Thyroid, Desiccated (Lexi-Drugs)

ALERT: US Boxed Warning
  Weight reduction:
Drug Shortages

One or more forms of this drug may be in short supply or unavailable. Refer to the following for additional information:

ASHP: http://www.ashp.org/menu/DrugShortages

Pronunciation

(THYE roid DES i kay tid)

Brand Names: US

Armour Thyroid; Nature-Throid; NP Thyroid; Westhroid; WP Thyroid

Pharmacologic Category

Thyroid Product

Dosing: Adult

Note: The American Thyroid Association/American Association of Clinical Endocrinologists do not recommend the use of desiccated thyroid as replacement therapy for hypothyroidism (ATA [Jonklaas 2014]; ATA/AACE [Garber 2012]). Tablet strengths may vary by manufacturer in terms of grains or mg; dosing recommendations are based on general clinical equivalencies that 1 grain = 60 mg or 65 mg; 1/2 grain = 30 mg or 32.5 mg; and 1/4 grain = 15 mg or 16.25 mg.

Hypothyroidism: Oral: Initial: 30 or 32.5 mg/day; may increase dose in 15 or 16.25 mg increments every 2 to 3 weeks until adequate replacement dose determined; initiate with 15 or 16.25 mg/day in patients with cardiovascular disease or long-standing myxedema. Usual dosage range: 60 to 130 mg/day. Inadequate response to doses up to 195 mg/day suggests noncompliance or malabsorption.

Dosing: Geriatric

Not recommended for use in the elderly.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

Note: Doses presented as mg/kg/dose or mg/dose; closely review dosing units; adjust dose based upon clinical response and laboratory parameters. Tablet strengths may vary by manufacturer in terms of grains or mg; dosing recommendations are based on general clinical equivalencies that 1 grain = 60 mg or 65 mg; 1/2 grain = 30 mg or 32.5 mg; and 1/4 grain = 15 mg or 16.25 mg.

Congenital hypothyroidism: Note: Guidelines do not recommend routine use of desiccated thyroid over levothyroxine monotherapy in the management of hypothyroidism (AAP 2006; ATA [Jonklaas 2014]). Infants should have therapy initiated at full doses; Oral:

Infants 1 to 6 months: 4.8 to 6 mg/kg/dose or 15 to 32.5 mg/dose once daily

Infants >6 to 12 months: 3.6 to 4.8 mg/kg/dose or 30 to 48.75 mg/dose once daily

Children 1 to 5 years: 3 to 3.6 mg/kg/dose or 45 to 65 mg/dose once daily

Children 6 to 12 years: 2.4 to 3 mg/kg/dose or 60 to 97.5 mg/dose once daily

Adolescents: Typical doses 1.2 to 1.8 mg/kg/dose or >90 mg/dose once daily

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Use: Labeled Indications

Hypothyroidism: Replacement or supplemental therapy in hypothyroidism

Use: Unsupported: Adult
TSH suppression

Although included as an indication in the manufacturer’s prescribing information for TSH suppression in the treatment or prevention of various types of euthyroid goiters (eg, thyroid nodules, subacute or chronic lymphocytic thyroiditis [Hashimoto], multinodular goiter) and in the management of thyroid cancer, clinical practice guidelines do not recommend use of desiccated thyroid products; in cases where treatment is necessary, levothyroxine is recommended (AACE/ACE/AME [Gharib 2016]; ATA [Haugen 2016]).

Clinical Practice Guidelines

Hypothyroidism:

ATA/AACE, “Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.” 2012

ATA, American Thyroid Association Task Force on Thyroid Hormone Replacement, “Guidelines for the Treatment of Hypothyroidism.” 2014

Administration: Oral

Administer on an empty stomach (eg, 30 to 60 minutes prior to breakfast) to increase absorption.

Administration: Pediatric

Oral: Administer on an empty stomach (eg, 30 to 60 minutes before breakfast) to increase absorption.

Storage/Stability

Store at 15°C to 30°C (59°F to 86°F).

