What should be paid attention to when taking levothyroxine for a long time to treat hypothyroidism?😮😮😮

Levothyroxine is a thyroid hormone drug. It is generally used clinically for the treatment of hypothyroidism, non-toxic goiter, thyroid hormone supplementation after surgical resection of thyroid cancer, and adjuvant treatment of hyperthyroidism with antithyroid drugs. The following will introduce the precautions about the use of levothyroxine.

The basic knowledge of levothyroxine.

In clinical practice, the most commonly used dosage form of levothyroxine is levothyroxine sodium tablets. It is most commonly used as a replacement for patients with hypothyroidism and as an adjunctive treatment for patients with hyperthyroidism.

What are the pharmacological effects of levothyroxine?

One of the main indications for levothyroxine is as an alternative treatment for hypothyroidism. Insufficient synthesis and secretion of thyroid hormone in the body is the main cause of hypothyroidism. Levothyroxine is a synthetic form of tetraiodothyronine (T4). It is converted in the body to the more active triiodothyronine (T3). Thus it will exert the same effect as the thyroxine secreted by the body itself and treat hypothyroidism.

Who are the suitable and contraindicated groups of levothyroxine?

It is generally used in patients with thyroid-related diseases. However, it should be prescribed by a doctor and should not be used by patients on their own. It should be contraindicated in patients with untreated adrenal or pituitary insufficiency, thyrotoxicosis, acute myocardial infarction, acute myocarditis, and acute pancarditis. In addition, it should be used with caution in pregnant and lactating women.

What are the common precautions for levothyroxine?

1. Will long-term use of levothyroxine cause adverse reactions?

Current studies have pointed out that when patients take levothyroxine for a long time, as long as they take it in the correct way and in the right dose, they will not cause adverse reactions. Within certain limits, the human body is able to metabolize thyroxine on its own. This keeps thyroxine from causing adverse reactions. However, if the patient takes levothyroxine in large doses for a long time or takes it by mistake, the patient may experience symptoms of hyperthyroidism such as sweating, insomnia, tremors (especially hand tremors), palpitation, and increased appetite.

2. Why is it not recommended to take soy products together with levothyroxine?

Although it is not recommended to eat soy products while patients are taking levothyroxine, it does not mean that patients cannot eat soy products. Under normal circumstances, patients are not recommended to eat soy products, eggs or milk and other related foods within four hours after taking the medicine. Because they reduce the intestinal absorption of levothyroxine, they affect how well it works. Because these foods reduce the amount of levothyroxine absorbed in the intestine, the dose of levothyroxine may need to be adjusted if the patient starts or stops taking soy products for nutritional supplementation.

3. When is the best time to take levothyroxine?

It is generally recommended that patients take one day's dose of levothyroxine with water half an hour before breakfast every day. It can avoid that when food and levothyroxine are taken at the same time, oily substances or other substances in food will affect the absorption of drugs in the gastrointestinal tract. If patients are unable or have difficulty taking levothyroxine in the morning, they may take it four hours after dinner or at bedtime. However, patients are generally not advised to take levothyroxine at night. It is because levothyroxine is an excitatory hormone. Patients taking levothyroxine at night may affect sleep quality. They may experience adverse effects of poor sleep quality or insomnia.

What are the other precautions for levothyroxine?

In addition to the above precautions, the foods and diseases described below can also affect the body's absorption of levothyroxine. 

• Food: soy foods or their products, grapefruit, iron or calcium-containing foods, milk or their products, tea, coffee, foods that can cause thyroid swelling (such as walnuts, cassava, cabbage, cabbage, rapeseed, etc.), cholesterol unhealthy foods (such as animal offal and butter), high-fat foods (such as cooking oil, walnut kernels, almonds, ham, etc.). Patients should avoid or reduce consumption of these foods. The consumption of these foods should also be separated from the time of taking levothyroxine.
• Diseases: malabsorption syndrome (such as achlorhydria), liver cirrhosis, celiac disease, etc.
• Drug Interactions: Antidiabetic drugs, coumarin derivatives, protease inhibitors (eg, ritonavir, lopinavir), phenytoin, cholestyramine, colestipol, drugs containing aluminum, iron, or calcium ( such as antacids), salicylic acid drugs, dicoumarol, furosemide, clofibrate, orlistat, sevelamer, tyrosine kinase inhibitors (such as imatinib), propylthiouracil, Glucocorticoids, amiodarone, iodine-containing contrast media, beta-sympathomimetics, sertraline, chloroquine, hepatic enzyme inducers (eg, barbiturates, carbamazepine), estrogens.

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Some learning points about levothyroxine.📝📝📝

The manual for levothyroxine.

Indications:

1. Treatment of non-toxic goiter with normal thyroid function.
2. After goiter resection, prevent the recurrence of goiter.
3. Adjuvant treatment of hyperthyroidism with antithyroid drugs.
4. Suppressive treatment after thyroid cancer surgery.
5. Alternative treatment of hypothyroidism caused by various reasons.
6. Thyroid suppression test (used in diagnosis and treatment of diseases).

