Euthyrox Special Precautions

In patients with hypothyroidism due to a disease of the pituitary gland, it must be clarified whether underactivity of the adrenal cortex (adrenocortical insufficiency) is also present. If so, the latter should be treated before initiating thyroid hormone therapy.
Thyroid hormone therapy in patients with concomitant diabetes mellitus or diabetes insipidus, or adrenal cortical insufficiency aggravates the intensity of the symptoms. Appropriate adjustments of the various therapeutic measures directed at those concomitant endocrine diseases are required. The therapy of myxedema coma may require simultaneous administration of glucocorticoids.
Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestation of toxicity, particularly when given in association with sympathomimetic amines eg, those used for anoretic effects.
Effects on the Ability to Drive or Operate Machinery: There are no indications that Euthyrox interferes with driving a vehicle, operating machinery or working without a firm hold.
Use in pregnancy & lactation: Systematic treatment with thyroid hormones is of special importance during pregnancy and the nursing period and must therefore be maintained.
During pregnancy, however, levothyroxine should not be taken together with medication for the treatment of hyperthyroidism (antithyroid drugs) as additional intake of levothyroxine may make a higher dose of the antithyroid drug necessary.
In contrast to levothyroxine, antithyroid drugs cross the placenta and can cause decreased thyroid activity in the unborn infant.
Use in children: Diagnosis and institution of therapy for creatinism should be done as soon as after birth as possible to prevent developmental deficiency screening for serum T4 and TSH will identify this group of newborn patients. In infants, excessive doses of thyroid hormone preparations may produce craniosynostosis.
Use in the elderly: Elderly people should dosed very carefully. A small dose should be chosen to start with, which can be increased gradually and at long intervals with frequent thyroid hormone checks. Even mild hyperthyroidism due to levothyroxine must be avoided by all means, especially in patients with coronary heart disease, heart failure or heart rhythm disturbances of the rapid type.