Levothyroxine - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

LEVOTHYROXINE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES...

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LEVOTHYROXINE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Levothyroxine: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00659-6 1. Levothyroxine-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on levothyroxine. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON LEVOTHYROXINE ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Levothyroxine................................................................................ 5 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND LEVOTHYROXINE ............................................................................ 43 Overview...................................................................................................................................... 43 Finding Nutrition Studies on Levothyroxine .............................................................................. 43 Federal Resources on Nutrition ................................................................................................... 44 Additional Web Resources ........................................................................................................... 44 CHAPTER 3. ALTERNATIVE MEDICINE AND LEVOTHYROXINE ...................................................... 47 Overview...................................................................................................................................... 47 National Center for Complementary and Alternative Medicine.................................................. 47 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 49 CHAPTER 4. DISSERTATIONS ON LEVOTHYROXINE ........................................................................ 51 Overview...................................................................................................................................... 51 Dissertations on Levothyroxine ................................................................................................... 51 Keeping Current .......................................................................................................................... 51 CHAPTER 5. PATENTS ON LEVOTHYROXINE ................................................................................... 53 Overview...................................................................................................................................... 53 Patents on Levothyroxine............................................................................................................. 53 Patent Applications on Levothyroxine......................................................................................... 58 Keeping Current .......................................................................................................................... 61 CHAPTER 6. PERIODICALS AND NEWS ON LEVOTHYROXINE ......................................................... 63 Overview...................................................................................................................................... 63 News Services and Press Releases................................................................................................ 63 Academic Periodicals covering Levothyroxine............................................................................. 65 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 67 Overview...................................................................................................................................... 67 U.S. Pharmacopeia....................................................................................................................... 67 Commercial Databases ................................................................................................................. 68 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 71 Overview...................................................................................................................................... 71 NIH Guidelines............................................................................................................................ 71 NIH Databases............................................................................................................................. 73 Other Commercial Databases....................................................................................................... 75 APPENDIX B. PATIENT RESOURCES ................................................................................................. 77 Overview...................................................................................................................................... 77 Patient Guideline Sources............................................................................................................ 77 Finding Associations.................................................................................................................... 79 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 81 Overview...................................................................................................................................... 81 Preparation................................................................................................................................... 81 Finding a Local Medical Library.................................................................................................. 81 Medical Libraries in the U.S. and Canada ................................................................................... 81 ONLINE GLOSSARIES.................................................................................................................. 87 Online Dictionary Directories ..................................................................................................... 87

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LEVOTHYROXINE DICTIONARY ............................................................................................. 89 INDEX .............................................................................................................................................. 113

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with levothyroxine is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about levothyroxine, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to levothyroxine, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on levothyroxine. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to levothyroxine, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on levothyroxine. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON LEVOTHYROXINE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on levothyroxine.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and levothyroxine, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “levothyroxine” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Most Frequently Prescribed Medications in the Elderly and Their Impact on Dental Treatment Source: Dental Clinics of North America. 41(4): 699-726. October 1997. Summary: The elderly dental patient may present with multiple chronic illnesses that are managed with drug therapy. This article reviews medications in the elderly and their potential impact on dental treatment. The authors stress that an awareness of ageassociated pharmacokinetics and pharmacodynamics, along with knowledge about the indications, adverse effects, key drug interactions, and oral side effects of frequently prescribed medications will help the clinician in assessment of the patient for dental care. Pharmacologic awareness also helps to identify patients at high risk for potential medical emergencies in the dental office, and prepares the staff to consider management changes to avoid these situations. The authors describe the most frequently prescribed

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medications for elderly persons, including diuretics, ACE inhibitors, calcium channel blockers, antianginals, beta-adrenergic blockers, cardiac glycosides, oral anticoagulants, antithrombotics, nonsteroidal anti-inflammatory drugs, and H2-receptor antagonists; central nervous system agents, including antianxiety agents, sedatives, and antidepressants; and endocrine agents, including oral hypoglycemic agents, levothyroxine, and estrogen. Other topics include age-related pharmacokinetic changes in drug metabolism; adverse drug reactions; and oral side effects of the most frequently prescribed medications, including xerostomia (dry mouth), taste changes, and stomatitis (inflammation of the oral mucosal tissues). The authors discuss the overall impact of medications on dental management, including physician consultation, monitoring vital signs, a stress reduction protocol, an orthostatic hypotension protocol, local anesthesia and vasopressor caution, semisupine chair position, oral side effects, caries and periodontal disease risk management, and drug interactions. The authors stress that effective diagnosis, treatment planning, and patient management should be based on a thorough review of the medical and medication history of each patient. The medication history should include a review of both prescription and over the counter medications because many over the counter drugs are involved in drug-drug interactions. 1 figure. 3 tables. 101 references. •

Drug/Nutrient Interactions Involving Twenty of the Most Commonly Prescribed Medications in the United States Source: Journal of Practical Hygiene. 9(1): 39-48. January-February 2000. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200. Summary: The increased use of prescribed medication in the United States has established the need for dental professionals to understand the possible interactions between medications and nutrients. This article discusses interactions between nutrients and the 20 most commonly prescribed medications in 1998: conjugated estrogen, levothyroxine, amoxicillin, hydrocodone, fluoxetine, omeprazole, azithromycin, atorvastin, amlodipine, loratine, digoxin, sertaline, aerosol, paroxetine, amoxicillin, lisinopril, enalapril, amoxicillin clavulanate potassium, and cephalexin. In addition, a discussion of practical considerations for the dental hygiene practice is provided. The authors stress that thoroughly completing and reviewing the dental patient's medical and drug history, as well as conducting a diet assessment, are methods by which the dental hygienist can determine if a patient's health is at risk due to drug and nutrient interactions. 3 figures. 2 tables. 38 references.

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Hypothyroidism, Hyperthyroidism, Hyperparathyroidism Source: Patient Care. 33(14): 186-188, 191, 195-200, 202-203, 206. September 15, 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article discusses the diagnosis and treatment of thyroid illnesses. These types of illnesses are among the most prevalent of the hormonal diseases that afflict people in the United States. Although hypothyroidism and hyperthyroidism are the most widespread, hyperparathyroidism (HPT) occurs in a large number of Americans as well. Diagnosis can be complicated because numerous patients present with nonspecific signs and symptoms that closely resemble other physical and mental conditions. Primary hypothyroidism occurs from failure of the thyroid gland itself, whereas secondary hypothyroidism results from a deficiency of pituitary thyroid-stimulating

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hormone. The most common cause of hypothyroidism among adult patients is Hashimoto's thyroiditis. Other causes include drug side effects, congenital hypothyroidism, iodine excess, previous thyroidectomy, neck irradiation, and pituitary or hypothalamic disorders. Women who have type 1 diabetes are at greater risk for a temporary disorder known as postpartum thyroiditis. Signs and symptoms can be overt, subtle, or nonexistent. Diagnosis involves performing a physical examination and conducting laboratory tests. The treatment of choice for managing hypothyroidism is daily oral administration of levothyroxine. Some patients may benefit from referral to an endocrinologist. Hyperthyroidism, which is not as prevalent as hypothyroidism, is caused by Graves' disease or diffuse toxic goiter. Other causes include pituitary tumors, pituitary resistance to thyroid hormones, neonatal hyperthyroidism, and malignancies. Signs and symptoms can be overt, subtle, or nonexistent. Diagnosis involves performing a physical examination and conducting laboratory tests. Patient referral to an endocrinologist is indicated following a positive diagnosis or when hyperthyroidism is suspected. Treatment options include radioactive iodine therapy, antithyroid drugs, and surgery. HPT, another fairly common endocrine disorder, is the most common cause of hypercalcemia. Although about 75 percent of patients have no signs or symptoms attributable to this disease, it may affect the skeletal system, kidneys, and gastrointestinal tract. The only successful treatment is surgical removal of one or more parathyroid glands. Patients who have primary HPT should be referred to an endocrinologist. 1 figure. 4 tables. 5 references.