In addition, levothyroxine is not used for weight loss. It is because inappropriate long-term use of levothyroxine can cause various complications of hyperthyroidism and even life-threatening.

Some moderate to severe obesity patients may have subclinical hypothyroidism. Thyroid stimulating hormone is compensatory elevated, but thyroid hormone levels are normal. Consider taking a small dose of levothyroxine sodium tablets (such as 25ug/day) within a certain period of time. It can reduce the level of thyroid-stimulating hormone and increase the basal metabolic rate, which may help weight loss, but also should pay attention to adverse reactions and strengthen thyroid function.

Medicine interactions:

For drugs that affect the absorption of levothyroxine, you can increase the interval or increase the dose:

1. Cholesterol-lowering drugs: such as cholestyramine and colestipol.
2. Drugs containing aluminum, iron and calcium. Such as gastric mucosal protective agent (sucralfate), antacids (aluminum hydroxide, ferrous sulfate, calcium carbonate tablets).
3. Acid inhibitors and stomach drugs: H2 receptor blockers and proton pump inhibitors (such as ranitidine, omeprazole).
4. Anti-epileptic drugs: such as phenobarbital, phenytoin sodium, carbamazepine.
5. Anti-tuberculosis drugs: such as rifampicin.

Drugs affected by levothyroxine:

1. Anti-diabetic drugs: Levothyroxine can reduce the effect of hypoglycemic. Therefore, patients with diabetes should increase blood glucose monitoring and adjust the dosage in time.
2. Anticoagulant: Levothyroxine can enhance the anticoagulant effect of coumarin derivatives (such as warfarin). Patients should pay attention to adjusting the dosage to prevent the risk of bleeding.

Others:

Propylthiouracil, amiodarone, iodine-containing contrast agents and β-sympathomimetic drugs, glucocorticoids, estrogen, sertraline, etc. can reduce the efficacy of the drug. Salicylate, dicoumarin, high-dose furosemide (250mg), oxytocin, phenytoin, etc. can increase the efficacy of the drug. Need to adjust the dose of levothyroxine sodium tablets as appropriate.

Foods:

Animal offal, spinach, cherries, grapes, peaches, grapefruit, soybeans, high-fiber foods, coffee, milk, yogurt, soy milk, etc.

Medication time:

Since food can affect the absorption of levothyroxine sodium tablets, it is recommended to take the dose with water every morning on an empty stomach. It can be taken immediately after getting up in the morning, but do not eat breakfast within half an hour.

If the dose of the drug is large, it is still not necessary to take it in divided doses. Try not to take the medicine before going to bed, otherwise it may increase the excitability of the body and affect the quality of sleep.

Dosage:

The blood level of thyroid stimulating hormone is a reliable basis for determining the dosage of treatment. If the child has no obvious contraindications, the full dose should be used at the beginning of treatment or the optimal dose can be reached quickly in a short period of time. However, adults should start with a small dose and gradually increase to the optimal dose every 2 to 4 weeks. Elderly patients should increase the dose more slowly.

1. Goiter (normal thyroid function): 75-200ug/day for adults, 50-150ug/day for teenagers.
2. Prevention of goiter recurrence after thyroidectomy: 75-200ug/day for adults.
3. Hypothyroidism in adults: initial dose 25-50ug/day, increase 25-50ug every 2-4 weeks, maintenance dose 125-250ug/day.
4. Hypothyroidism in children: the initial dose is 12.5-50ug/day/m² body surface area, and the maintenance dose is 100-150ug/day/m² body surface area.
5. Adjuvant treatment of anti-hyperthyroidism: 50-100ug/day. After total thyroidectomy: 150-300ug/day.
6. Thyroid suppression test: 200ug/day.

Monitor:

At the beginning of treatment and every time the dosage is adjusted, thyroid function needs to be measured every 4 to 6 weeks. Adjust the dose according to the inspection results. After the treatment reaches the standard, check again every 6 to 12 months. If the treatment is not up to standard, you should carefully look for the reasons, such as clinical compliance and medication time.

Adverse reactions:

Levothyroxine is generally well tolerated. Patients who increase the dose too quickly in the early stage of treatment or overdose may have symptoms of hyperthyroidism, such as palpitations, tremor, sweating, skin flushing, diarrhea, weight loss, menstrual disorders, insomnia and irritability.

When the patient has any adverse reactions, appropriate treatment should be given. If necessary, reduce the dose or discontinue the drug until the adverse reaction disappears and then start the treatment from a small dose.

Long-term use of levothyroxine can accelerate the bone transformation process. Elderly and postmenopausal patients with osteoporosis should pay attention to calcium and vitamin D supplementation. They should monitor the bone density regularly.

Missed medication:

The half-life of levothyroxine is 7 days and its effect is slow and lasting. The effect is significant and stable after taking the medicine one month. 