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience hair loss. Have patient report immediately to prescriber angina, tachycardia, abnormal heartbeat, headache, shortness of breath, swelling of arms or legs, lump in neck, anxiety, tremors, insomnia, sensitivity to heat, sweating a lot, lack of appetite, increased hunger, excessive weight gain, weight loss, diarrhea, vomiting, irritability, abdominal cramps, leg cramps, muscle weakness, or menstrual changes (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Medication Safety Issues
  Geriatric Patients: High-Risk Medication:
Contraindications

Hypersensitivity to any component of the formulation; untreated thyrotoxicosis; uncorrected adrenal insufficiency

Warnings/Precautions

Disease-related concerns:

• Adrenal insufficiency: Use with caution in patients with adrenal insufficiency; symptoms may be exaggerated or aggravated; contraindicated in patients with uncorrected adrenal insufficiency. Treatment with glucocorticoids should precede thyroid replacement therapy in patients with adrenal insufficiency (ATA/AACE [Garber 2012]).

• Cardiovascular disease: Use with caution and reduce dosage in patients with angina pectoris or other cardiovascular disease; chronic hypothyroidism predisposes patients to coronary artery disease.

• Diabetes: Use with caution in patients with diabetes mellitus and insipidus; symptoms may be exaggerated or aggravated.

• Myxedema: Use with caution in patients with myxedema; symptoms may be exaggerated or aggravated; initial dosage reduction is recommended in patients with long-standing myxedema.

Dosage form specific issues:

• Desiccated thyroid: Contains variable amounts of T3, T4, and other triiodothyronine compounds which are more likely to cause cardiac signs or symptoms due to fluctuating levels.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Other warnings/precautions:

• Infertility (unapproved use): Thyroid supplements are not recommended for the treatment of female or male infertility, unless associated with hypothyroidism.

• Porcine derived: Some desiccated thyroid products are acquired from porcine thyroid glands of pigs processed for human food; production also occurs at a facility that handles bovine tissues from cows processed for human food. Contamination with porcine or bovine viruses, or other novel or unidentified viruses, is potentially a risk; however, there have been no reported cases of transmission of an infectious illness.

• Weight reduction (unapproved use): [US Boxed Warning]: In euthyroid patients, thyroid supplements within the range of daily hormonal requirements are ineffective for weight reduction. High doses may produce serious or even life-threatening toxic effects particularly when used with some anorectic drugs (eg, sympathomimetic amines).

Geriatric Considerations

Desiccated thyroid contains variable amounts of T3, T4, and other triiodothyronine compounds which are more likely to cause cardiac signs or symptoms due to fluctuating levels. Should avoid use in the elderly for this reason. Many clinicians consider levothyroxine to be the drug of choice.

Warnings: Additional Pediatric Considerations

Overtreatment may result in craniosynostosis in infants and premature closure of epiphyses in children; monitor use closely. May cause transient alopecia in children during the first few months of therapy. In neonates and infants, cardiac overload, arrhythmias, and aspiration from avid suckling may occur during initiation of therapy (eg, first 2 weeks); monitor closely.

Pregnancy Risk Factor

A

Pregnancy Considerations

Endogenous thyroid hormones minimally cross the placenta. Desiccated thyroid has not been found to adversely affect the fetus following maternal use during pregnancy.

Uncontrolled maternal hypothyroidism may result in adverse neonatal and maternal outcomes (ACOG 2015). Subnormal intellectual development may occur in infants of mothers with serum thyroxine concentrations in the lowest tenth percentile at the end of the first trimester (ATA/AACE [Garber 2012]). To prevent adverse events, normal maternal thyroid function should be maintained prior to conception and throughout pregnancy and thyroid replacement should not be discontinued during pregnancy (ACOG 2015). However, desiccated thyroid is not the preferred treatment for hypothyroidism in pregnant women because use may result in lowering serum thyroxine concentrations. Women treated with desiccated thyroid who are planning to conceive or who become pregnant should be transitioned to a preferred therapy and TSH should be monitored (ACOG 2015; ATA/AACE [Garber 2012]).

Breast-Feeding Considerations

Endogenous thyroid hormones are minimally present in breast milk and are not associated with adverse events. The manufacturer recommends caution be used if desiccated thyroid is administered to a breastfeeding woman.

Lexicomp Pregnancy & Lactation, In-Depth
Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

Adverse reactions are often indicative of excess thyroid replacement and/or hyperthyroidism.