Federally Funded Research on Levothyroxine The U.S. Government supports a variety of research studies relating to levothyroxine. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to levothyroxine. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore levothyroxine. The following is typical of the type of information found when searching the CRISP database for levothyroxine: •

Project Title: THERAPY

LEVOTHYROXINE:

TRIIODOTHYRONINE

COMBINATION

Principal Investigator & Institution: Jonklaas, Jacqueliine; Medicine; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2002; Project Start 15-MAY-2002; Project End 30-APR-2007

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Summary: (provided by applicant): The objective of this project is to determine what combination of thyroid hormones provides optimum replacement therapy for hypothyroidism. There are two circulating thyroid hormones, thyroxine and triiodothyronine, and standard thyroid hormone replacement consists of synthetic thyroxine (levothyroxine) alone. Although levothyroxine is converted into triiodothyronine in the circulation, triiodothyronine levels achieved may not be equal to those seen with intact thyroid function. Therefore, the overall hypothesis of this project is that levothyroxine replacement results in a subtle deficiency of triiodothyronine and provides incomplete treatment for hypothyroidism. The initial hypothesis to be tested in this project is whether, within individual patients, standard replacement with levothyroxine results in lower serum levels of triiodothyronine than those seen while the thyroid gland is functioning. Participants will be euthyroid individuals scheduled for thyroidectomy for benign nodular disease or thyroid cancer. Serum triiodothyronine levels prior to thyroid surgery will be compared with those after thyroidectomy, to determine if levothyroxine replacement results in lower, sub-physiologic triiodothyronine levels. Another hypothesis of this project is that a panel of genes can be identified whose expression level is reflective of thyroid status. Complimentary (c) DNA array technology will be used to develop a gene panel whose expression is regulated by thyroid hormone. This gene panel will be included in the biochemical markers used to assess thyroid status. The third hypothesis is that levothyroxinetriiodothyronine combination will provide superior treatment of hypothyroidism. Biochemical, physiologic and psychologic indices of thyroid status will be compared during combination therapy with several ratios of levothyroxine and triiodothyronine to indices during treatment with levothyroxine alone. The regimens will be compared to determine if the one that most closely reproduces the triiodothyronine levels seen with intact thyroid function, also has the most favorable impact on thyroid status. The final hypothesis of this project is that sustained release triiodothyronine is superior to commercially available triiodothyronine. Because of its short half-life, replacement with triiodothyronine leads to fluctuating serum levels. A new sustained release product, which results in steady triiodothyronine levels, will furnish more physiologic replacement. This will be tested against treatment with levothyroxine, and levothyroxine and triiodothyronine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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To generate your own bibliography of studies dealing with levothyroxine, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “levothyroxine” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for levothyroxine (hyperlinks lead to article summaries): •

A longitudinal assessment of bone loss in women with levothyroxine-suppressed benign thyroid disease and thyroid cancer. Author(s): McDermott MT, Perloff JJ, Kidd GS. Source: Calcified Tissue International. 1995 June; 56(6): 521-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7648478

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A prospective randomized trial of levothyroxine suppressive therapy for solitary thyroid nodules. Author(s): Papini E, Bacci V, Panunzi C, Pacella CM, Fabbrini R, Bizzarri G, Petrucci L, Giammarco V, La Medica P, Masala M, et al. Source: Clinical Endocrinology. 1993 May; 38(5): 507-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8330445

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A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter. Author(s): Wesche MF, Tiel-V Buul MM, Lips P, Smits NJ, Wiersinga WM. Source: The Journal of Clinical Endocrinology and Metabolism. 2001 March; 86(3): 9981005. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11238476

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A study in normal human volunteers to compare the rate and extent of levothyroxine absorption from Synthroid and Levoxine. Author(s): Berg JA, Mayor GH. Source: Journal of Clinical Pharmacology. 1992 December; 32(12): 1135-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1487553

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Acute hemodynamic effects of levothyroxine loading in critically ill hypothyroid patients. Author(s): Kaptein EM, Quion-Verde H, Swinney RS, Egodage PM, Massry SG. Source: Archives of Internal Medicine. 1986 April; 146(4): 662-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3963946

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Adequate thyroid-stimulating hormone levels after levothyroxine discontinuation in the follow-up of patients with well-differentiated thyroid carcinoma. Author(s): Sanchez R, Espinosa-de-los-Monteros AL, Mendoza V, Brea E, Hernandez I, Sosa E, Mercado M. Source: Archives of Medical Research. 2002 September-October; 33(5): 478-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12459319

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Alopecia of myxedema: clinical response to levothyroxine sodium. Author(s): Signore RJ, von Weiss J. Source: Journal of the American Academy of Dermatology. 1991 November; 25(5 Pt 2): 902-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1761768

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Altered bioavailability due to changes in the formulation of a commercial preparation of levothyroxine in patients with differentiated thyroid carcinoma. Author(s): Olveira G, Almaraz MC, Soriguer F, Garriga MJ, Gonzalez-Romero S, Tinahones F, Ruiz de Adana MS. Source: Clinical Endocrinology. 1997 June; 46(6): 707-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9274701

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Amiodarone-induced elevation of thyroid stimulating hormone in patients receiving levothyroxine for primary hypothyroidism. Author(s): Figge J, Dluhy RG. Source: Annals of Internal Medicine. 1990 October 1; 113(7): 553-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2393210

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Annual reevaluation of patients treated with levothyroxine. Author(s): Stoffer SS, Szpunar WE, Block MR. Source: Postgraduate Medicine. 1982 May; 71(5): 201-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7071035

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Assessment of interchangeability of two brands of levothyroxine preparations with a third-generation TSH assay. Author(s): Escalante DA, Arem N, Arem R. Source: The American Journal of Medicine. 1995 April; 98(4): 374-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7709950

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Augmented hepatic and skeletal thyromimetic effects of tiratricol in comparison with levothyroxine. Author(s): Sherman SI, Ringel MD, Smith MJ, Kopelen HA, Zoghbi WA, Ladenson PW. Source: The Journal of Clinical Endocrinology and Metabolism. 1997 July; 82(7): 2153-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9215287

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Benign course after massive levothyroxine ingestion. Author(s): Tenenbein M, Dean HJ. Source: Pediatric Emergency Care. 1986 March; 2(1): 15-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3774567

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Bioavailability of levothyroxine preparations. Author(s): Wenzel KW. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 July; 13(7): 665. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12964974

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Bioequivalence of generic and brand-name levothyroxine products in the treatment of hypothyroidism. Author(s): Dong BJ, Hauck WW, Gambertoglio JG, Gee L, White JR, Bubp JL, Greenspan FS. Source: Jama : the Journal of the American Medical Association. 1997 April 16; 277(15): 1205-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9103344

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Bioequivalence of levothyroxine preparations for treatment of hypothyroidism. Author(s): Spigelman MK. Source: Jama : the Journal of the American Medical Association. 1997 April 16; 277(15): 1199-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9103337

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Bioequivalence of levothyroxine preparations: industry sponsorship and academic freedom. Author(s): Eckert CH. Source: Jama : the Journal of the American Medical Association. 1997 April 16; 277(15): 1200-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9103338

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Birnbaum R. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 897-8; Author Reply 898-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302239

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Lankin KM. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 897; Author Reply 898-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302238

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Dreyer NA. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 897; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302237

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Brantigan CO. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 897; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302236

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Donohoe M. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 896-7; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302235

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Bell BM. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 896; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302234

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): Gordon BD. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 896; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302233

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): St Germain DL, Ridgway EC. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 895-6; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302232

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Bioequivalence of levothyroxine preparations: issues of science, publication, and advertising. Author(s): DeGroot LJ. Source: Jama : the Journal of the American Medical Association. 1997 September 17; 278(11): 895; Author Reply 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9302231

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Bioequivalence of levothyroxine tablets administered to a target population in steady state. Author(s): Cerutti R, Rivolta G, Cavalieri L, Di Giulio C, Grossi E, Vago T, Baldi G, Righini V, Marzo A. Source: Pharmacological Research : the Official Journal of the Italian Pharmacological Society. 1999 March; 39(3): 193-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10094844

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Bioequivalence of two commercially available levothyroxine-Na preparations in athyreotic patients. Author(s): Gottwald R, Lorkowski G, Petersen G, Schnitzler M, Lucker PW. Source: Methods Find Exp Clin Pharmacol. 1994 November; 16(9): 645-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7746026

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Biologic blood markers reflecting thyroid hormone effect at peripheral tissue level in patients receiving levothyroxine replacement for hypothyroidism. Author(s): Foldes J, Tarjan G, Banos C, Nemeth J, Varga F, Buki B. Source: Acta Med Hung. 1991; 48(1-2): 33-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1813856

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Biologic markers in blood reflecting thyroid hormone effect at peripheral tissue level in patients receiving levothyroxine replacement for hypothyroidism. Author(s): Foldes J, Tarjan G, Banos C, Nemeth J, Varga F, Buki B. Source: Exp Clin Endocrinol. 1992; 99(3): 129-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1526260

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Biopharmaceutical comparison of two levothyroxine sodium products. Author(s): Blouin RA, Clifton GD, Adams MA, Foster TS, Flueck J. Source: Clin Pharm. 1989 August; 8(8): 588-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2504532

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Bone changes in pre- and postmenopausal women with thyroid cancer on levothyroxine therapy: evolution of axial and appendicular bone mass. Author(s): Jodar E, Begona Lopez M, Garcia L, Rigopoulou D, Martinez G, Hawkins F. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1998; 8(4): 311-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10024900

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Bone density is not reduced during the short-term administration of levothyroxine to postmenopausal women with subclinical hypothyroidism: a randomized, prospective study. Author(s): Ross DS. Source: The American Journal of Medicine. 1993 October; 95(4): 385-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8213870