In the early treatment of hypothyroidism, if there is a missed dose, it may be considered supplementing the dose on the same day or doubling the dose the next day. If the thyroid function is relatively stable after taking the medicine regularly for a long time, it may be considered that there is no need to take supplements, and it can be maintained at the current dose.

Patients after thyroid cancer surgery should ensure that they do not miss a dose as much as possible. If a missed dose is taken, it should be refilled in time to ensure that the dose is sufficient for at least the entire week.

Special population:

At the recommended dose, levothyroxine is not teratogenic to the fetus, nor will it interfere with fetal thyroid function. Therefore, women during pregnancy and lactation cannot stop levothyroxine treatment. The dose may need to increase during pregnancy. Hypothyroidism caused by drug withdrawal has a great impact on maternal and fetal development. Levothyroxine cannot be used as an adjuvant treatment for hyperthyroidism during pregnancy, as this will increase the dose of antithyroid drugs and increase the risk of suppressing fetal thyroid function.

Patients with coronary heart disease, elderly, severe or long-term hypothyroidism must be very cautious about the dose of levothyroxine. It must be started with a small dose, the interval between dose increases should be lengthened, and the monitoring of thyroid function should be strengthened.

Patients with after thyroid cancer surgery take levothyroxine on the one hand to supplement thyroid hormones to prevent hypothyroidism, and on the other to inhibit thyroid stimulating hormone to prevent cancer recurrence.

Contraindications:

1. Allergy.
2. Untreated adrenal insufficiency, pituitary insufficiency, hyperthyroidism, coronary heart disease, angina pectoris, arteriosclerosis and high blood pressure.
3. Acute myocardial infarction, acute myocarditis.

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Why do women age faster than men, but live longer?👨👩👫

Aging is a process that everyone has to go through, but observing the people around us, we will find that aging seems to be a bit of "female preference". At the same age, men tend to look younger, but women always look older. Research has also found that although women age faster than men, they tend to live longer. What is going on?

Why do women age faster than men?

1. Collagen is lost faster than men.

Studies have found that under the same conditions of sun exposure and natural aging, the loss of collagen in the skin of women is faster than that of men. This also means that women are more likely to have problems such as wrinkles, enlarged pores and sagging skin.

2. Pregnancy and childcare.

Women usually take on the heavy responsibility of having children and pay a lot for pregnancy and raising babies. From a medical point of view, pregnancy and raising babies will not directly lead to aging. However, the fatigue of the process of pregnancy and raising babies can easily accelerate female aging. For women who are employed, they need to work during the day and take care of their children at night. They are often prone to lack of sleep and exhaustion. This is also the reason why married women look older.

3. Decline in estrogen during menopause.

Menopause is a necessary process for women and it is also an important turning point for women to age. During this period, women's menstruation naturally fails, ovarian function gradually declines, estrogen secretion is reduced, endocrine disorders, the balance of collagen synthesis will also be imbalanced. Wrinkles, osteoporosis and other aging manifestations are more likely to occur. 

👵Although women age faster than men, women tend to live longer than men in terms of life span. Why does this happen?

Why do women live longer than men?

According to data, the average life expectancy of men is 70.31 years, and that of women is 75.33 years in 2021 in 224 countries and regions around the world. Women live 5 years longer than men on average. What is the reason? In fact, this has both innate factors and acquired factors.

1. Genetic.

Human genetic differences, especially differences in genes or chromosomes may determine the lifespan of men and women. Studies have pointed out that the existence of the Y chromosome may shorten the life span. Females are made up of two X chromosomes. Males are made up of one X chromosome paired with one Y chromosome. Two X chromosomes can complement each other. If one X chromosome goes wrong, there is another one available for backup. However, this is not the case with men's chromosomes. When a certain X chromosome goes wrong, corresponding diseases will occur.

2. Hormonal differences.

The difference between male and female hormones also makes women live longer than men. The cholesterol levels of men and women before puberty are similar. But after the age of 40, men are at the risk of heart disease, while the risk of women is after the age of 50. Women's heart disease risk generally begins after menopause. It is because women's estrogen levels are lowered after menopause. Estrogen can reduce the concentration of low-density lipoprotein, a cholesterol in the blood that is harmful to the heart. At the same time, it can also increase the level of high-density lipoprotein, another cholesterol in the blood that is benefit to the heart. The male androgen does not have this function.

3. Lifestyle and mental health.

Compared with women, men are more likely to have bad habits such as smoking, drinking, overeating and staying up late. Therefore, men's physical health is often not as good as women's, which also affects life expectancy.

Women also have an advantage in emotional release, and men rarely vent to the outside even when they are under great pressure. This can seriously damage physical and mental health.

4. Relatively fewer women choose high-risk occupations.

In some high-risk industries, such as construction and mining, there are relatively fewer female employees than male employees. Any injury or disability in these dangerous industries will affect the life expectancy of men in the future.