<1%, postmarketing, and/or case reports: Abdominal cramps, alopecia, ataxia, cardiac arrhythmia, chest pain, constipation, diaphoresis, diarrhea, dyspnea, fever, headache, heat intolerance, increased appetite, insomnia, menstrual disease, myalgia, nervousness, palpitations, tachycardia, tremor, tremor of hands, vomiting, weight loss

Metabolism/Transport Effects

None known.

Drug Interactions 

Amezinium: Thyroid Products may enhance the stimulatory effect of Amezinium. Risk C: Monitor therapy

Amiodarone: May diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy

Apalutamide: May diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the serum concentration of Thyroid Products. Management: Administer oral thyroid products at least 4 h prior to colesevelam, and at least 1 h before or 4-6 h after cholestyramine. Specific recommendations for colestipol are not available. Monitor for decreased concentrations/effects of the thyroid product. Risk D: Consider therapy modification

Calcium Polystyrene Sulfonate: May decrease the serum concentration of Thyroid Products. Management: To minimize risk of interaction, separate dosing of oral calcium polystyrene sulfonate and thyroid products (eg, levothyroxine) or administer calcium polystyrene sulfonate rectally. Monitor for signs/symptoms of hypothyroidism with concomitant use (oral).Risk D: Consider therapy modification

Calcium Salts: May diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours.Risk D: Consider therapy modification

CarBAMazepine: May decrease the serum concentration of Thyroid Products. Risk C: Monitor therapy

Ciprofloxacin (Systemic): May decrease the serum concentration of Thyroid Products. Risk C: Monitor therapy

Estrogen Derivatives: May diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy

Fosphenytoin: May decrease the serum concentration of Thyroid Products. Phenytoin may also displace thyroid hormones from protein binding sites. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Thyroid Products. Management: Administer oral thyroid products at least two hours before or after lanthanum. Risk D: Consider therapy modification

Phenytoin: May decrease the serum concentration of Thyroid Products. Phenytoin may also displace thyroid hormones from protein binding sites. Risk C: Monitor therapy

Piracetam: May enhance the adverse/toxic effect of Thyroid Products. Specifically, symptoms including confusion, irritability, and sleep disorder have been described during concomitant use. Risk C: Monitor therapy

RifAMPin: May decrease the serum concentration of Thyroid Products. Risk C: Monitor therapy

Ritonavir: May diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May diminish the therapeutic effect of Thyroid Products. Thyroid product dose requirements may be increased. Risk C: Monitor therapy

Sodium Iodide I131: Thyroid Products may diminish the therapeutic effect of Sodium Iodide I131. Risk X: Avoid combination

Sodium Polystyrene Sulfonate: May decrease the serum concentration of Thyroid Products. Management: To minimize risk of interaction, separate dosing of oral sodium polystyrene sulfonate and thyroid products (e.g., levothyroxine) or administer sodium polystyrene sulfonate rectally. Monitor for signs/symptoms of hypothyroidism with concomitant use (oral).Risk D: Consider therapy modification

Somatropin: May diminish the therapeutic effect of Thyroid Products. Risk C: Monitor therapy

Theophylline Derivatives: Thyroid Products may increase the metabolism of Theophylline Derivatives. Exceptions: Dyphylline. Risk C: Monitor therapy

Tricyclic Antidepressants: Thyroid Products may enhance the arrhythmogenic effect of Tricyclic Antidepressants. Thyroid Products may enhance the stimulatory effect of Tricyclic Antidepressants. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Thyroid Products may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Test Interactions

T4-binding globulin (TBG): Factors that alter binding in serum (ATA/AACE [Garber 2012]):

Note: T4 is ~99.97% protein bound. Factors that alter protein binding will affect serum total T4 levels; however, measurement of serum free T4 (the metabolically active moiety) has largely replaced serum total T4 for thyroid status assessment.