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Bone metabolism in patients with differentiated thyroid carcinoma receiving suppressive levothyroxine treatment. Author(s): Mikosch P, Obermayer-Pietsch B, Jost R, Jauk B, Gallowitsch HJ, Kresnik E, Leb G, Lind P. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 April; 13(4): 347-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804103

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Bone mineral density in premenopausal women receiving levothyroxine suppressive therapy. Author(s): Nuzzo V, Lupoli G, Esposito Del Puente A, Rampone E, Carpinelli A, Del Puente AE, Oriente P. Source: Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology. 1998 October; 12(5): 333-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9859026

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Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine. Author(s): Kung AW, Pun KK. Source: Jama : the Journal of the American Medical Association. 1991 May 22-29; 265(20): 2688-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2023349

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Bone minerals and levothyroxine. Author(s): Schneider P, Borner W. Source: Lancet. 1992 August 15; 340(8816): 437. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1353597

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Bone minerals and levothyroxine. Author(s): Walker JD, Mariash CN, Oppenheimer JH. Source: Lancet. 1992 August 15; 340(8816): 436-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1353596

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Bone minerals and levothyroxine. Author(s): Egsmose C, Hegedus L, Lund B, Hansen JE. Source: Lancet. 1992 August 15; 340(8816): 436. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1353595

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Bone minerals and levothyroxine. Author(s): Wenzel KW. Source: Lancet. 1992 August 15; 340(8816): 435-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1353594

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Calcium carbonate and reduction of levothyroxine efficacy. Author(s): Schneyer CR. Source: Jama : the Journal of the American Medical Association. 1998 March 11; 279(10): 750. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9508149

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Cardiac arrest after intravenous administration of levothyroxine. Author(s): Bacci V, Schussler GC, Bhogal RS, Carter AC. Source: Jama : the Journal of the American Medical Association. 1981 March 6; 245(9): 920. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7463688

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Cardiac effects of long term thyrotropin-suppressive therapy with levothyroxine. Author(s): Biondi B, Fazio S, Carella C, Amato G, Cittadini A, Lupoli G, Sacca L, Bellastella A, Lombardi G. Source: The Journal of Clinical Endocrinology and Metabolism. 1993 August; 77(2): 3348. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8345037

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Cardiac function, physical exercise capacity, and quality of life during long-term thyrotropin-suppressive therapy with levothyroxine: effect of individual dose tailoring. Author(s): Mercuro G, Panzuto MG, Bina A, Leo M, Cabula R, Petrini L, Pigliaru F, Mariotti S. Source: The Journal of Clinical Endocrinology and Metabolism. 2000 January; 85(1): 15964. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10634380

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Carefully monitored levothyroxine suppressive therapy is not associated with bone loss in premenopausal women. Author(s): Marcocci C, Golia F, Bruno-Bossio G, Vignali E, Pinchera A. Source: The Journal of Clinical Endocrinology and Metabolism. 1994 April; 78(4): 818-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8157704

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Change in von Willebrand factor and carotid intima-media thickness in hypothyroid patients with normal thyroid function after levothyroxine replacement therapy. Author(s): Nagasaki T, Inaba M, Henmi Y, Kumeda Y, Ueda M, Tahara H, Ishimura E, Onoda N, Ishikawa T, Nishizawa Y. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2004 February; 150(2): 125-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763909

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Changes in both size and cytological features of thyroid nodule after levothyroxine treatment. Author(s): Vermiglio F, Lo Presti VP, Violi MA, Moleti M, Castagna MG, Finocchiaro MD, Mattina F, Mandolfino M, Zimbaro G, Trimarchi F. Source: Clinical Endocrinology. 2003 September; 59(3): 347-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12919158

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Chemical hyperthyroidism: serum triiodothyronine levels in clinically euthyroid individuals treated with levothyroxine. Author(s): Salmon D, Rendell M, Williams J, Smith C, Ross DA, Waud JM, Howard JE. Source: Archives of Internal Medicine. 1982 March; 142(3): 571-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7065792

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Chronic intestinal giardiasis with isolated levothyroxine malabsorption as reason for severe hypothyroidism--implications for localization of thyroid hormone absorption in the gut. Author(s): Seppel T, Rose F, Schlaghecke R. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 1996; 104(2): 180-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8740944

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Circulating telopeptide type I is a peripheral marker of thyroid hormone action in hyperthyroidism and during levothyroxine suppressive therapy. Author(s): Loviselli A, Mastinu R, Rizzolo E, Massa GM, Velluzzi F, Sammartano L, Mela Q, Mariotti S. Source: Thyroid : Official Journal of the American Thyroid Association. 1997 August; 7(4): 561-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9292943

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Clinical case seminar: Reentrant atrioventricular nodal tachycardia induced by levothyroxine. Author(s): Biondi B, Fazio S, Coltorti F, Palmieri EA, Carella C, Lombardi G, Sacca L. Source: The Journal of Clinical Endocrinology and Metabolism. 1998 August; 83(8): 2643-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9709925

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Cognition and behavior at school entry in children with congenital hypothyroidism treated early with high-dose levothyroxine. Author(s): Simoneau-Roy J, Marti S, Deal C, Huot C, Robaey P, Van Vliet G. Source: The Journal of Pediatrics. 2004 June; 144(6): 747-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15192621

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Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. Author(s): Clyde PW, Harari AE, Getka EJ, Shakir KM. Source: Jama : the Journal of the American Medical Association. 2003 December 10; 290(22): 2952-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14665656

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Comment: levothyroxine bioequivalence. Author(s): Berg JA, Wilson JT. Source: Dicp. 1989 October; 23(10): 812-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2815860

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Comment: therapeutic failure with levothyroxine brand interchange. Author(s): Wolfson BB. Source: The Annals of Pharmacotherapy. 1995 October; 29(10): 1049-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8845549

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Comparative bioequivalence study of a new levothyroxine solution versus a reference L-thyroxine solution in normal healthy volunteers. Author(s): Chassard D, Kerihuel JC, Caplain H, Tran Quang N, Thebault JJ. Source: Eur J Drug Metab Pharmacokinet. 1991; Spec No 3: 324-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1820903

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Comparative effectiveness of dextrothyroxine and levothyroxine in correcting hypothyroidism and lowering blood lipid levels in hypothyroid patients. Author(s): Gorman CA, Jiang NS, Ellefson RD, Elveback LR. Source: The Journal of Clinical Endocrinology and Metabolism. 1979 July; 49(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=447807

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Confusion over levothyroxine settled. Author(s): Murphy JC. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2001 August 15; 58(16): 1476. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11515339

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Congenital hypothyroidism: developmental outcome in relation to levothyroxine treatment variables. Author(s): Heyerdahl S, Oerbeck B. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 November; 13(11): 1029-38. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14651787

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Control of adrenergic overactivity by beta-blockade improves the quality of life in patients receiving long term suppressive therapy with levothyroxine. Author(s): Biondi B, Fazio S, Carella C, Sabatini D, Amato G, Cittadini A, Bellastella A, Lombardi G, Sacca L. Source: The Journal of Clinical Endocrinology and Metabolism. 1994 May; 78(5): 1028-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8175955

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Course of thyroid iodine concentration during treatment of endemic goitre with iodine and a combination of iodine and levothyroxine. Author(s): Saller B, Hoermann R, Ritter MM, Morell R, Kreisig T, Mann K. Source: Acta Endocrinol (Copenh). 1991 December; 125(6): 662-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1789063

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Cretinism after weekly dosing with levothyroxine for treatment of congenital hypothyroidism. Author(s): Rivkees SA, Hardin DS. Source: The Journal of Pediatrics. 1994 July; 125(1): 147-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8021766

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Decreased levothyroxine requirement in women with hypothyroidism during androgen therapy for breast cancer. Author(s): Arafah BM. Source: Annals of Internal Medicine. 1994 August 15; 121(4): 247-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7518657

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Delayed intestinal absorption of levothyroxine. Author(s): Benvenga S, Bartolone L, Squadrito S, Lo Giudice F, Trimarchi F. Source: Thyroid : Official Journal of the American Thyroid Association. 1995 August; 5(4): 249-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7488863

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Desiccated thyroid and levothyroxine in hypothyroidism: comparison in replacement therapy. Author(s): Singh SP, Feldman EB, Carter AC. Source: N Y State J Med. 1972 May 1; 72(9): 1045-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4502390

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Diarrhoea soon after levothyroxine replacement therapy. Author(s): El-Houni A, Younis N, Soran H, Bowen-Jones D. Source: Qjm : Monthly Journal of the Association of Physicians. 2002 February; 95(2): 125-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11861961

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Diastolic dysfunction in patients on thyroid-stimulating hormone suppressive therapy with levothyroxine: beneficial effect of beta-blockade. Author(s): Fazio S, Biondi B, Carella C, Sabatini D, Cittadini A, Panza N, Lombardi G, Sacca L. Source: The Journal of Clinical Endocrinology and Metabolism. 1995 July; 80(7): 2222-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7608283