👇Do the following to make you look younger than your peers:

1. Sun protection.

Sunlight is the biggest cause of wrinkles. Because the long-wave ultraviolet in the sun can brown and age people, and the short-wave ultraviolet can sunburn. Sunlight is the biggest cause of wrinkles. Because the long-wave ultraviolet (UVA) in the sun can tan and age people, and the short-wave ultraviolet (UVB) can sunburn. Therefore, if you don't want to age in advance, you must first minimize your exposure to ultraviolet rays and always pay attention to sun protection. You can try physical sun protection, such as wearing a sun hat and long clothes. You can also try wiping off sunscreen.

2. Enough sleep.

Long-term lack of sleep will not only accelerate the aging of the human body. It can also cause yellowing of the skin, swollen eyes, etc. It can also affect the health of the human body and reduce life span. Therefore, if you want to delay aging and prolong your life, you must first have enough sleep. It is recommended to go to bed before 11 o'clock in the evening to ensure 6-8 hours of sleep.

3. Balanced diet.

Modern people's lifestyle of overeating is really harmful to health. The diet should be balanced and appropriate. Usually eat potatoes, beans and other foods rich in dietary fiber. Also pay attention to supplementing milk, soybeans or their products. Drink yogurt in moderation to supplement probiotics. Eat moderate amounts of fish, poultry, eggs and lean meat. Reduce the amount of cooking oil and eat light and salt-less meals. Brightly colored fruits and vegetables are often rich in anthocyanins, vitamin C and vitamin E. It can effectively remove harmful free radicals in the body and help the body to resist oxidation and delay aging. These fruits and vegetables can be eaten more appropriately.

4. Regular exercise.

Common sports can be divided into four basic types: endurance sports, strength sports, balance sports and flexible sports. You can randomly combine exercise methods according to your own physical condition and don't be limited to one type of exercise.

5. Develop a good attitude.

You should also pay attention to adjusting your emotions and keep your mood cheerful.

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The most effective medicine for hair loss.👳👳👳

Men who think too much and sleep too little can cause hair loss and the most common cause is androgenetic alopecia. Nowadays, the society pays much attention to appearance. It may be due to factors such as diet and stress, there are more and more people who lose hair. It is regardless of whether they are male or female. Therefore, hair loss is also a concern of many people. Hair loss not only affects the appearance, but may even affect the psychology and cause mental illness.

1. What is androgenetic alopecia?

Androgenetic alopecia used to be called seborrheic alopecia which is mainly manifested by the loss of hair on the top of the head and the receding hairline. Although there are many drugs that are clinically used to treat androgenic alopecia, currently there are two types of drugs that are generally recognized as effective: the oral drug and the topical drug.

2. Finasteride: For men only

The growth and development of the prostate depends on the level of dihydrotestosterone. Finasteride is a 5α-reductase inhibitor. It can inhibit the conversion of testosterone into more active dihydrotestosterone. It has an antiandrogenic effect, so it is also used to treat existing symptoms of benign prostatic hyperplasia (BPH).

The activity of 5α-reductase in hair follicles in male hair loss areas is significantly higher than that in non-hair loss areas. High levels of dihydrotestosterone can shrink hair follicles which will gradually lead to long-term hair shortening, thinning and shedding. Since finasteride can reduce the level of dihydrotestosterone, it is also used in the treatment of androgen alopecia.

Oral finasteride generally takes more than three months to observe increased hair growth or prevent continued hair loss. Symptoms can recur within 12 months after stopping the drug.

Dosage: Oral finasteride is available in 5 mg and 1 mg specifications.

• 5mg each time, once a day. It is used for the treatment of benign prostatic hyperplasia.
• 1mg each time, once a day. It is used for the treatment of male hair loss.
• Finasteride can reduce sexual function. Use during pregnancy can feminize the male fetus (hypospadias). Women who are pregnant or may become pregnant should not even touch the fragments of finasteride. Not only that, finasteride is not effective in treating female hair loss. Therefore, finasteride is not recommended for female hair loss.

3. Spironolactone: For female's androgenetic alopecia

Spironolactone is an anti-androgen. It can reduce the secretion of androgens. It can play a role in multiple links in the occurrence of hair loss. It significantly reduces the binding of DHT to the androgen receptor in the follicle. It has a certain therapeutic effect on androgenetic alopecia. It can also increase the concentration of estrogen relatively and play a role in promoting hair growth. The best way to use it is combining with minoxidil. There are researches pointed out that the use of spironolactone combined with minoxidil can increase the effect by more than 40% compared with minoxidil alone.

Dosage: 

• The recommended dosage of spironolactone for the treatment of hair loss is 100-200mg, twice a day and take the medicine on time every day. Only when the therapeutic dosage is achieved, the best effect can be reached. This drug should be consulted by a doctor for using.