Conditions/states that increase TBG binding: Pregnancy, hepatitis, porphyria, neonatal state

Medications that increase TBG binding: Estrogens, 5-fluorouracil, heroin, methadone, mitotane, perphenazine, selective estrogen receptor modulators (eg, tamoxifen, raloxifene)

Conditions/states that decrease TBG binding: Hepatic failure, nephrosis, severe illness

Medications that decrease TBG binding: Androgens, anabolic steroids, glucocorticoids, L-asparaginase, nicotinic acid

Thyroxine (T4) and Triiodothyronine (T3): Serum binding inhibitors (ATA/AACE [Garber 2012]):

Medications that inhibit T4 and T3 binding: Carbamazepine, furosemide, free fatty acids, heparin, NSAIDS (variable, transient), phenytoin, salicylates

Thyroid gland hormone: Interference with production and secretion (ATA/AACE [Garber 2012]):

Medications affecting iodine uptake: Amiodarone, iodinated contrast agents, iodine, ethionamide

Medications affecting hormone production: Amiodarone, ethionamide, iodinated contrast agents, iodine, sulfonylureas, sulfonamides, thionamides (carbimazole, methimazole, propylthiouracil)

Medications affecting secretion: Amiodarone, iodinated contrast agents, iodine, lithium

Medications inducing thyroiditis: Alemtuzumab, amiodarone, antiangiogenic agents (lenalidomide, thalidomide), denileukin diftitoxin, interferon alpha, interleukins, lithium, tyrosine kinase inhibitors (sunitinib, sorafenib)

Medications potentially causing the development of Graves’: Alemtuzumab, interferon alpha, antiretroviral therapy

Medications potentially ameliorating thyroiditis (if autoimmune) or Graves’: Glucocorticoids

Hypothalamic-pituitary axis and TSH: Interference with secretion (ATA/AACE [Garber 2012]):

Medications decreasing TSH secretion: Bexarotene, dopamine, dopaminergic agonists (bromocriptine, cabergoline), glucocorticoids, interleukin-6, metformin, opiates, somatostatin analogues (octreotide, lanreotide), thyroid hormone analogues

Medications increasing TSH secretion: Amphetamine, interleukin 2, metoclopramide, ritonavir, St John’s wort

Medications potentially causing hypophysitis: Ipilimumab

Monitoring Parameters

TSH 4 to 6 weeks after treatment initiation or dose changes, 4 to 6 months after adequate replacement dose determined, followed by every 12 months thereafter (or more frequently depending on clinical situation) (Jonklaas 2014); T4; heart rate, blood pressure; clinical signs of hypo- and hyperthyroidism; TSH is the most reliable guide for evaluating adequacy of thyroid replacement dosage in primary thyroid dysfunction. TSH may be elevated during the first few months of thyroid replacement despite patients being clinically euthyroid. In cases where T4 remains low and TSH is within normal limits, an evaluation of “free” (unbound) T4 is needed to evaluate further increase in dosage. Free T4 (not TSH) should be monitored to guide treatment in patients with central hypothyroidism (ATA/AACE [Garber 2012]).

Reference Range

T4 (thyroxine) serum concentrations: Adults: ~4 to 12 mcg/dL (SI: 51 to 154 nmol/L). Note: Normal range in pregnancy: ~5.5 to 16 mcg/dL (SI: ~71 to 206 nmol/L)

T4 free (free thyroxine; free T4) serum concentrations: Adults: 0.7 to 1.8 ng/dL (SI: 9 to 23 pmol/L).

T3 total (triiodothyronine; total T3) serum concentrations: Adults: 80 to 230 ng/dL (SI: 1.2 to 3.5 nmol/L). Note: T3 levels may vary substantially throughout the day in patients taking desiccated thyroid, and therefore cannot be easily monitored (ATA/AACE [Garber 2012].

Thyroid-stimulating hormone (TSH) serum concentrations: Adults: Varies by laboratory and assay used; refer to laboratory provided reference range. If an upper and lower limit of normal for a third generation TSH assay is not available, a reference range of 0.45 to 4.12 milliunits/L should be considered (ATA/AACE [Garber 2012]). A higher target range of 4 to 6 milliunits/L has been suggested in patients >70 years (ATA [Jonklaas 2014]).

