following symptoms may occur:

• presence of headaches,
• increased blood pressure,
• tremors in the hands and eyelids,
• emotional instability,
• frequent stomach upsets,
• increased appetite and lack of feeling of satiety,
• constantly elevated body temperature,
• increased heart rate.

Treatment

Prevention and treatment of both increased and decreased levels of thyroid-stimulating hormone should be carried out only as prescribed by an endocrinologist, after all necessary medical examinations. Self-administration of hormonal medications is unacceptable. Many patients with this disease use traditional medicine in the form of herbal remedies or medicinal plants. However, this method of treatment should be used only after consultation with a doctor.

In cases where the TSH level is higher than normal and exceeds 7.1 mU/l, this indicates the presence of hyperthyroidism. Drug therapy involves the use of a synthetic substitute for free thyroxine (T4). If previously specially treated thyroid glands of domestic animals were used for treatment, today synthetic medications are more effective and have a higher degree of purification.

Drug therapy begins with the introduction of minimal doses of synthetic hormonal drugs, which are gradually increased until the levels of TSH and free T4 are normalized. In this case, only an endocrinologist prescribes a specific course of treatment for each patient, which can use various synthetic T4 substitutes. This is due to the fact that the synthesis of TSH and free thyroxine is individual for each patient, and the drug is prescribed only after passing all the necessary tests.

In addition, thyroid-stimulating hormone can cause the appearance and development of malignant neoplasms of the thyroid gland. To eliminate the slightest possibility of such phenomena, the course of treatment begins with minimal doses, which are adjusted until the levels of TSH and free hormones T3 and T4 return to normal.

After completing a course of treatment, patients susceptible to hormonal imbalances are examined once a year to confirm the absence of hormonal imbalances.

If the TSH level is low (less than 0.01 mU/l), its normal level is restored using hormonal drugs, and the treatment itself is carried out under the supervision of an endocrinologist.

If the levels of free hormones T3 and T4 are normal, and the concentration of thyroid-stimulating hormone exceeds the permissible value, then endocrinologists diagnose subclinical hypothyroidism. The term “subclinical” itself suggests that a hormonal imbalance occurs, but external symptoms are either expressed implicitly or are completely absent. In this case, the final diagnosis is made based on a blood test. The main causes of this disease may be:

• lack of iodine in the body,
• consequences of treating the thyroid gland with radioactive iodine preparations,
• surgical removal of the thyroid gland or part thereof,
• drug therapy using thyreostatics.

In this case, the symptoms are often atypical and expressed by the following signs, which are also characteristic of other somatic diseases:

• decreased sexual activity,
• dry skin and hair loss.
• lethargy and slowness,
• disruption of the digestive tract,
• obesity.

In modern medicine, there is an opinion that with normal levels of free hormones T3 and T4, adjustment of an elevated TSH level is not necessary. However, if the hormonal levels are not adjusted on a full scale, this is fraught with the most undesirable consequences. After establishing an elevated level of thyroid-stimulating hormone, treatment with Levothyroxine is prescribed. Unfortunately, this drug has a large number of contraindications and has a significant number of side effects, which means that it is undesirable to take it during pregnancy.

Subclinical hypothyroidism in children is determined immediately after the baby is born by taking a blood test from the heel. The main symptoms of this disease in newborns are:

• hoarse crying of a child;
• refusal of breastfeeding;
• presence of congenital jaundice.

Treatment of childhood subclinical hypothyroidism is carried out with synthetic thyroid hormone preparations. Moreover, if hormonal treatment is not carried out in time, disruption of the normal functioning of the body can last a lifetime.

Conclusion

As can be seen from the above review, periodic monitoring of hormonal levels allows you to begin treatment in the early stages of the disease, and this in turn guarantees the preservation of a person’s health and the absence of side diseases that may arise due to an existing imbalance in the body’s synthesis of TSH and independent T3 hormones and T4. In this case, one should take into account the feedback that exists between all three substances.