Medical Editor: Charles Patrick Davis, MD, PhD
What Is Synthroid?
Synthroid (levothyroxine sodium) is a synthetic compound identical to T4 (levothyroxine) produced by the human thyroid gland used to treat hypothyroidism due to many causes (for example:
- thyroid removal,
- thyroid atrophy,
- functional T4 deficiency,
- radiation treatment of the thyroid,
- and other causes).
Synthroid is also used for pituitary TSH suppression. Synthroid is available in generic form.
What Are Side Effects of Synthroid?
Synthroid may cause serious side effects including:
- fast or irregular heartbeats,
- chest pain,
- shortness of breath,
- fever,
- hot flashes,
- sweating,
- tremors,
- feeling cold,
- weakness,
- tiredness,
- sleep problems (insomnia),
- memory problems,
- feeling depressed, nervous or irritable,
- headache,
- leg cramps,
- muscle aches,
- dryness of skin or hair,
- hair loss,
- changes in your menstrual periods,
- vomiting,
- diarrhea,
- appetite changes,
- weight changes
Get medical help right away, if you have any of the symptoms listed above.
Common side effects of Synthroid include:
- fever,
- hot flashes,
- sensitivity to heat,
- sweating,
- headache,
- nervousness,
- irritability,
- nausea,
- sleep problems (insomnia),
- changes in appetite or changes in weight,
- changes in menstrual perdiods,
- and temporary hair loss.
Notify your doctor if you experience serious side effects of Synthroid including rapid heartbeat, fluttering in your chest, or chest pain.
Seek medical care or call 911 at once if you have the following serious side effects:
- Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
- Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in your chest; shortness of breath; and sudden dizziness, lightheartedness, or passing out;
- Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors.
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
Dosage for Synthroid
Synthroid is prescribed in tablets that range from 25 to 300 mcg in strength and is usually taken once a day with a full glass of water (about 8 ounces) 30 to 60 minutes before breakfast for best adsorption into the body. Children can take the medicine if the tablet is crushed and put into about 1 to 2 teaspoons of water; do not store or delay giving this crushed pill suspension. Doctors often may have to slowly increase the dose; patients should not increase or decrease this medication themselves. Because some preparations of the drug may contain iodine or lactose, patients should tell their doctors about such allergies or reactions to these components.
What Drugs, Substances, or Supplements Interact with Synthroid?
Many drugs can inhibit Synthroid's adsorption by the body; other medications may increase or decrease its effectiveness once it is adsorbed. Providing a complete list of medications to the doctor will help with getting the correct dose established for each individual patient.
Synthroid During Pregnancy and Breastfeeding
Pregnant and lactating females need to discuss the dose and use of this medication with their caregivers.
Additional Information
Our Synthroid Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
SLIDESHOW
Hyperthyroidism Symptoms and Treatment See Slideshow3 pharmacies near 98837 have coupons for synthroid (Brand Names:Synthroid for 137MCG)
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- fast or irregular heartbeats;
- chest pain, pain spreading to your jaw or shoulder;
- shortness of breath;
- fever, hot flashes, sweating;
- tremors, or if you feel unusually cold;
- weakness, tiredness, sleep problems (insomnia);
- memory problems, feeling depressed or irritable;
- headache, leg cramps, muscle aches;
- feeling nervous or irritable;
- dryness of your skin or hair, hair loss;
- irregular menstrual periods; or
- vomiting, diarrhea, appetite changes, weight changes.
Certain side effects may be more likely in older adults.
Common side effects may include:
- chest pain, irregular heartbeats;
- shortness of breath;
- headache, leg cramps, muscle pain or weakness;
- tremors, feeling nervous or irritable, trouble sleeping;
- increased appetite;
- feeling hot;
- weight loss;
- changes in your menstrual periods;
- diarrhea; or
- skin rash, partial hair loss.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
QUESTION
Where is the thyroid gland located? See AnswerSIDE EFFECTS
Adverse reactions associated with SYNTHROID therapy are primarily those of hyperthyroidism due to therapeutic overdosage [see WARNINGS AND PRECAUTIONS and OVERDOSE]. They include the following:
- General: fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating
- Central nervous system: headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, insomnia
- Musculoskeletal: tremors, muscle weakness, muscle spasm
- Cardiovascular: palpitations, tachycardia, arrhythmias, increased pulse and blood pressure, heart failure, angina, myocardial infarction, cardiac arrest
- Respiratory: dyspnea
- Gastrointestinal: diarrhea, vomiting, abdominal cramps, elevations in liver function tests
- Dermatologic: hair loss, flushing, rash
- Endocrine: decreased bone mineral density
- Reproductive: menstrual irregularities, impaired fertility
Seizures have been reported rarely with the institution of levothyroxine therapy.