Subclinical hypothyroidism (elevated TSH; free T4 within normal range):

Severe (TSH ≥10 milliunits/L): These patients are at increased risk for heart failure and cardiovascular mortality and should be considered for treatment with L-thyroxine (ATA/AACE [Garber 2012]; ETA [Pearce 2013])

Mild to moderate (TSH 4 to 10 milliunits/L): Decision for when to treat should be tailored to individual patient based on age, symptoms, and cardiovascular risk (ATA/AACE [Garber 2012]; ETA [Pearce 2013])

Advanced Practitioners Physical Assessment/Monitoring

Obtain T3, T4, TSH, and unbound T4 levels; monitor. Monitor for hyperthyroidism. Check blood pressure and heart rate. Caution patients with diabetes to monitor glucose levels closely (may increase need for oral hypoglycemics or insulin). Assess other medicines patient may be taking; alternate therapy or dosage adjustments may be needed.

Nursing Physical Assessment/Monitoring

Check labs and report any abnormalities. Monitor vital signs closely, as well as signs of heart disease. Monitor for and instruct patients to report any signs/symptoms of hyperthyroidism (weight loss, nervousness, sweating, tachycardia, insomnia, heat intolerance, palpitations, vomiting, psychosis, fever, seizures, angina, arrhythmias). Instruct patients with diabetes to monitor glucose levels closely (may increase need for oral hypoglycemics or insulin).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Armour Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg

Armour Thyroid: 180 mg [scored]

Armour Thyroid: 240 mg

Armour Thyroid: 300 mg [scored]

Nature-Throid: 16.25 mg, 32.5 mg

Nature-Throid: 48.75 mg, 65 mg, 81.25 mg, 97.5 mg, 113.75 mg, 130 mg, 146.25 mg, 162.5 mg, 195 mg, 260 mg, 325 mg [scored]

NP Thyroid: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg

Westhroid: 32.5 mg

Westhroid: 65 mg, 97.5 mg, 130 mg, 195 mg [scored]

WP Thyroid: 16.25 mg, 32.5 mg

WP Thyroid: 48.75 mg, 65 mg [scored]

WP Thyroid: 81.25 mg

WP Thyroid: 81.25 mg, 97.5 mg, 113.75 mg, 130 mg [scored]

Generic: 15 mg, 30 mg, 60 mg, 90 mg, 120 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 30 mg, 60 mg, 125 mg

Anatomic Therapeutic Chemical (ATC) Classification
  • H03AA05
Generic Available (US)

Yes

Pricing: US

Tablets (Armour Thyroid Oral)

15 mg (per each): $0.77

30 mg (per each): $0.91

60 mg (per each): $1.01

90 mg (per each): $1.58

120 mg (per each): $1.84

180 mg (per each): $1.38

240 mg (per each): $1.68

300 mg (per each): $1.97

Tablets (Nature-Throid Oral)

16.25 mg (per each): $0.33

32.5 mg (per each): $0.39

48.75 mg (per each): $0.42

65 mg (per each): $0.46

81.25 mg (per each): $0.51

97.5 mg (per each): $0.56

113.75 mg (per each): $0.61

130 mg (per each): $0.67

146.25 mg (per each): $0.75

162.5 mg (per each): $0.83

195 mg (per each): $0.97

260 mg (per each): $0.69

325 mg (per each): $0.83

Tablets (Westhroid Oral)

32.5 mg (per each): $0.39

65 mg (per each): $0.46

97.5 mg (per each): $0.32

130 mg (per each): $0.38

195 mg (per each): $0.55

Tablets (WP Thyroid Oral)

16.25 mg (per each): $0.44

32.5 mg (per each): $0.52

48.75 mg (per each): $0.56

65 mg (per each): $0.61

81.25 mg (per each): $0.67

97.5 mg (per each): $0.76

113.75 mg (per each): $0.81

130 mg (per each): $0.89

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

The primary active compound is T3 (triiodothyronine), which may be converted from T4 (thyroxine) and then circulates throughout the body to influence growth and maturation of various tissues; exact mechanism of action is unknown; however, it is believed the thyroid hormone exerts its many metabolic effects through control of DNA transcription and protein synthesis; involved in normal metabolism, growth, and development; promotes gluconeogenesis, increases utilization and mobilization of glycogen stores and stimulates protein synthesis, increases basal metabolic rate

Pharmacodynamics/Kinetics

Onset of action: Liothyronine (T3): ~3 hours

Absorption: Thyroxine (T4): 40% to 80%; T3: 95%; desiccated thyroid contains T4, T3, and iodine (primarily bound)