4. Minoxidil: Men and women available

Minoxidil is a K⁺ channel opener. It can relax blood vessels and lower blood pressure. It is mainly used for the treatment of refractory severe hypertension. It is not suitable for using alone. it needs to be used in combination with diuretics and β-receptor blockers to avoid water and sodium retention and sympathetic reflex excitement. 

The curative effect of topical minoxidil in the treatment of male and female hair loss has been confirmed by clinical research. It may be related to the fact that minoxidil stimulates dermal papilla cells to express vascular endothelial growth factor, expands scalp blood vessels, and improves microcirculation. The average onset time for topical application is 12 weeks and the recommended course of medication is 0.5 to 1 year.

Dosage: There are two kinds of minoxidil topical preparations: 5% and 2%.

• Regardless of men and women, 5% minoxidil is more effective than 2% minoxidil. But it is still recommended: 5% minoxidil for male patients and 2% minoxidil for female patients. It is because 5% minoxidil can increase local or generalized hirsutism in women.
• The usage and dosage of minoxidil topical preparations are as follows: apply to the affected area of the head 1ml each time, twice a day. Researches have proved that for topical application about 0.3-4.5% of minoxidil which can be absorbed through the skin. So the daily dosage should not exceed 2ml, otherwise it may cause systemic adverse reactions.

👉The above drugs are all prescription drugs. Before using them, you should consult the doctor for more details.

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Obesity should be seen as a potentially chronic disease.🍨🍩🍪

Obesity is not just a physical problem, but a disease that needs attention and treatment. In December 2016, the American Association of Clinical Endocrinologists and the American Endocrinologists Association issued a statement suggesting that a new medical diagnostic term for obesity-based chronic diseases. It was intended to emphasize that obesity affect health and need to control and manage complications as the chronic diseases. 

With the improvement of living standards and changes in lifestyles, the incidence of obesity is showing an obviously increasing. People are paying more and more attention to chronic diseases. The incidences of hypertension, hyperlipidemia and diabetes are also increasing year by year. More researches believe that obesity has become one of the important predisposing factors for many chronic diseases. World Health Organization recognize obesity as the fifth largest risk factor affecting health and can easily lead to many serious complications.

1. Obesity and cardiovascular disease

Obesity can cause the body's fat metabolism disorder which further leads to the occurrence of hyperlipidemia and hypertension. With the increase of BMI, the incidence of hyperlipidemia and hypertension gradually increases.

Adipocytes proliferate and increase in number, the number of insulin receptors on the surface of hypertrophic adipocytes is relatively reduced and insulin affinity decreases. It results in insulin resistance. This may be one of the reasons that obesity leads to abnormal lipid metabolism and causes hyperlipidemia. The mechanism of obesity-induced hypertension may be related to the comprehensive effects of  the immune system, the sympathetic nervous system and the renin-angiotensin system. 

2. Obesity and diabetes

Overweight and obesity are one of the important risk factors related to the onset of diabetes. As the BMI level increases, the risk of disease increases.

The possible mechanism is that excessive eating will cause a large increase in blood sugar and stimulate the islet cells to secrete a large amount of insulin to maintain blood sugar in the normal blood sugar range. It cannot meet the body's requirement for glucose metabolism regulation and cause increased blood sugar. The excess body fat of overweight and obese people leads to the enhancement of fat degradation. Glycogen utilization is impaired, glucose oxidative metabolism decreases and blood sugar rises. In addition, the liver intake of insulin is reduced which leads to an increase in insulin concentration in the body. It leads to hyperinsulinemia and causes down-regulation of insulin receptor expression and insulin resistance.

3. Obesity and hyperuricemia

Uric acid is the end product of purine metabolism which is mainly derived from the enzyme decomposition of nucleic acids and other purine compounds and purine components in food. More and more studies have shown that hyperuricemia is an important component of metabolic syndrome. It has a certain relationship with obesity. Obese people are more likely to suffer from hyperuricemia. Obesity, especially abdominal obesity, is closely related to hyperuricemia. 

The possible mechanisms are: 

1. Too much energy intake, increased purine synthesis in the body and increased uric acid. 

2. Too much eating and too little consumption. It leads to the accumulation of excessive visceral fat and when the liver fatty acid synthesis is hyperactive. It eventually leads to the synthesis of triglyceride and the production of uric acid are hyperactive. 

3. Insulin resistance leads to a decrease in uric acid excretion.

Insulin resistance is one of the main pathophysiological mechanisms of metabolic syndrome and obesity is the theory that leads to the most evidence of insulin resistance.

4. Obesity and other complications

Lungs: The lungs are squeezed by fat. The breathing becomes difficult and it is difficult for the blood to carry out effective oxygen circulation. That can damage the immune system and cause high blood pressure.

Joint: Obesity will increase the weight-bearing of joints such as wrists and knees. It cause osteoarthritis. Obese people are much more likely to develop arthritis than ordinary people.