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Does sucralfate impede levothyroxine therapy? Author(s): Khan F, Jeanniton E, Renedo M. Source: Annals of Internal Medicine. 1993 February 15; 118(4): 317. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8481187

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Effect of calcium carbonate on the absorption of levothyroxine. Author(s): Singh N, Singh PN, Hershman JM. Source: Jama : the Journal of the American Medical Association. 2000 June 7; 283(21): 2822-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10838651

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Effect of different starting doses of levothyroxine on growth and intellectual outcome at four years of age in congenital hypothyroidism. Author(s): Salerno M, Militerni R, Bravaccio C, Micillo M, Capalbo D, Di MS, Tenore A. Source: Thyroid : Official Journal of the American Thyroid Association. 2002 January; 12(1): 45-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11838730

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Effect of levothyroxine administration on intestinal P-glycoprotein expression: consequences for drug disposition. Author(s): Siegmund W, Altmannsberger S, Paneitz A, Hecker U, Zschiesche M, Franke G, Meng W, Warzok R, Schroeder E, Sperker B, Terhaag B, Cascorbi I, Kroemer HK. Source: Clinical Pharmacology and Therapeutics. 2002 September; 72(3): 256-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12235446

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Effect of levothyroxine administration time on serum TSH in elderly patients. Author(s): Elliott DP. Source: The Annals of Pharmacotherapy. 2001 May; 35(5): 529-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11346056

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Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study. Author(s): Monzani F, Di Bello V, Caraccio N, Bertini A, Giorgi D, Giusti C, Ferrannini E. Source: The Journal of Clinical Endocrinology and Metabolism. 2001 March; 86(3): 11105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11238494

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Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo- controlled study. Author(s): Monzani F, Caraccio N, Kozakowa M, Dardano A, Vittone F, Virdis A, Taddei S, Palombo C, Ferrannini E. Source: The Journal of Clinical Endocrinology and Metabolism. 2004 May; 89(5): 2099106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15126526

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Effect of low- and high-dose levothyroxine on thyroid nodule volume: a crossover placebo-controlled trial. Author(s): Koc M, Ersoz HO, Akpinar I, Gogas-Yavuz D, Deyneli O, Akalin S. Source: Clinical Endocrinology. 2002 November; 57(5): 621-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12390336

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Effect of TSH-suppressive doses of levothyroxine on bone mineral density in Thai women. Author(s): Ongphiphadhanakul B, Puavilai G, Rajatanavin R. Source: J Med Assoc Thai. 1996 September; 79(9): 563-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8996984

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Effects of levothyroxine suppressive therapy on bone mineral density in premenopausal women. Author(s): Larijani B, Gharibdoost F, Pajouhi M, Sadjadi A, Aghakhani S, Eshraghian R, Akrami SM, Maalouf G. Source: Journal of Clinical Pharmacy and Therapeutics. 2004 February; 29(1): 1-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14748891

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Effects of restricting levothyroxine dosage strength availability. Author(s): Ain KB, Pucino F, Csako G, Wesley RA, Drass JA, Clark C, Ketteridge P, Crawford K, Banks SM, Dorworth TE. Source: Pharmacotherapy. 1996 November-December; 16(6): 1103-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8947984

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Effects of suppressive doses of levothyroxine treatment on sex-hormone-binding globulin and bone metabolism. Author(s): Lecomte P, Lecureuil N, Osorio-Salazar C, Lecureuil M, Valat C. Source: Thyroid : Official Journal of the American Thyroid Association. 1995 February; 5(1): 19-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7787428

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Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a randomized, double-blind, placebo-controlled trial by the French Thyroid Research Group. Author(s): Wemeau JL, Caron P, Schvartz C, Schlienger JL, Orgiazzi J, Cousty C, Vlaeminck-Guillem V. Source: The Journal of Clinical Endocrinology and Metabolism. 2002 November; 87(11): 4928-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12414852

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Elevated serum thyroxine concentration in patients receiving "replacement" doses of levothyroxine. Author(s): Ingbar JC, Borges M, Iflah S, Kleinmann RE, Braverman LE, Ingbar SH. Source: J Endocrinol Invest. 1982 March-April; 5(2): 77-85. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7096921

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Enhancing compliance in schizophrenic patients by weekly dosing with levothyroxine sodium. Author(s): Walch TJ. Source: The Journal of Clinical Psychiatry. 1994 December; 55(12): 543. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7814350

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Equivalence of levothyroxine tablets. Author(s): Lee M. Source: Drug Intell Clin Pharm. 1983 April; 17(4): 265. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6839955

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Equivalence of various levothyroxine preparations. Author(s): Fischer RG, Kibbe AH, Nicholas WC, Sbravati C, Read VH. Source: The Journal of Family Practice. 1982 March; 14(3): 591-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7038029

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Error in dose of levothyroxine. Author(s): Stoffer SS. Source: Jama : the Journal of the American Medical Association. 1978 June 16; 239(24): 2552. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=660784

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Estimation of a physiologic replacement dose of levothyroxine in elderly patients with hypothyroidism. Author(s): Davis FB, LaMantia RS, Spaulding SW, Wehmann RE, Davis PJ. Source: Archives of Internal Medicine. 1984 September; 144(9): 1752-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6433829

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Evaluation of the adequacy of levothyroxine replacement therapy in patients with central hypothyroidism. Author(s): Ferretti E, Persani L, Jaffrain-Rea ML, Giambona S, Tamburrano G, BeckPeccoz P. Source: The Journal of Clinical Endocrinology and Metabolism. 1999 March; 84(3): 924-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084572

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Evaluation of the therapeutic efficacy of different levothyroxine preparations in the treatment of human thyroid disease. Author(s): Klein I, Danzi S. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 December; 13(12): 1127-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14751033

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Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypothyroid patients. Author(s): Liel Y, Harman-Boehm I, Shany S. Source: The Journal of Clinical Endocrinology and Metabolism. 1996 February; 81(2): 857-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8636317

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Evidence for interference with the intestinal absorption of levothyroxine sodium by aluminum hydroxide. Author(s): Sperber AD, Liel Y. Source: Archives of Internal Medicine. 1992 January; 152(1): 183-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1728914

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Evidence of hyperthyroidism in apparently euthyroid patients treated with levothyroxine. Author(s): Banovac K, Papic M, Bilsker MS, Zakarija M, McKenzie JM. Source: Archives of Internal Medicine. 1989 April; 149(4): 809-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2495780

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Exaggerated levothyroxine malabsorption due to calcium carbonate supplementation in gastrointestinal disorders. Author(s): Csako G, McGriff NJ, Rotman-Pikielny P, Sarlis NJ, Pucino F. Source: The Annals of Pharmacotherapy. 2001 December; 35(12): 1578-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11793625

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Gluten-induced enteropathy (coeliac disease) revealed by resistance to treatment with levothyroxine and alfacalcidol in a sixty-eight-year-old patient: a case report. Author(s): d'Esteve-Bonetti L, Bennet AP, Malet D, Hoff M, Louvet JP, Caron P. Source: Thyroid : Official Journal of the American Thyroid Association. 2002 July; 12(7): 633-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12193310

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Graves' hyperthyroidism and ophthalmopathy following treatment of spontaneous hypothyroidism with levothyroxine. Author(s): Easton PA, Wall JR. Source: Can Med Assoc J. 1981 July 1; 125(1): 65-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6894884

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Hemodynamic changes after levothyroxine treatment in subclinical hypothyroidism. Author(s): Faber J, Petersen L, Wiinberg N, Schifter S, Mehlsen J. Source: Thyroid : Official Journal of the American Thyroid Association. 2002 April; 12(4): 319-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12034057

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High doses of levothyroxine for refractory rapid cycling. Author(s): Extein IL. Source: The American Journal of Psychiatry. 2000 October; 157(10): 1704-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11007733

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How big a dose of levothyroxine? Author(s): Isley WL. Source: Postgraduate Medicine. 1993 December; 94(8): 38, 45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8247999

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How does levothyroxine therapy affect thyroid function studies? Author(s): Stoffer SS, Szpunar WE. Source: Postgraduate Medicine. 1990 May 1; 87(6): 71-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2336423

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Hypoglycaemia in patients with liver diseases administered levothyroxine. Author(s): Iihara N, Kurokohchi K, Tsukamoto T, Masaki T, Kuriyama S, Ohnishi H, Taminato T, Morita S. Source: Journal of Clinical Pharmacy and Therapeutics. 2003 October; 28(5): 355-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632959

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Hypothyroidism resulting from generic levothyroxine failure. Author(s): Dong BJ, Brown CH. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1991 May-June; 4(3): 167-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2053456

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Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. Author(s): Biondi B, Fazio S, Cuocolo A, Sabatini D, Nicolai E, Lombardi G, Salvatore M, Sacca L. Source: The Journal of Clinical Endocrinology and Metabolism. 1996 December; 81(12): 4224-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8954019