Adverse Reactions In Pediatric Patients
Pseudotumor cerebri and slipped capital femoral epiphysis have been reported in pediatric patients receiving levothyroxine therapy. Overtreatment may result in craniosynostosis in infants who have not undergone complete closure of the fontanelles, and in premature closure of the epiphyses in pediatric patients still experiencing growth with resultant compromised adult height.
Hypersensitivity Reactions
Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products. These include urticaria, pruritus, skin rash, flushing, angioedema, various gastrointestinal symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness, and wheezing. Hypersensitivity to levothyroxine itself is not known to occur.
DRUG INTERACTIONS
Drugs Known To Affect Thyroid Hormone Pharmacokinetics
Many drugs can exert effects on thyroid hormone pharmacokinetics and metabolism (e.g., absorption, synthesis, secretion, catabolism, protein binding, and target tissue response) and may alter the therapeutic response to SYNTHROID (Tables 5 to 8).
Table 5. Drugs That May Decrease T4 Absorption (Hypothyroidism)
| Potential impact: Concurrent use may reduce the efficacy of SYNTHROID by binding and delaying or preventing absorption, potentially resulting in hypothyroidism. | |
| Drug or Drug Class | Effect |
| Phosphate Binders (e.g., calcium carbonate, ferrous sulfate, sevelamer, lanthanum) |
Phosphate binders may bind to levothyroxine. Administer SYNTHROID at least 4 hours apart from these agents. |
| Orlistat | Monitor patients treated concomitantly with orlistat and SYNTHROID for changes in thyroid function. |
| Bile Acid Sequestrants (e.g., colesevelam, cholestyramine, colestipol) Ion Exchange Resins (e.g., Kayexalate) |
Bile acid sequestrants and ion exchange resins are known to decrease levothyroxine absorption. Administer SYNTHROID at least 4 hours prior to these drugs or monitor TSH levels. |
| Proton Pump Inhibitors Sucralfate Antacids (e.g., aluminum & magnesium hydroxides, simethicone) |
Gastric acidity is an essential requirement for adequate absorption of levothyroxine. Sucralfate, antacids and proton pump inhibitors may cause hypochlorhydria, affect intragastric pH, and reduce levothyroxine absorption. Monitor patients appropriately. |
Table 6. Drugs That May Alter T4 and Triiodothyronine (T3) Serum Transport Without Affecting Free Thyroxine (FT4) Concentration (Euthyroidism)
| Drug or Drug Class | Effect |
| Clofibrate Estrogen-containing oral contraceptives Estrogens (oral) Heroin / Methadone 5-Fluorouracil |
These drugs may increase serum thyroxine-binding globulin (TBG) concentration. |
| Mitotane Tamoxifen |
|
| Androgens / Anabolic Steroids Asparaginase Glucocorticoids Slow-Release Nicotinic Acid |
These drugs may decrease serum TBG concentration. |
| Potential impact (below): Administration of these agents with SYNTHROID results in an initial transient increase in FT4. Continued administration results in a decrease in serum T4 and normal FT4 and TSH concentrations. | |
| Salicylates (> 2 g/day) | Salicylates inhibit binding of T4 and T3 to TBG and transthyretin. An initial increase in serum FT4 is followed by return of FT4 to normal levels with sustained therapeutic serum salicylate concentrations, although total T4 levels may decrease by as much as 30%. |
| Other drugs: Carbamazepine Furosemide (> 80 mg IV) Heparin Hydantoins Non-Steroidal Anti-inflammatory Drugs
|
These drugs may cause protein-binding site displacement. Furosemide has been shown to inhibit the protein binding of T4 to TBG and albumin, causing an increase free T4 fraction in serum. Furosemide competes for T4-binding sites on TBG, prealbumin, and albumin, so that a single high dose can acutely lower the total T4 level. Phenytoin and carbamazepine reduce serum protein binding of levothyroxine, and total and free T4 may be reduced by 20% to 40%, but most patients have normal serum TSH levels and are clinically euthyroid. Closely monitor thyroid hormone parameters. |
Table 7. Drugs That May Alter Hepatic Metabolism of T4 (Hypothyroidism)
| Potential impact: Stimulation of hepatic microsomal drug-metabolizing enzyme activity may cause increased hepatic degradation of levothyroxine, resulting in increased SYNTHROID requirements. | |
| Drug or Drug Class | Effect |
| Phenobarbital Rifampin |
Phenobarbital has been shown to reduce the response to thyroxine. Phenobarbital increases L-thyroxine metabolism by inducing uridine 5’-diphospho-glucuronosyltransferase (UGT) and leads to lower T4 serum levels. Changes in thyroid status may occur if barbiturates are added or withdrawn from patients being treated for hypothyroidism. Rifampin has been shown to accelerate the metabolism of levothyroxine. |