Protein binding: T4: >99% bound to plasma proteins including thyroxine-binding globulin, thyroxine-binding prealbumin, and albumin

Metabolism: Hepatic to triiodothyronine (active); ~80% T4 deiodinated in kidney and periphery; glucuronidation/conjugation also occurs; undergoes enterohepatic recirculation

Half-life elimination:

T4: Euthyroid: 6 to 7 days; Hyperthyroid: 3 to 4 days; Hypothyroid: 9 to 10 days

T3: 0.75 days (Brent, 2011)

Time to peak: Serum: T4: 2 to 4 hours; T3: 2 to 3 days

Excretion: Urine (major route of elimination); partially feces

Local Anesthetic/Vasoconstrictor Precautions

No precautions with vasoconstrictor are necessary if patient is well controlled with thyroid preparations

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Index Terms

Desiccated Thyroid; Levothyroxine and Liothyronine; Tetraiodothyronine and Triiodothyronine; Thyroid Extract; Thyroid USP

References

American College of Obstetricians and Gynecologists. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol. 2015;125(4):996-1005.[PubMed 25798985]

American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227-2246. doi:10.1111/jgs.13702.[PubMed 26446832]

Armour Thyroid (thyroid tablet) [prescribing information]. Madison, NJ: Allergan; June 2018.

Bhasin S, Wallace W, Lawrence JB, et al, “Sudden Death Associated With Thyroid Hormone Abuse,” Am J Med, 1981, 71(5):887-90.[PubMed 7304660]

Brent GA, Koenig RJ. Chapter 39. Thyroid and Anti-Thyroid Drugs. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill Medical; 2011.

Garber KR, Cobin RH, Gharib H, et al; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028.[PubMed 23246686]

Gharib H, Papini E, Garber JR, et al; AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules–2016 update. Endocr Pract. 2016;22(5):622-639. doi: 10.4158/EP161208.GL.[PubMed 27167915]

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi: 10.1089/thy.2015.0020.[PubMed 26462967]

Helfand M and Crapo LM, “Monitoring Therapy in Patients Taking Levothyroxine,” Ann Intern Med, 1990, 113(6):450-4.[PubMed 2143640]

Johnson DG and Campbell S, “Hormonal and Metabolic Agents,” Geriatric Pharmacology, Bressler R and Katz MD, eds, New York, NY: McGraw-Hill, 1993, 427-50.

Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. doi: 10.1089/thy.2014.0028.[PubMed 25266247]10.1089/thy.2014.0028

Nature-Throid (thyroid USP) tablets [prescribing information]. Cave Creek, AZ: RLC Labs; received February 9, 2012.

Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of subclinical hypothyroidism. Eur Thyroid J. 2013;2(4):215-228. doi: 10.1159/000356507.[PubMed 24783053]

Pharmacy Quality Alliance. Use of high-risk medications in the elderly (HRM). http://pqaalliance.org/images/uploads/files/HRM2015.pdf. Published 2015. Accessed October 26, 2015.

Sanders LR, “Pituitary, Thyroid, Adrenal and Parathyroid Diseases in the Elderly,” Geriatric Medicine, 1990, 475-87.

Sawin CT, Geller A, Hershman JM, et al, “The Aging Thyroid. The Use of Thyroid Hormone in Older Persons,” JAMA, 1989, 261(18):2653-5.[PubMed 2709545]

Watts NB, “Use of a Sensitive Thyrotropin Assay for Monitoring Treatment With Levothyroxine,” Arch Intern Med, 1989, 149(2):309-12.[PubMed 2644903]

Thyroid, Desiccated (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(THYE roid DES i kay tid)