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Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. Author(s): Taddei S, Caraccio N, Virdis A, Dardano A, Versari D, Ghiadoni L, Salvetti A, Ferrannini E, Monzani F. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 August; 88(8): 3731-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915662

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Impaired Na+,K+ATPase activity in red blood cells in euthyroid women treated with levothyroxine after total thyroidectomy for Graves' disease. Author(s): De Riva C, Vircici F. Source: Metabolism: Clinical and Experimental. 1998 October; 47(10): 1194-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9781620

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In vivo comparison of levothyroxine preparations. Author(s): Ramos-Gabatin A, Jacobson JM, Young RL. Source: Jama : the Journal of the American Medical Association. 1982 January 8; 247(2): 203-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7053460

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Increased lead excretion in hypothyroid patients after levothyroxine medication. Author(s): Osterode W, Zettinig G, Potzi C, Manner G. Source: Journal of Toxicology and Environmental Health. Part A. 2002 May 10; 65(9): 649-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11996405

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Increased levothyroxine requirements in pregnancy--why, when, and how much? Author(s): Toft A. Source: The New England Journal of Medicine. 2004 July 15; 351(3): 292-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15254288

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Increased levothyroxine requirements presenting as "inappropriate" TSH secretion syndrome in a patient with nephrotic syndrome. Author(s): Collins MT, Remaley AT, Csako G, Pucino F, Skarulis MC, Balow JE, Sarlis NJ. Source: J Endocrinol Invest. 2000 June; 23(6): 383-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10908166

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Influence of age on optimal daily levothyroxine dosage in patients with primary hypothyroidism grouped according to etiology. Author(s): Kabadi UM. Source: Southern Medical Journal. 1997 September; 90(9): 920-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9305304

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Interaction between levothyroxine and indinavir in a patient with HIV infection. Author(s): Lanzafame M, Trevenzoli M, Faggian F, Marcati P, Gatti F, Carolo G, Concia E. Source: Infection. 2002 January; 30(1): 54-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11876520

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Interaction between rifampin and levothyroxine. Author(s): Nolan SR, Self TH, Norwood JM. Source: Southern Medical Journal. 1999 May; 92(5): 529-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10342905

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Interaction between ritonavir and levothyroxine. Author(s): Tseng A, Fletcher D. Source: Aids (London, England). 1998 November 12; 12(16): 2235-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9833871

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Interchangeability of levothyroxine preparations. Author(s): Bootman JL. Source: The American Journal of Medicine. 1996 February; 100(2): 247-8; Author Reply 248-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8629667

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Interchangeability of levothyroxine preparations. Author(s): Ridgway EC. Source: The American Journal of Medicine. 1996 February; 100(2): 245-6; Author Reply 246-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8629666

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Interchangeability of levothyroxine preparations. Author(s): Davies TF. Source: The American Journal of Medicine. 1996 February; 100(2): 245; Author Reply 246-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8629665

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Interchangeability of levothyroxine preparations. Author(s): DeGroot LJ. Source: The American Journal of Medicine. 1996 February; 100(2): 244-5; Author Reply 246-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8629664

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Intestinal adsorption of levothyroxine by antacids and laxatives: case stories and in vitro experiments. Author(s): Mersebach H, Rasmussen AK, Kirkegaard L, Feldt-Rasmussen U. Source: Pharmacology & Toxicology. 1999 March; 84(3): 107-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10193669

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Iodine-induced thyrotoxicosis in a woman with a multinodular goiter taking levothyroxine. Author(s): Reith PE, Granner DK. Source: Archives of Internal Medicine. 1985 February; 145(2): 355-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3977499

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Is long-term levothyroxine therapy safe? Author(s): Burman KD. Source: Archives of Internal Medicine. 1990 October; 150(10): 2010-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2222084

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Letter: Less potent levothyroxine tablets. Author(s): Goldstein MS. Source: The New England Journal of Medicine. 1975 March 27; 292(13): 702-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1113772

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Letter: Less potent tablets of levothyroxine. Author(s): Stoffer SS, Hamburger JI, Meier DA. Source: The New England Journal of Medicine. 1975 February 6; 292(6): 318. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1110713

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Letter: Levothyroxine dosage after thyroidectomy for metastatic papillary cancer. Author(s): Caplan H. Source: Jama : the Journal of the American Medical Association. 1976 August 2; 236(5): 448. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=947064

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Levothyroxine a new drug? Since when? How could that be? Author(s): Hennessey JV. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 March; 13(3): 279-82. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12729477

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Levothyroxine abuse and bulimia nervosa. Author(s): Crow S, Mitchell J, Kendall D. Source: Psychosomatics. 1997 March-April; 38(2): 151-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9063047

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Levothyroxine anaphylaxis? Vocal cord dysfunction mimicking an anaphylactic drug reaction. Author(s): Nugent JS, Nugent AL, Whisman BA, White K, Hagan LL. Source: Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 2003 October; 91(4): 337-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14582811

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Levothyroxine and potassium iodide are both effective in treating benign solitary solid cold nodules of the thyroid. Author(s): La Rosa GL, Lupo L, Giuffrida D, Gullo D, Vigneri R, Belfiore A. Source: Annals of Internal Medicine. 1995 January 1; 122(1): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7985890

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Levothyroxine binding by sucralfate. Author(s): Havrankova J, Lahaie R. Source: Annals of Internal Medicine. 1992 September 1; 117(5): 445-6. Erratum In: Ann Intern Med 1993 March 1; 118(5): 398. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1503346

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Levothyroxine bioequivalence. Author(s): Katz MD, Scherger JE. Source: The Journal of Family Practice. 1998 February; 46(2): 108-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9487307

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Levothyroxine bioequivalence. Author(s): Schellhase KG, Ellsworth A. Source: The Journal of Family Practice. 1997 July; 45(1): 23-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9228909

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Levothyroxine dose requirements for thyrotropin suppression in the treatment of differentiated thyroid cancer. Author(s): Burmeister LA, Goumaz MO, Mariash CN, Oppenheimer JH. Source: The Journal of Clinical Endocrinology and Metabolism. 1992 August; 75(2): 34450. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1639933

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Levothyroxine loses potency with age. Author(s): Stoffer SS, Szpunar WE. Source: Jama : the Journal of the American Medical Association. 1986 April 11; 255(14): 1881-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3951112

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Levothyroxine overdose associated with seizures in a young child. Author(s): Kulig K, Golightly LK, Rumack BH. Source: Jama : the Journal of the American Medical Association. 1985 October 18; 254(15): 2109-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4046139

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Levothyroxine poisoning. Author(s): White JD, Litovitz TL. Source: Pediatrics. 1985 January; 75(1): 129-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3966038

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Levothyroxine replacement dose for primary hypothyroidism decreases with age. Author(s): Rosenbaum RL, Barzel US. Source: Annals of Internal Medicine. 1982 January; 96(1): 53-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7053703

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Levothyroxine replacement therapy in central hypothyroidism: a practice report. Author(s): Carrozza V, Csako G, Yanovski JA, Skarulis MC, Nieman L, Wesley R, Pucino F. Source: Pharmacotherapy. 1999 March; 19(3): 349-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10221374

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Levothyroxine sodium tablets: chemical equivalence and bioequivalence. Author(s): Curry SH, Gums JG, Williams LL, Curry RW, Wolfson BB. Source: Drug Intell Clin Pharm. 1988 July-August; 22(7-8): 589-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3046889

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Levothyroxine suppression of thyroglobulin in patients with differentiated thyroid carcinoma. Author(s): Wang PW, Wang ST, Liu RT, Chien WY, Tung SC, Lu YC, Chen HY, Lee CH. Source: The Journal of Clinical Endocrinology and Metabolism. 1999 December; 84(12): 4549-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10599717

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Levothyroxine suppressive therapy for solitary thyroid nodule. Author(s): Mainini E, Martinelli I, Morandi G, Villa S, Stefani I, Mazzi C. Source: J Endocrinol Invest. 1995 November; 18(10): 796-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8787957

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Levothyroxine suppressive therapy in the medical management of nontoxic benign multinodular goiter. Author(s): Celani MF. Source: Exp Clin Endocrinol. 1993; 101(5): 326-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8299711

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Levothyroxine suppressive therapy is partially effective in treating patients with benign, solid thyroid nodules and multinodular goiters. Author(s): Lima N, Knobel M, Cavaliere H, Sztejnsznajd C, Tomimori E, Medeiros-Neto G. Source: Thyroid : Official Journal of the American Thyroid Association. 1997 October; 7(5): 691-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9349571

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Levothyroxine suppressive therapy: harmful and useless or harmless and useful? Author(s): Bartalena L, Pinchera A. Source: J Endocrinol Invest. 1994 September; 17(8): 675-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7868810

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Levothyroxine therapy and osteoporosis. An end to the controversy? Author(s): Wartofsky L. Source: Archives of Internal Medicine. 1995 June 12; 155(11): 1130-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7763118

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Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations. Author(s): Woeber KA. Source: J Endocrinol Invest. 2002 February; 25(2): 106-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11929079

