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Levothyroxine: The Importance of RDH Familiarity

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Jessica Jarrard

As a registered dental hygienist, there are health concerns to remain aware of when providing care to clients, specifically health conditions that the client may or may not be aware of, and more importantly any medications that may affect dental care in general as well as in the office. As a RDH, one should be able to recognize signs and symptoms and be knowledgeable about how the care being provided to the client may be affected by medication and the health conditions associated with its use as it relates to dental health. The top medication prescribed to individuals is Levothyroxine. The use of this medication is common, and it is important for the RDH to be aware of the conditions associated with its use, the effects this medication may have on the care provided or vice versa, as well as how to direct the client for providing aftercare once they have the left the office. Any possible health concerns the RDH may recognize in regards to the use of Levothyroxine are especially important if the client has signs of a possible condition that may be associated with its use or if the client may be suffering an adverse effect resulting from a medication interaction that the client may be unaware of. Being familiar with the medication as it relates to the care provided will help the RDH recognize if referring the client to seek further care from their primary medical provider is necessary.

Levothyroxine is a synthetic hormone medication used for the treatment of hypothyroidism, a condition associated with underproduction of hormones secreted within the thyroid gland. Thyroxine, the T4 hormone, is indirectly responsible for regulating many metabolic processes within the body and when deficient or absent can cause a number of health concerns including lethargy, low body temperature, myxedema, intolerance to cold, and weight gain among other, more serious complications (Weinberg, Westphal, & Fine, 2008). Although Levothyroxine can regulate the symptoms associated with this health condition, there are also risks involved with long term use of the drug such as cardiovascular disease, stroke, and atrial fibrillation, especially among individuals with thyroid cancer (Nelson, 2017). Therapeutically this medication is utilized as a replacement hormone in the absence of Thyroxine (Vallerand, Sanoski, & Deglin, 2013). Although there are other treatments available for hypothyroidism, there is no evidence they are better options, and Levothyroxine remains a common treatment and has been proven to work well (What is T4, n.d.).

Levothyroxine C15H11I4NO4 is commonly known as Synthroid but is also known by other names such as Eltroxin or Euthyrox in Canada and Levo-T, Levothroid, Levoxyl, T4, Tirosint, and Unithroid depending on the manufacturer marketing the drug (Hopkins, 2006). "Although most commonly used to treat hypothyroidism it is also used as a treatment for suppression of euthyroid goiter as well as thyroid cancer" which is often directly related (Vallerand, Sanoski, & Deglin, 2013, p. 779). Levothyroxine is absorbed through the GI tract and metabolized by the liver and other body tissues by being converted to Triiodothyronine, the T3 hormone, which regulates metabolism in the body as well as other body functions (What is T4 , n.d.).

Levothyroxine can be taken intravenously and intramuscularly, although it is commonly prescribed as a single dose, oral medication. Dosages of this medication are determined by many factors including age, weight, severity of the condition being treated, and other present health conditions. As with all medications, individuals with certain health conditions should use caution while taking Levothyroxine. These include individuals suffering from cardiovascular disease, renal insufficiency, and uncorrected adrenocortical disorders as well as pediatric and geriatric patients who should be monitored especially close as they are more vulnerable to complications or risks associated with any medication or illness (Vallerand, Sanoski, & Deglin, 2013). Dosages are increased at regular intervals, usually bi weekly and should be taken in the morning, as the risk for insomnia is increased with its use. It is important that this medication is taken at the same time daily and should not be stopped without consulting the prescribing physician, as it may result in negative health consequences (Vallerand, Sanoski, & Deglin,2013).

When taking this medication, it is important that patients understand that treatment with Levothyroxine is not a cure for hypothyroidism and should be considered a lifelong therapy. Patients should also understand that it may have an effect on other body systems, resulting in undesirable symptoms such as

"headache, insomnia, irritability, angina pectoris, arrhythmias, tachycardia, abdominal cramps, diarrhea, vomiting, sweating, hyperthyroidism, menstrual irregularities, heat intolerance, weight loss, and accelerated bone maturation in children. These adverse effects are usually only seen when excessive doses of the medication cause iatrogenic hyperthyroidism" (Vallerand, Sanoski, & Deglin, 2013, p. 780).

Some other medications have been known to interact in conjunction with Levothyroxine and should not be taken together unless directed by a physician. These medications include Warfarin, some diabetic medications, and Estrogen, which may increase the effects of Levothyroxine. Other supplements or foods which contain calcium, iron, and zinc prevent absorption of Levothyroxine and should also not be taken in conjunction. If these medications or supplements are needed, it is best to do so under the care of a physician who can monitor any potential risks or effects and make adjustments in health care accordingly (Vallerand, Sanoski, & Deglin, 2013).

The use of Levothyroxine is increasingly common in individuals and can cause undesirable effects if not considered when providing dental care as well as any other care to clients. For instance, a common side effect of this medication is xerostomia. This side effect can cause a number of risks to clients as the mouth's essential, protective enzymes, which are provided and carried through saliva, are depleted or completely absent. Without this level of protection, the teeth and gums become weak and vulnerable to excessive damage from routine dental care as well as other normal activities, such as eating. "It has been reported that there is almost four times greater prevalence of xerostomia in patients taking medications (28%), compared with those not taking any (7.5%)" (Risk factors, hyposalivation, 2017). If the RDH is aware of this side effect, whether or not it is a result of the medication, adjustments in dental care can be made preventing further damage. The RDH can also provide replacement therapy for the missing enzymes by offering products or medications that supplement these enzymes to prevent further dry mouth. All RDH should be educated and aware of the signs and symptoms of disorders or health conditions associated with Levothyroxine and the possible risks involved when providing dental care for a client taking this medication. Understanding how the medication works and the effects it has in conjunction with other medications, supplements, or medical/dental treatments will not only serve to protect the client from any further risks or complications regarding care, but will also allow the RDH to perform client services more effectively and with greater success to the client's well-being.

References

Flaitz, C., Shlafer, M., Tornwall, R., & Viola, T. (2014). Mosby Dental Drug Reference 11th ed.

St. Louis, MO: Elsevier Mosby.

Haveles, E. (2011). Applied Pharmacology for the Dental Hygienist. Maryland Heights, MO:

Mosby Elsevier.

Joe (MSC Nutrition). (n.d.).What is T4 and T3: The complete guide. Retrieved from

https://www.dietvsdisease.org/t4-t3-thyroid-hormone levels/?hilite=%22levothyroxin%22

Nelson, R. (2017). High risk for CHD and stroke in patients with thyroid cancer. Retrieved

from www.medscape.com/viewarticle/875375

Niklander, S., Veas, L., Barrera, C., Fuentes, F., Chiappini, G., Marshall, M. (2017). Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life. Pub Med, 31. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S180683242017000100211&lng =en&nrm=iso&tlng=en#B12

Vallerand, A., Sanoski, C., & Deglin, J. (2013). Davis's Drug Guide for Nurses 13th ed.

Philadelphia, PA: F.A. Davis Company.

Weinberg, M., Westphal, C., & Fine, J. (2008). Oral Pharmacology for the Dental Hygienist.

Upper Saddle River, NJ: Pearson Education Inc.


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