Intestinal: The fat accumulated around the internal organs will continue to secrete a large number of hormones or chemicals, which will cause changes in metabolism and cause type 2 diabetes. In addition, the secreted hormones can cause endocrine disorders and cause polycystic ovary syndrome, which can have a certain impact on women's future fertility.

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Application of glucocorticoids in clinical diseases.👀

The applications of glucocorticoids are very extensive and vary with the dose.
Glucocorticoids secreted under physiological conditions mainly affect the metabolism of substances. It will cause metabolic disorders and death when lacking. When glucocorticoids are pharmacological doses, in addition to affecting substance metabolism, it also have immunosuppressive , anti-inflammatory, detoxify and anti-shock effects.

1. Classification and difference of common glucocorticoids

According to the duration of action, glucocorticoids can be divided into three categories:

Category	Drug	Dose equivalent (mg)	Effective drug duration (hours)
Short-acting	Cortisone	25	8-12
	Hydrocortisone	20
Medium-acting	Prednisone	5	12-36
	Prednisolone	5
	Methylprednisolone	4
Long-acting	Dexamethasone	0.75	36-54
	Betamethasone	0.6

2. Glucocorticoid treatment course and withdrawal

Pulse therapy: The course of treatment is usually less than 5 days. It indicated for rescue of critically ill patients. The drug can be withdrawn quickly.

Short-term treatment: The course of treatment is less than 1 month. It indicated for infection or allergic diseases. Withdraw the drug by gradually reducing.

Medium-term treatment: The course of treatment is during within 3 months. It indicated for long term and multiple organ involvement disease. Withdraw the drug by gradually reducing.

Long-term treatment: The course of treatment is more than 3 months. It indicated for chronic autoimmune diseases, such as systemic lupus erythematosus. Before stopping the drug, the drug treatment should be gradually transitioned to alternate day therapy, then reduce the dose gradually and slowly.

Alternative therapy: Lifetime use. It indicated for primary or secondary chronic adrenocortical insufficiency.

3. Application of glucocorticoids in common diseases

Hyperthyroidism crisis: The level of thyroid hormones is sudden increase in the body. It is always related to the patients with insufficient treatment in severe or chronic hyperthyroidism. 

Treatment: Inorganic iodides, antithyroid drugs, β-receptor blockers and glucocorticoids (glucocorticoids can inhibit the conversion of peripheral T4 to T3).

Graves' ophthalmopathy: It is an organ-specific autoimmune disease related to the thyroid. It mainly manifests as exophthalmos, eyelid contracture, periorbital edema, bulbar conjunctival edema and eyeball activity dysfunction.

Treatment: For mild, the main treatment is to control hyperthyroidism or hypothyroidism. For moderate to severe, intravenous or oral glucocorticoid therapy is the main treatment.

Autoimmune hemolytic anemia: It is caused by lymphocytes function abnormally. Lymphocytes produce antibodies against the red blood cells, which accelerates the destruction of red blood cells in the body.

Treatment: For acute hemolytic attacks, intravenous infusion of dexamethasone or methylprednisolone is the first choice. Oral prednisone is the first choice for milder conditions (Taken in the morning).

Idiopathic thrombocytopenic purpura: The patient produces anti-platelet autoantibodies in the body.

Treatment: Glucocorticoids are the first choice. Immunosuppressants are needed for ineffectiveness and large doses of intravenous γ-globulin are used for severe bleeding.

Aplastic anemia: Abnormal activation and hyperfunction of T lymphocytes cause bone marrow damage.

Treatment: Antithymus/lymphocyte globulin (daily simultaneous application of glucocorticoids to prevent allergic reactions) and cyclosporine are commonly used.

Graft-versus-host disease: It is the most common complication of allogeneic hematopoietic stem cell transplantation and involving a variety of immune cells and inflammatory cytokines.

Treatment: For acute, use glucocorticoids (common use methylprednisolone and prednisone) combined with calcineurin inhibitors. For chronic, use cyclosporine A combined with glucocorticoids.

Nephrotic syndrome: It is characterized by massive proteinuria and it often accompanied by hypoalbuminemia (≤30g/L), edema and hyperlipidemia.

Treatment: Glucocorticoids or combined immunosuppressive agents (cyclophosphamide, cyclosporine A, mycophenolate mofetil, etc.).

Lupus nephritis: It refers to systemic lupus erythematosus complicated by kidney damage. It has varying clinical manifestations, such as hematuria, tubular urine, persistent proteinuria or decreased renal function.

Treatment: Oral glucocorticoid therapy is the main treatment. If it is necessary, glucocorticoid pulse therapy or other immunosuppressive agents should be added.

Adrenal crisis: Acute reduction of adrenal cortex function induced by infection, trauma and other stress conditions or withdrawal of hormones. It leads to high fever, drop in blood pressure and so on. 

Treatment: Intravenous infusion of glucocorticoid (hydrocortisone), correction of dehydration and electrolyte disturbances and treatment of hypoglycemia.

Systemic lupus erythematosus: It is an autoimmune-mediated diffuse connective tissue disease characterized by immune inflammation.

