After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
A. Euthyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Primary hypothyroidism
Correct Answer: D. Primary hypothyroidism
Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. Oral levothyroxine is primarily indicated for the treatment of primary, secondary, and tertiary hypothyroidism. Primary hypothyroidism is when the problem occurs in the thyroid gland, with the most common cause being an autoimmune condition (Hashimoto thyroiditis) followed up by iatrogenic hypothyroidism (after thyroidectomy).
Option A: Euthyroidism, a term used to describe normal thyroid function, wouldn’t require any thyroid preparation. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range.
Option B: It is contraindicated in Graves’ disease because these conditions are forms of hyperthyroidism. Patients should receive education about the symptoms of hyperthyroidism, and to contact their clinician for medication dose decrease if those symptoms were to appear. Important to mention that patients with secondary or tertiary hypothyroidism, the TSH is not reliable (will remain low), and the best indicator to adjust dosing will be the free or total T4.
Option C: Levothyroxine is contraindicated in individuals with uncorrected adrenal insufficiency, individuals with acute myocardial infarction, acute myocarditis, pancarditis, active heart arrhythmias, and persons with thyrotoxicosis or hyperthyroidism.
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