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Levothyroxine therapy in patients with thyroid disease. Author(s): Mandel SJ, Brent GA, Larsen PR. Source: Annals of Internal Medicine. 1993 September 15; 119(6): 492-502. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8357116

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Levothyroxine therapy. Author(s): Liel Y. Source: Annals of Internal Medicine. 1994 April 1; 120(7): 619; Author Reply 619-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8117005

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Levothyroxine therapy. Author(s): Leinung MC. Source: Annals of Internal Medicine. 1994 April 1; 120(7): 619; Author Reply 619-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8117004

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Levothyroxine treatment and occurrence of fracture of the hip. Author(s): Sheppard MC, Holder R, Franklyn JA. Source: Archives of Internal Medicine. 2002 February 11; 162(3): 338-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11822927

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Levothyroxine. Author(s): Cheng TO. Source: Jama : the Journal of the American Medical Association. 1992 January 8; 267(2): 236. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1727519

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Levothyroxine: therapeutic use and regulatory issues related to bioequivalence. Author(s): Wartofsky L. Source: Expert Opinion on Pharmacotherapy. 2002 June; 3(6): 727-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12036412

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Levothyroxine-cholestyramine interaction reemphasized. Author(s): Harmon SM, Seifert CF. Source: Annals of Internal Medicine. 1991 October 15; 115(8): 658-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1892339

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Levothyroxine-induced hyperthyroidism. Author(s): Nguyen LT, Luong KV. Source: Allergy. 2004 February; 59(2): 233-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763944

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Levothyroxine-induced liver dysfunction in a primary hypothyroid patient. Author(s): Ohmori M, Harada K, Tsuruoka S, Sugimoto K, Kobayashi E, Fujimura A. Source: Endocrine Journal. 1999 August; 46(4): 579-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10580751

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Lipoprotein (a) levels and apolipoprotein (a) isoform size in patients with subclinical hypothyroidism: effect of treatment with levothyroxine. Author(s): Milionis HJ, Efstathiadou Z, Tselepis AD, Bairaktari ET, Tsironis LD, Tsatsoulis A, Elisaf MS. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 April; 13(4): 365-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804105

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Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Effect of levothyroxine therapy. Author(s): Arem R, Patsch W. Source: Archives of Internal Medicine. 1990 October; 150(10): 2097-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2222095

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Lipoprotein profile in subclinical hypothyroidism: response to levothyroxine replacement, a randomized placebo-controlled study. Author(s): Caraccio N, Ferrannini E, Monzani F. Source: The Journal of Clinical Endocrinology and Metabolism. 2002 April; 87(4): 1533-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11932277

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Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. Author(s): Papini E, Petrucci L, Guglielmi R, Panunzi C, Rinaldi R, Bacci V, Crescenzi A, Nardi F, Fabbrini R, Pacella CM. Source: The Journal of Clinical Endocrinology and Metabolism. 1998 March; 83(3): 780-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9506726

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Massive levothyroxine ingestion. Conservative management. Author(s): Mandel SH, Magnusson AR, Burton BT, Swanson JR, LaFranchi SH. Source: Clinical Pediatrics. 1989 August; 28(8): 374-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2758719

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Massive levothyroxine overdose: high anxiety--low toxicity. Author(s): Gorman RL, Chamberlain JM, Rose SR, Oderda GM. Source: Pediatrics. 1988 October; 82(4): 666-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3174321

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Monitoring therapy in patients taking levothyroxine. Author(s): Helfand M, Crapo LM. Source: Annals of Internal Medicine. 1990 September 15; 113(6): 450-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2143640

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Morbidity, mortality, and quality of life for patients treated with levothyroxine. Author(s): Petersen K, Bengtsson C, Lapidus L, Lindstedt G, Nystrom E. Source: Archives of Internal Medicine. 1990 October; 150(10): 2077-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2222093

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Noncompliance with medical treatment: pseudomalabsorption of levothyroxine. Author(s): Eledrisi MS, Szymajda A, Alshanti M, Urban RJ. Source: Southern Medical Journal. 2001 August; 94(8): 833-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11549198

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Nonspecific intestinal adsorption of levothyroxine by aluminum hydroxide. Author(s): Liel Y, Sperber AD, Shany S. Source: The American Journal of Medicine. 1994 October; 97(4): 363-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7942938

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On the usefulness of levothyroxine suppressive therapy in the medical treatment of benign solitary, solid or predominantly solid, thyroid nodules. Author(s): Celani MF, Mariani M, Mariani G. Source: Acta Endocrinol (Copenh). 1990 December; 123(6): 603-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2284885

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One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit? Author(s): Padberg S, Heller K, Usadel KH, Schumm-Draeger PM. Source: Thyroid : Official Journal of the American Thyroid Association. 2001 March; 11(3): 249-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11327616

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Optimal daily levothyroxine dose in primary hypothyroidism. Its relation to pretreatment thyroid hormone indexes. Author(s): Kabadi UM. Source: Archives of Internal Medicine. 1989 October; 149(10): 2209-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2508585

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Outcome of severe congenital hypothyroidism: closing the developmental gap with early high dose levothyroxine treatment. Author(s): Dubuis JM, Glorieux J, Richer F, Deal CL, Dussault JH, Van Vliet G. Source: The Journal of Clinical Endocrinology and Metabolism. 1996 January; 81(1): 2227. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8550756

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Pilot study on the absolute and relative bioavailability of Synthroid and Levothroid, two brands of sodium levothyroxine. Author(s): Maxon HR, Ritschel WA, Volle CP, Eldon MA, Chen IW, Fernandez MF, Cline J, Mayfield G. Source: Int J Clin Pharmacol Ther Toxicol. 1983 August; 21(8): 379-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6688797

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Plasma free thyroxine concentrations in patients receiving levothyroxine for thyroid suppression. Author(s): Hughes JM, Gallagher DL, Olson JE. Source: Surgery. 1989 December; 106(6): 951-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2588121

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Possible leaching of diethyl phthalate into levothyroxine sodium tablets. Author(s): Cafmeyer NR, Wolfson BB. Source: Am J Hosp Pharm. 1991 April; 48(4): 735-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2042676

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Postintervention serum TSH levels may be useful to differentiate patients who should undergo levothyroxine suppressive therapy after thyroid surgery for multinodular goiter in a region with moderate iodine deficiency. Author(s): Rotondi M, Amato G, Del Buono A, Mazziotti G, Manganella G, Biondi B, Sinisi AM, Santini L, Bellastella A, Carella C. Source: Thyroid : Official Journal of the American Thyroid Association. 2000 December; 10(12): 1081-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11201853

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Potency of brand name and generic levothyroxine. Author(s): Stoffer SS, Szpunar WE. Source: Jama : the Journal of the American Medical Association. 1980 October 10; 244(15): 1704-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7411829

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Potency of levothyroxine products. Author(s): Stoffer SS, Szpunar WE. Source: Jama : the Journal of the American Medical Association. 1984 February 3; 251(5): 635-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6690838

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Prevention of progressive renal failure by levothyroxine sodium in a diabetic patient with renal insufficiency and hypothyroidism. Author(s): Miura M, Nomoto Y, Sakai H. Source: Intern Med. 1992 February; 31(2): 251-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1600275

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Prevention of thyroid neoplasm recurrence with Triac and levothyroxine. Author(s): Pujol P, Osman A, Bringer J, Jaffiol C. Source: Clinical Endocrinology. 1997 January; 46(1): 121-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9059568

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Preventive effect of levothyroxine in patients operated for non-toxic goitre: a randomized trial of one hundred patients with nine years follow-up. Author(s): Bistrup C, Nielsen JD, Gregersen G, Franch P. Source: Clinical Endocrinology. 1994 March; 40(3): 323-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8187295

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Primary amenorrhea and pseudoprolactinoma in a patient with primary hypothyroidism. Reversal of clinical, biochemical, and radiologic abnormalities with levothyroxine. Author(s): Poretsky L, Garber J, Kleefield J. Source: The American Journal of Medicine. 1986 July; 81(1): 180-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3728546

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Prophylactic levothyroxine therapy in patients with Hashimoto's thyroiditis. Author(s): Schumm-Draeger PM, Padberg S, Heller K. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 1999; 107 Suppl 3: S84-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10522812

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Prospective, randomized, double-blind study about effectiveness of levothyroxine suppressive therapy in prevention of recurrence after operation: result at the third year of follow-up. Author(s): Miccoli P, Antonelli A, Iacconi P, Alberti B, Gambuzza C, Baschieri L. Source: Surgery. 1993 December; 114(6): 1097-101; Discussion 1101-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8256213

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Pseudomalabsorption of levothyroxine. Author(s): Ain KB, Refetoff S, Fein HG, Weintraub BD. Source: Jama : the Journal of the American Medical Association. 1991 October 16; 266(15): 2118-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1920700