Treatment: For mild, use no or small doses glucocorticoids. For medium, glucocorticoids + other immunosuppressive agents (cyclophosphamide or mycophenolate mofetil). For severe conditions, it is required large doses of glucocorticoids + other immunosuppressive agents. If it is necessary pulse treatment, methylprednisolone can be used.

Bronchial asthma: Asthma is a chronic airway inflammatory disease involving a variety of cells and cellular components.

Treatment: Inhaled glucocorticosteroids (ICS) are the first choice for long-term treatment of asthma. For chronic severe persistent asthma that cannot be controlled by high-dose ICS + LABA (Long-acting beta-agonists, such as formoterol.), low-dose oral glucocorticoid maintenance therapy can be added. Generally use a short half-life glucocorticoids (such as prednisone.), and take it in the morning. 

Idiopathic pulmonary fibrosis (IPF): It is a chronic, progressive and fibrotic interstitial pneumonia of unknown etiology. The median survival time from diagnosis is only 2 to 3 years.

Treatment: Anti-fibrosis agents pirfenidone and nintedanib can delay the decline of pulmonary function in patients with IPF. Patients with acute exacerbations should be treated with glucocorticoids as appropriate and avoiding glucocorticoids in the stable phase is beneficial to prolong the natural progress of the disease.

Ulcerative colitis (UC): Inflammatory bowel disease refers specifically to inflammatory bowel disease of unknown etiology, including ulcerative colitis and Crohn's disease. The cause is unknown and there is no cure for the time being. The lesions of UC were distributed continuously.

Treatment: For mild, use aminosalicylic acid preparations (such as mesalazine). For moderate, adequate aminosalicylic acid preparations are not well controlled and switch to glucocorticoid therapy. Thiopurine drugs can be used for glucocorticoid-ineffective or dependent patients. If the above treatments are ineffective, it should consider using infliximab.

Crohn's disease: Crohn's disease is also an inflammatory bowel disease of unknown etiology and the lesions are distributed in segments.

Treatment: For mild, use aminosalicylic acid preparations (such as mesalazine). For moderate to severe, use glucocorticoid. For those who fail to treat glucocorticoids or sulfa drugs, switch to or add azathioprine, cyclosporine and other immunosuppressive agents Agent. If the above treatments are ineffective, consider using infliximab.

Ankylosing spondylitis: It is a chronic inflammatory disease that mainly affects the sacroiliac joints, spine, paraspinal soft tissues and peripheral joints. It may be accompanied by extra-articular manifestations. In severe cases, spinal deformity and rigidity can occur.

Treatment: First using the drugs  to improve symptoms and disease progress, such as NSAIDs, sulfasalazine and anti-TNFα antagonists. Systemic corticosteroid therapy is generally not recommended. Glucocorticoids are usually used as local adjuvant drugs to improve Symptoms (such as injection into the joint cavity).

Rheumatoid arthritis: It is an autoimmune disease with erosive arthritis as the main clinical manifestation. It can occur at any age.

Treatment: The first choice is methotrexate alone. If it does not achieve treatment effect, it combined with leflunomide, sulfasalazine, and tocilizumab. Patients with moderate/high disease activity, combined with glucocorticoid therapy to quickly control symptoms.

👉When taking glucocorticoids for a long time, calcium and active vitamin D should be supplemented regularly to prevent osteoporosis and femoral head necrosis.

👉Patients with long-term use of glucocorticoids should check their weight, blood pressure, blood lipids, blood sugar, electrolytes, growth and development regularly.

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Inventory of various new discoveries of metformin😎😎😎

Metformin is an anti-diabetic drug and a classic oral hypoglycemic agent. Since its inception in 1957, it has been used clinically for more than 60 years. It is currently one of the most widely used oral hypoglycemic drugs in the world. Even though there are many new hypoglycemic drugs, metformin is still the primary drug for type 2 diabetes.

Metformin was born in 1929 and originated from galega officinalis. In 1957, French diabetologist professor Jean Sterne first used metformin for clinical hypoglycemic reduction. Then its application value is still being discovered. Let us take a look at what new discoveries have been made recently.

1. Cancer

Acidic phospholipids play an important role in regulating electrostatic membrane association of programmed cell death ligand 1 cytoplasmic domain (PD-L1-CD). Metformin can competitively dissociate PD-L1-CD from the membrane and affect the stability of PD-L1. This revealed that the molecular mechanism of metformin's anti-tumor effect and provided new ideas for related immunotherapy targeting PD-L1.

There are many studies that supporting metformin can decrease the risk or improve the symptoms of cancer patients. Such as esophageal squamous cell cancer, pancreatic cancer, primary bone cancer.

