Parenteral replacement of 1-T4 in hypothyroid patients with esophageal stenosis and unconsciousness

Abstract

Hypothyroid patients are usually treated with in an oral administration of 1-T4. When oral administration is impossible because of esophageal stenosis or unconsciousness in such patients, parenteral replacement is required. We prepared a solution of 1-T4 50 micrograms/ml for intravenous administration in Tohoku University Hospital as follows: 5mg of 1-T4 (Nakarai Co.) was dissolved in 1ml of 0.1N NaOH and diluted with 0.9% NaCl and sterilized with membrane filter. Two patients with esophageal stenosis due to thyroid cancer and esophageal cancer and one in a coma due to adrenal crisis had replacement with intravenous 1-T4. Initial doses of 12.5 micrograms or 25 micrograms diluted with 100ml of 0.9% NaCl containing 1% albumin were given by drip infusion. Every week 12.5 micrograms or 25 micrograms of 1-T4 was increased. By replacement of low doses, 50 micrograms or 75 micrograms, serum T4 reached a normal level. No adverse action was observed during or after parenteral replacement. The preparation of 1-T4 was stable at least for one year and 11 months. Parenteral replacement of T4 is a useful and safe method for patients who are unable to take drugs orally.