Alternative uses for Synthroid?

[CareGiving]

Hi AllNurses,

I just had my second day of clinicals on the med surg unit and my patient had been in for 11 days. Pt was admitted to have a rectal mass removed, and received a new ileostomy. The surgical wound became infected by a leaking ostomy appliance, so pt was being treated for that. I'm now working on the care plan, and I am perplexed by the order for IV Synthroid. I did not see anything in his history indicating hypothyroid, nor that he was on Synthroid prior to this hospitalization. Are there unlabeled uses for Synthroid that might be related to this condition? A little more on pt's diagnoses... pt is recovering from post-op pneumonia, is bipolar and autistic. Labs normal except for the hematology labs being slightly below normal. Any thoughts would be greatly appreciated!

[pink816]

people who are bipolar and take lithium often have thyroid problems because of the lithium. Therefore they can get hypothyroid and need a replacement which is why synthroid may have been ordered

[CareGiving]

All your thoughts are much appreciated, thank you! It's pretty amazing to have this community of nurses to be able to glean knowledge from.

Since my patient is not on lithium, the question still remains, why was he being given Synthroid?? The prophylaxis idea was a very interesting one, but he was being given Reglan which has the effect of increasing peristalsis.

The dose ordered was 0.05 mg/1.25 mL if that helps spur ideas.

I'll continue looking into this, and post if I learn definitively why this pt was receiving this drug.

[blondy2061h, MSN, RN]

IV Synthroid? I wasn't aware it was given IV. Where have I been????

We give it IV fairly frequently. It can be a pain in the butt to draw up the specific doses.

[KatieMI, BSN, MSN, RN]

Giving Syntroid in usual dose to an euthyroid patient is pointless - his own thyroid gland will just shut down itself for a while, and the net effect will remain just the same.

Using thyroid hormones for losing weight/increasing peristalsis/"increasing energy"/making one looking as a mute cinema star (you know - long fingers, huge eyes, flat shape and lots of "nerves") actually requires creating a jatrogenic hyperthyroidism with all its sequela, some of them potentially deadly.

The patient in question might have subclinical hypothyroidism b/o lithium he received sometimes in the past for his bipolar disorder (as it was mentioned before, up to 30% of patients treated with lithium develop hypothyreosis, and not all of them recover). Also, subclinical hypothyroidism is common among autistic patients, and among critically sick, especially post-operative patients as well. To treat subclinical hypothyroidism (if patient has no symptoms and sometimes even normal thyroid profile, but abnormal thyroid functional tests) or not is a big open question now, but since it is known that hypothyroidism causes, among other things, poor wound healing and depressed immune functions, it is imaginable that Syntroid in standard therapeutic dose can be given if doctor suspects subclinical hypothyroidism. IV form is probably because of patient's psycho history and possible non-compliance.

[etaoinshrdluRN]

Is the pt overweight? I read an article recently about using it for weight loss.

Holy crap! As someone who has been hyperthyroid a couple of times, I'd rather have a bareback root canal than deliberately make myself hyperthyroid. NOT fun, not healthful, either.