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Pseudomalabsorption of levothyroxine: a case report. Author(s): Ogawa D, Otsuka F, Mimura U, Ueno A, Hashimoto H, Kishida M, Ogura T, Makino H. Source: Endocrine Journal. 2000 February; 47(1): 45-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10811292

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Pseudotumor cerebri associated with initiation of levothyroxine therapy for juvenile hypothyroidism. Author(s): Van Dop C, Conte FA, Koch TK, Clark SJ, Wilson-Davis SL, Grumbach MM. Source: The New England Journal of Medicine. 1983 May 5; 308(18): 1076-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6835321

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Raloxifene causing malabsorption of levothyroxine. Author(s): Siraj ES, Gupta MK, Reddy SS. Source: Archives of Internal Medicine. 2003 June 9; 163(11): 1367-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796075

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Rapid cycling bipolar affective disorder. II. Treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study. Author(s): Bauer MS, Whybrow PC. Source: Archives of General Psychiatry. 1990 May; 47(5): 435-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2184796

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Reduced glomerular filtration rate in a lithium-treated bipolar patient with primary hypothyroidism--reversal by levothyroxine. Author(s): Balldin J, Berggren U, Svennerholm L, Kjellbo H, Lindstedt G, Aurell M. Source: Clinical Nephrology. 1988 March; 29(3): 160-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3359707

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Regression of a pituitary adenoma following levothyroxine therapy of primary hypothyroidism. Author(s): Valenta LJ, Tamkin J, Sostrin R, Elias AN, Eisenberg H. Source: Fertility and Sterility. 1983 September; 40(3): 389-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6411499

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Relapse of Graves' disease after successful outcome of antithyroid drug therapy: results of a prospective randomized study on the use of levothyroxine. Author(s): Hoermann R, Quadbeck B, Roggenbuck U, Szabolcs I, Pfeilschifter J, Meng W, Reschke K, Hackenberg K, Dettmann J, Prehn B, Hirche H, Mann K; Basedow Study Group. Source: Thyroid : Official Journal of the American Thyroid Association. 2002 December; 12(12): 1119-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12593726

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Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. Author(s): Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH. Source: The New England Journal of Medicine. 1987 March 26; 316(13): 764-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3821822

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Replacement doses of levothyroxine. Author(s): Glinoer D. Source: Annals of Internal Medicine. 1982 May; 96(5): 682-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7073163

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Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14 : 1) is not superior to thyroxine alone to improve well-being and cognitive performance in hypothyroidism. Author(s): Siegmund W, Spieker K, Weike AI, Giessmann T, Modess C, Dabers T, Kirsch G, Sanger E, Engel G, Hamm AO, Nauck M, Meng W. Source: Clinical Endocrinology. 2004 June; 60(6): 750-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15163340

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Serum concentrations of osteocalcin in pregnant women with multinodular thyroid goiter undergoing treatment with levothyroxine. Author(s): Letizia C, Minisola S, Cerci S, De Ciocchis A, Coassin S, D'Ambrosio C, Scuro L, Di Iorio R. Source: Endocrine Research. 1995 August; 21(3): 645-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7588433

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Serum thyrotropin in primary hypothyroidism. A possible predictor of optimal daily levothyroxine dose in primary hypothyroidism. Author(s): Kabadi UM, Jackson T. Source: Archives of Internal Medicine. 1995 May 22; 155(10): 1046-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7748047

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Serum thyrotropin in primary hypothyroidism: a reliable and accurate predictor of optimal daily levothyroxine dose. Author(s): Kabadi UM, Kabadi MM. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2001 January-February; 7(1): 16-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11250763

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Sodium levothyroxine (Synthroid R) intoxication in a child. Author(s): Funderburk SJ, Spaulding JS. Source: Pediatrics. 1970 February; 45(2): 298-301. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4189839

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Solitary nodular disease and multinodular goiter: a retrospective study on suppressive versus replacement levothyroxine therapy. Author(s): Paggi A, Persegani-Trimarchi C, Russo P, Mastropasqua M, Mosetti MA, Losi T, Leri O. Source: Endocrine Research. 1999 May; 25(2): 229-38. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10382684

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Standards for levothyroxine preparations. Author(s): Shroff AP, Jones JK. Source: Jama : the Journal of the American Medical Association. 1980 August 15; 244(7): 658-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7392162

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Starting dose of levothyroxine for the treatment of congenital hypothyroidism: a systematic review. Author(s): Hrytsiuk I, Gilbert R, Logan S, Pindoria S, Brook CG. Source: Archives of Pediatrics & Adolescent Medicine. 2002 May; 156(5): 485-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11980555

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Subjective response to and tolerability of long-term supraphysiological doses of levothyroxine in refractory mood disorders. Author(s): Bauer M, Priebe S, Berghofer A, Bschor T, Kiesslinger U, Whybrow PC. Source: Journal of Affective Disorders. 2001 April; 64(1): 35-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11292518

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Substitution of levothyroxine products. Author(s): Stoffer SS. Source: Jama : the Journal of the American Medical Association. 1979 March 23; 241(12): 1229. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=762783

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Successful management of a patient with pseudomalabsorption of levothyroxine. Author(s): Kubota S, Fukata S, Matsuzuka F, Kuma K, Miyauchi A. Source: International Journal of Psychiatry in Medicine. 2003; 33(2): 183-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968832

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Successful treatment of hypothyroid Graves' disease with a combination of levothyroxine replacement, intravenous high-dose steroid and irradiation to the orbit. Author(s): Koshiyama H, Mori S, Fujiwara K, Hayakawa K, Koh T. Source: Intern Med. 1993 May; 32(5): 421-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8400507

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Suppressive levothyroxine therapy has no significant influence on bone degradation in women with thyroid carcinoma: a comparison with other disorders affecting bone metabolism. Author(s): Mikosch P, Jauk B, Gallowitsch HJ, Pipam W, Kresnik E, Lind P. Source: Thyroid : Official Journal of the American Thyroid Association. 2001 March; 11(3): 257-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11327617

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Suppressive therapy with levothyroxine for euthyroid diffuse and nodular goiter. Author(s): Gullu S, Gurses MA, Baskal N, Uysal AR, Kamel AN, Erdogan G. Source: Endocrine Journal. 1999 February; 46(1): 221-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10426591

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Suppressive therapy with levothyroxine for solitary thyroid nodules. Author(s): Reverter JL, Lucas A, Salinas I, Audi L, Foz M, Sanmarti A. Source: Clinical Endocrinology. 1992 January; 36(1): 25-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1559296

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Suppressive therapy with levothyroxine for solitary thyroid nodules. A double-blind controlled clinical study. Author(s): Gharib H, James EM, Charboneau JW, Naessens JM, Offord KP, Gorman CA. Source: The New England Journal of Medicine. 1987 July 9; 317(2): 70-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3295553

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Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses. Author(s): Zelmanovitz F, Genro S, Gross JL. Source: The Journal of Clinical Endocrinology and Metabolism. 1998 November; 83(11): 3881-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9814462

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Surveillance of TSH-suppressive levothyroxine treatment in thyroid cancer patients: TRH testing versus basal TSH determination by a third generation assay. Author(s): Gorges R, Saller B, Eising EG, Quadbeck B, Mann K, Bockisch A. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 2002 October; 110(7): 35560. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12397535

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Tablet formulation of levothyroxine is absorbed less well than powdered levothyroxine. Author(s): Yamamoto T. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 December; 13(12): 1177-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14751040

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The acute effect of calcium carbonate on the intestinal absorption of levothyroxine. Author(s): Singh N, Weisler SL, Hershman JM. Source: Thyroid : Official Journal of the American Thyroid Association. 2001 October; 11(10): 967-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11716045

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The effect of acute administration of ACTH and levothyroxine on serum carnitine. Author(s): Gilchrist JM, Kandula M, Hennessey JV. Source: The Journal of Clinical Endocrinology and Metabolism. 1997 September; 82(9): 3176-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9284767

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The effect of long-term, non-suppressive levothyroxine treatment on quantitative ultrasonometry of bone in women. Author(s): Hadji P, Hars O, Sturm G, Bauer T, Emons G, Schulz KD. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2000 May; 142(5): 445-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10802520

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The effect of treatment with levothyroxine or iodine on thyroid size and thyroid growth stimulating immunoglobulins in endemic goitre patients. Author(s): Wilders-Truschnig MM, Warnkross H, Leb G, Langsteger W, Eber O, Tiran A, Dobnig H, Passath A, Lanzer G, Drexhage HA. Source: Clinical Endocrinology. 1993 September; 39(3): 281-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7900936

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The nonequivalence of levothyroxine products. Author(s): Dong BJ, Young VR, Rapoport B. Source: Drug Intell Clin Pharm. 1986 January; 20(1): 77-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3943462

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The rationale of levothyroxine therapy in hypothyroidism. Author(s): Desai M. Source: Indian Pediatrics. 1983 January; 20(1): 3-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6862597

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Thyroid hormone augmentation with levothyroxine in bipolar depression. Author(s): Bauer M. Source: Bipolar Disorders. 2002; 4 Suppl 1: 109-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12479694