Brand Names: US

Armour Thyroid; Nature-Throid; NP Thyroid; Westhroid; WP Thyroid

Warning
  • Do not use this drug to treat obesity or for weight loss. Very bad and sometimes deadly side effects may happen with this drug if it is taken in large doses or with other drugs for weight loss. Talk with the doctor.
What is this drug used for?
  • It is used to add thyroid hormone to the body.
  • It is used to treat or prevent an enlarged thyroid.
  • It is used to manage thyroid cancer.
  • It may be given to you for other reasons. Talk with the doctor.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to thyroid drugs or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Overactive thyroid gland or weak adrenal gland.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Do not run out of this drug.
  • It may take several weeks to see the full effects.
  • If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • This drug may affect how much of some other drugs are in your body. If you are taking other drugs, talk with your doctor. You may need to have your blood work checked more closely while taking this drug with your other drugs.
  • This drug is made from pork (pig) thyroid tissue. There is a very small risk of getting a viral disease from this drug. No cases have been reported. If you have questions, talk with the doctor.
  • If you are 65 or older, use this drug with care. You could have more side effects.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.
  • Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Chest pain or pressure or a fast heartbeat.
  • A heartbeat that does not feel normal.
  • Shortness of breath, a big weight gain, or swelling in the arms or legs.
  • Lump on the neck.
  • Headache.
  • Feeling nervous and excitable.
  • Shakiness.
  • Not able to sleep.
  • Bothered by heat.
  • Sweating a lot.
  • Feeling more or less hungry.
  • A change in weight without trying.
  • Diarrhea.
  • Stomach cramps.
  • Throwing up.
  • Feeling irritable.
  • Fever.
  • Leg cramps.
  • Muscle weakness.
  • Period (menstrual) changes.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Hair loss may happen in some people in the first few months of using this drug. This most often goes back to normal.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • There is more than 1 brand of this drug. One brand cannot safely be used for the other. The doctor will tell you about any needed change.
  • Do not take colesevelam, colestipol, or cholestyramine within 4 hours of this drug.
  • Some foods like soybean flour (infant formula) may change how this drug works in your body. Talk with your doctor.
  • To gain the most benefit, do not miss doses.
  • Take this drug at the same time of day.
  • Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.
What do I do if I miss a dose?
  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Thyroid, Desiccated (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(THYE roid DES i kay tid)

Brand Names: US

Armour Thyroid; Nature-Throid; NP Thyroid; Westhroid; WP Thyroid

Warning
  • Do not use this drug to treat obesity or for weight loss. Very bad and sometimes deadly side effects may happen with this drug if it is taken in large doses or with other drugs for weight loss. Talk with the doctor.
What is this drug used for?
  • It is used to add thyroid hormone to the body.
  • It is used to treat or prevent an enlarged thyroid.
  • It is used to manage thyroid cancer.
  • It may be given to your child for other reasons. Talk with the doctor.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child has any of these health problems: Overactive thyroid gland or weak adrenal gland.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Do not run out of this drug.
  • It may take several weeks to see the full effects.
  • If your child has high blood sugar (diabetes), you will need to watch his/her blood sugar closely.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • This drug may affect how much of some other drugs are in the body. If your child is taking other drugs, talk with the doctor. Your child may need to have blood work checked more closely while taking this drug with other drugs.
  • This drug is made from pork (pig) thyroid tissue. There is a very small risk of getting a viral disease from this drug. No cases have been reported. If you have questions, talk with the doctor.
  • If your child is pregnant or breast-feeding a baby:
  • Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Chest pain or pressure or a fast heartbeat.
  • A heartbeat that does not feel normal.
  • Shortness of breath, a big weight gain, or swelling in the arms or legs.
  • Lump on the neck.
  • Headache.
  • Feeling more or less hungry.
  • A change in weight without trying.
  • Diarrhea.
  • Stomach cramps.
  • Throwing up.
  • Feeling irritable.
  • Feeling nervous and excitable.
  • Shakiness.
  • Not able to sleep.
  • Bothered by heat.
  • Sweating a lot.
  • Fever.
  • Leg cramps.
  • Muscle weakness.
  • If your child has menstrual periods:
  • Period (menstrual) changes.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Hair loss may happen in some people in the first few months of using this drug. This most often goes back to normal.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • There is more than 1 brand of this drug. One brand cannot safely be used for the other. The doctor will tell you about any needed change.
  • Do not give colesevelam, colestipol, or cholestyramine within 4 hours of this drug.
  • Some foods like soybean flour (infant formula) may change how this drug works in your body. Talk with your doctor.
  • To gain the most benefit, do not miss giving your child doses.
  • Give this drug at the same time of day.
  • Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
What do I do if my child misses a dose?
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.