Indications for Intravenous T3 and T4

Jasper David Feldkamp; Joachim Feldkamp

doi:10.1055/a-2318-5156

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2024; 56(08): 541-546
DOI: 10.1055/a-2318-5156

Review

Indications for Intravenous T3 and T4

Jasper David Feldkamp

¹Division of Hematology, Oncology, and Cancer Immunology, Charite Medical Faculty Berlin, Berlin, Germany (Ringgold ID: RIN14903)

,

Joachim Feldkamp

²Klinikum Bielefeld, Academic Department of General Internal Medicine, Endocrinology and Diabetes, Infectiology, Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Bielefeld, Germany

› Author Affiliations

Abstract

Therapy with thyroid hormones normally is restricted to substitution therapy of patients with primary or secondary hypothyroidism. Typically, thyroid hormones are given orally. There are few indications for intravenous use of thyroid hormones. Indications for parenteral application are insufficient resorption of oral medications due to alterations of the gastrointestinal tract, partial or total loss of consciousness, sedation in the intensive care unit or shock. In almost all cases, levothyroxine is the therapy of choice including congenital hypothyroidism. In preterm infants with an altered thyroid hormone status, studies with thyroid hormones including intravenous liothyronine showed a normalisation of T3 levels and in some cases an amelioration of parameters of ventilation. A benefit for mortality or later morbidity could not be seen. Effects on neurological improvements later in life are under discussion. Decreased thyroid hormone levels are often found after cardiac surgery in infants and adults. Intravenous therapy with thyroid hormones improves the cardiac index, but in all other parameters investigated, no substantial effect on morbidity and mortality could be demonstrated. Oral liothyronine therapy in these situations was equivalent to an intravenous route of application. In myxoedema coma, intravenous levothyroxine is given for 3 to 10 days until the patient can take oral medication and normal resorption in the gastrointestinal tract is achieved by restoring at least peripheral euthyroidism. Intravenous levothyroxine is the standard in treating patients with myxoedema coma. A protective effect on the heart of i.v. levothyroxine in brain-dead organ donors may be possible.

Keywords

thyroid - hypothyroidism - liothyronine - levothyroxine - triiodothyronine

Full Text

References

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