2. Obstetrics & Gynecology

a. Improve neonatal obesity

    Metformin has many benefits for mother's blood glucose and neonatal obesity, including improved blood glucose, reduced caesarean section, reduced mother's weight, lower insulin requirements,  lower birth weight and obesity measurements of newborns.

b. Prevent adverse pregnancy outcomes in patients with polycystic ovary syndrome

    Metformin can prevent late period abortion and premature birth in women with polycystic ovary syndrome.

3. Metabolic diseases

Metformin can improve the metabolic status of patients treated with systemic glucocorticoids. It can not only reverse the metabolic complications caused by the use of systemic glucocorticoids, but also reserve the anti-inflammatory effects of glucocorticoids. It benefits many patients taking systemic glucocorticoids.

4. Cardiovascular System

 a. Heart failure

    Non-diabetic heart failure patients with reduced ejection fraction (HFrEF) use metformin to reduce myocardial oxygen consumption and improve myocardial efficiency.

b. Left ventricular hypertrophy

    Metformin treatment significantly reduced the left ventricular mass index. Patients taking metformin reduced left ventricular thickening by two time less. In addition, metformin also reduced blood pressure, oxidative stress, and weight. Metformin has the potential to improve cardiovascular health.

c. Air-pollution-induced thrombosis

    Atmospheric particulate matter can induce alveolar macrophages to release pro-inflammatory factors including interleukin 6 (IL-6), leading to arterial thrombosis and death.

    Metformin blocks the mitochondrial electron transport and inhibits the production of reactive oxygen species, thereby blocking the release of IL-6 and inhibiting the formation of arterial thrombosis. This confirms that metformin can be used as a potential therapeutic drug to prevent cardiovascular diseases caused by air pollution.

5. Nervous system

a. Cognitive and nerve recovery after brain tumor surgery

    For children with brain tumor patients who have received craniocerebral radiotherapy, metformin can significantly improve their statement memory and working memory function, repairing white matter damage. Metformin is also safe and tolerable in this population.

b. Multiple Sclerosis

    After treatment with metformin, oligodendrocyte precursor cells can restore their response to the signal of promoting-differentiation, promote the regeneration of nerve myelin. This is useful for the treatment of central nerve demyelination such as multiple sclerosis.

c. Cognitive decline and dementia

    Patients with type 2 diabetes who take metformin have slower cognitive decline and a lower risk of dementia.

6. Locomotor system

a. Osteoarthritis

    Metformin can prevent the occurrence and development of osteoarthritis, alleviate the pain sensitivity associated with osteoarthritis in mice. Its protective effect on cartilage is mainly through the activation of AMPK signals.

b. Intervertebral disc degenerative disease

    Metformin can promote the release of small extracellular vesicles of mesenchymal stem cells, increase the level of proteins that regulate cell proliferation in the vesicles, and can optimize the application effect of extracellular vesicles in the regeneration and repair of intervertebral discs.

7. Digestive system

Metformin stimulates bile secretion in the intact liver, but this drug can also cause severe damage to bile acid secretion.

8. Infection

a. COVID-19

   Metformin inhibits the activation of NLRP3 inflammasomes and the production of IL-1β in cultured macrophages and alveolar macrophages, as well as the secretion of inflammasome-independent IL-6, thereby attenuating lipopolysaccharide and COVID-19 induced acute respiratory distress syndrome. Metformin can be a potential treatment for severely patients with COVID-19 and other induced acute respiratory distress syndrome.

b. HIV

    Metformin reacted on mitochondrial respiratory chain complex-I and inhibit the oxidative phosphorylation (OXPHOS) pathway. It inhibited the replication of human CD4⁺ T cells and HIV-1 virus in humanized mouse models. It revealed that metformin and others OXPHOS pathway inhibitors may be an adjunct to treat AIDS.

👉Metformin has also anti-aging effect. Most effects still are at the research stage and may not be used on treatment. Therefore, metformin still deserves more in depth research.

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Why some doctors prescribe levothyroxine tablets to the hyperthyroidism or hypothyroidism patient?😨😨😨

Do you see the doctor do that? Do you feel confused? Let's see why the doctor do it~~

Levothyroxine

It is a thyroid medicine that can substitute hormone normally produced by the thyroid gland to regulate the body's metabolism and energy. 

So, it is easy to understand why the doctor prescribes it to the hypothyroidism patient. It will supply the patient enough material to transform into thyroxine.

But why the hyperthyroidism patient is also prescribed it?

Clinically, the hyperthyroidism patients with exophthalmos or goiter, can be given appropriate amount of levothyroxine. The purpose is to inhibit thyroid stimulating hormone (TSH). Because when the antithyroid drugs are given to treat hyperthyroidism, the patient's thyroxine will gradually decrease, the inhibition of TSH gradually weakens. The increasing TSH will aggravate exophthalmos or goiter.

In another case, some patient will have hypothyroidism when the antithyroid drugs are a little more, and they will have hyperthyroidism when the antithyroid drugs are slightly reduced. It is difficult to adjust the dosage. Using levothyroxine and antithyroid drugs can better balance the level of thyroid hormones.

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