Table 8. Drugs That May Decrease Conversion of T4 to T3
| Potential impact: Administration of these enzyme inhibitors decreases the peripheral conversion of T4 to T3, leading to decreased T3 levels. However, serum T4 levels are usually normal but may occasionally be slightly increased. | |
| Drug or Drug Class | Effect |
| Beta-adrenergic antagonists (e.g., Propranolol > 160 mg/day) |
In patients treated with large doses of propranolol (> 160 mg/day), T3 and T4 levels change, TSH levels remain normal, and patients are clinically euthyroid. Actions of particular beta-adrenergic antagonists may be impaired when a hypothyroid patient is converted to the euthyroid state. |
| Glucocorticoids (e.g., Dexamethasone ≥ 4 mg/day) |
Short-term administration of large doses of glucocorticoids may decrease serum T3 concentrations by 30% with minimal change in serum T4 levels. However, long-term glucocorticoid therapy may result in slightly decreased T3 and T4 levels due to decreased TBG production (See above). |
| Other drugs: Amiodarone |
Amiodarone inhibits peripheral conversion of levothyroxine (T4) to triiodothyronine (T3) and may cause isolated biochemical changes (increase in serum free-T4, and decreased or normal free-T3) in clinically euthyroid patients. |
Antidiabetic Therapy
Addition of SYNTHROID therapy in patients with diabetes mellitus may worsen glycemic control and result in increased antidiabetic agent or insulin requirements. Carefully monitor glycemic control, especially when thyroid therapy is started, changed, or discontinued [see WARNINGS AND PRECAUTIONS].
Oral Anticoagulants
SYNTHROID increases the response to oral anticoagulant therapy. Therefore, a decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the SYNTHROID dose is increased. Closely monitor coagulation tests to permit appropriate and timely dosage adjustments.
Digitalis Glycosides
SYNTHROID may reduce the therapeutic effects of digitalis glycosides. Serum digitalis glycoside levels may decrease when a hypothyroid patient becomes euthyroid, necessitating an increase in the dose of digitalis glycosides.
Antidepressant Therapy
Concurrent use of tricyclic (e.g., amitriptyline) or tetracyclic (e.g., maprotiline) antidepressants and SYNTHROID may increase the therapeutic and toxic effects of both drugs, possibly due to increased receptor sensitivity to catecholamines. Toxic effects may include increased risk of cardiac arrhythmias and central nervous system stimulation. SYNTHROID may accelerate the onset of action of tricyclics. Administration of sertraline in patients stabilized on SYNTHROID may result in increased SYNTHROID requirements.
Ketamine
Concurrent use of ketamine and SYNTHROID may produce marked hypertension and tachycardia. Closely monitor blood pressure and heart rate in these patients.
Sympathomimetics
Concurrent use of sympathomimetics and SYNTHROID may increase the effects of sympathomimetics or thyroid hormone. Thyroid hormones may increase the risk of coronary insufficiency when sympathomimetic agents are administered to patients with coronary artery disease.
Tyrosine-Kinase Inhibitors
Concurrent use of tyrosine-kinase inhibitors such as imatinib may cause hypothyroidism. Closely monitor TSH levels in such patients.
Drug-Food Interactions
Consumption of certain foods may affect SYNTHROID absorption thereby necessitating adjustments in dosing [see DOSAGE AND ADMINISTRATION]. Soybean flour, cottonseed meal, walnuts, and dietary fiber may bind and decrease the absorption of SYNTHROID from the gastrointestinal tract. Grapefruit juice may delay the absorption of levothyroxine and reduce its bioavailability.
Drug-Laboratory Test Interactions
Consider changes in TBG concentration when interpreting T4 and T3 values. Measure and evaluate unbound (free) hormone and/or determine the free-T4 index (FT4I) in this circumstance. Pregnancy, infectious hepatitis, estrogens, estrogen-containing oral contraceptives, and acute intermittent porphyria increase TBG concentration. Nephrosis, severe hypoproteinemia, severe liver disease, acromegaly, androgens, and corticosteroids decrease TBG concentration. Familial hyper- or hypo-thyroxine binding globulinemias have been described, with the incidence of TBG deficiency approximating 1 in 9000.
Read the entire FDA prescribing information for Synthroid (Levothyroxine Sodium)
© Synthroid Patient Information is supplied by Cerner Multum, Inc. and Synthroid Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.
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