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Thyrotoxicosis after a single ingestion of levothyroxine. Author(s): Hofe SE, Young RL. Source: Jama : the Journal of the American Medical Association. 1977 March 28; 237(13): 1361. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=576486

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Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. Author(s): Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Source: The New England Journal of Medicine. 2004 July 15; 351(3): 241-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15254282

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Treatment of endemic goitre due to iodine deficiency with iodine, levothyroxine or both: results of a multicentre trial. Author(s): Hintze G, Emrich D, Kobberling J. Source: European Journal of Clinical Investigation. 1989 December; 19(6): 527-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2515973

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Treatment of hypothyroidism with levothyroxine. Author(s): Laan RF, Pieters GF, Smals AG, Kloppenborg PW. Source: The New England Journal of Medicine. 1987 September 17; 317(12): 770-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3627192

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Treatment of intractable rapid-cycling manic-depressive disorder with levothyroxine. Clinical observations. Author(s): Stancer HC, Persad E. Source: Archives of General Psychiatry. 1982 March; 39(3): 311-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7065841

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Treatment of iodine deficiency goiter with iodine, levothyroxine or a combination of both. Author(s): Hintze G, Kobberling J. Source: Thyroidology. 1992 April; 4(1): 37-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1284331

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Treatment of juvenile goitre with levothyroxine, iodide or a combination of both: the value of ultrasound grey-scale analysis. Author(s): Einenkel D, Bauch KH, Benker G. Source: Acta Endocrinol (Copenh). 1992 October; 127(4): 301-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1449041

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Treatment-resistant mania with primary hypothyroidism: a case of recovery after levothyroxine. Author(s): Balldin J, Berggren U, Rybo E, Kjellbo H, Lindstedt G. Source: The Journal of Clinical Psychiatry. 1987 December; 48(12): 490-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2891683

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Two cases of therapeutic failure associated with levothyroxine brand interchange. Author(s): Copeland PM. Source: The Annals of Pharmacotherapy. 1995 May; 29(5): 482-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7655130

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Unithroid becomes first levothyroxine tablet to gain FDA approval. Author(s): Traynor K. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2000 October 1; 57(19): 1736-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11030022

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Unusual malabsorption of levothyroxine. Author(s): Jauk B, Mikosch P, Gallowitsch HJ, Kresnik E, Molnar M, Gomez I, Lind P. Source: Thyroid : Official Journal of the American Thyroid Association. 2000 January; 10(1): 93-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10691319

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Use of a sensitive thyrotropin assay for monitoring treatment with levothyroxine. Author(s): Watts NB. Source: Archives of Internal Medicine. 1989 February; 149(2): 309-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2644903

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What is the best test for monitoring levothyroxine therapy? Author(s): Wong MM, Volpe R. Source: Can Med Assoc J. 1981 May 1; 124(9): 1181-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7237340

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Why do clinicians continue to debate the use of levothyroxine in the diagnosis and management of thyroid nodules? Author(s): Blum M. Source: Annals of Internal Medicine. 1995 January 1; 122(1): 63-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7985898

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CHAPTER 2. NUTRITION AND LEVOTHYROXINE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and levothyroxine.

Finding Nutrition Studies on Levothyroxine The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “levothyroxine” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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Levothyroxine

The following information is typical of that found when using the “Full IBIDS Database” to search for “levothyroxine” (or a synonym): •

Effect of hypothyroidism on the testes in mature rats and treatment with levothyroxine and zinc. Author(s): Gulhane Military Medical Academy, Department of Urology, Ankara, Turkey. [email protected] Source: Tahmaz, L Gokalp, A Kibar, Y Kocak, I Yalcin, O Ozercan, Y Andrologia. 2000 March; 32(2): 85-9 0303-4569

•

Effects of pharmacological fiber supplements on levothyroxine absorption. Author(s): Department of Medical Specialties, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA. Source: Chiu, A C Sherman, S I Thyroid. 1998 August; 8(8): 667-71 1050-7256

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

Nutrition

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to levothyroxine; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Iron Alternative names: Ferrous Sulfate Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com

•

Food and Diet Ferrous Sulfate Alternative names: Iron Source: Integrative Medicine Communications; www.drkoop.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND LEVOTHYROXINE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to levothyroxine. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to levothyroxine and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “levothyroxine” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to levothyroxine: •

Clinical effects of accidental levothyroxine ingestion in children. Author(s): Golightly LK, Smolinske SC, Kulig KW, Wruk KM, Gelman CJ, Rumack BH, Linden CH. Source: Am J Dis Child. 1987 September; 141(9): 1025-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2887106

•

Effects of pharmacological fiber supplements on levothyroxine absorption. Author(s): Chiu AC, Sherman SI. Source: Thyroid : Official Journal of the American Thyroid Association. 1998 August; 8(8): 667-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9737361

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Levothyroxine

•

Exaggerated levothyroxine malabsorption due to calcium carbonate supplementation in gastrointestinal disorders. Author(s): Ann Intern Med. 2002 Apr 16;136(8):I42 Source: The Annals of Pharmacotherapy. 2001 December; 35(12): 1578-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11955047

•

Inhibition of T3 production in levothyroxine-treated female mice by the root extract of Convolvulus pluricaulis. Author(s): Panda S, Kar A. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 2001 January; 33(1): 16-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11280709

•

Levothyroxine ingestions in children: an analysis of 78 cases. Author(s): Litovitz TL, White JD. Source: The American Journal of Emergency Medicine. 1985 July; 3(4): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2860910

•

Levothyroxine up-regulates P-glycoprotein independent of the pregnane X receptor. Author(s): Mitin T, Von Moltke LL, Court MH, Greenblatt DJ. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 2004 August; 32(8): 779-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15258100

•

Use of soy protein supplement and resultant need for increased dose of levothyroxine. Author(s): Bell DS, Ovalle F. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2001 May-June; 7(3): 193-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11421567

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

Alternative Medicine 49

•

Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to levothyroxine; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Hypothyroidism Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.drkoop.com Glycyrrhiza glabra Source: Integrative Medicine Communications; www.drkoop.com Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Thyroid Hormones Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON LEVOTHYROXINE Overview In this chapter, we will give you a bibliography on recent dissertations relating to levothyroxine. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “levothyroxine” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on levothyroxine, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Levothyroxine ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to levothyroxine. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

The effect of formulation and processing variables on the stability of levothyroxine sodium tablets by Patel, Himanshu, PhD from University of Cincinnati, 2003, 151 pages http://wwwlib.umi.com/dissertations/fullcit/3109696

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON LEVOTHYROXINE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “levothyroxine” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on levothyroxine, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Levothyroxine By performing a patent search focusing on levothyroxine, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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Levothyroxine

example of the type of information that you can expect to obtain from a patent search on levothyroxine: •

Levothyroxine compositions and methods Inventor(s): DiMenna; Philip A. (St. Petersburg, FL), Franz; G. Andrew (St. Louis, MO), Gemma; Rocco L. (Dover, OH), Strauss; Elaine A. (Seminole, FL) Assignee(s): Jones Pharma, Inc. (St. Petersburg, FL) Patent Number: 6,555,581 Date filed: February 15, 2002 Abstract: The present invention generally relates to stable pharmaceutical compositions, and methods of making and administering such compositions. In one aspect, the invention features stabilized pharmaceutical compositions that include pharmaceutically active ingredients such as levothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormone drugs), preferably in an immediate release solid dosage form. Also provided are methods for making and using such immediate release and stabilized compositions. Excerpt(s): The invention generally relates to stable pharmaceutical compositions, and methods of making and administering such compositions. In one aspect, the invention features stabilized pharmaceutical compositions that include pharmaceutically active ingredients, such as levothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormone drugs), preferably in an immediate release solid dosage form. Also provided are methods for making and using such immediate release and stabilized compositions. Thyroid hormone preparations of levothyroxine sodium and liothyronine sodium are pharmaceutical preparations useful to the treatment of hypothyroidism and thyroid hormone replacement therapy in mammals, for example, humans and dogs. Thyroid hormone preparations are used to treat reduced or absent thyroid function of any etiology, including human or animal ailments such as myxedema, cretinism and obesity. Web site: http://www.delphion.com/details?pn=US06555581__

•

Pharmaceutical levothyroxine preparation Inventor(s): Nischwitz; Marion (Darmstadt, DE), Schreder; Sven (Heidelberg, DE) Assignee(s): Merck Patent Gesellschaft (Darmstadt, DE) Patent Number: 6,491,946 Date filed: January 5, 2001 Abstract: The invention relates to a pharmaceutical preparation comprising levothyroxine sodium, potassium iodide, microcrystalline cellulose and binding agent, which is free of antioxidants or further auxiliaries, and processes for its production. Excerpt(s): The invention relates to a novel stable pharmaceutical preparation comprising levothyroxine sodium, potassium iodide, microcrystalline cellulose and binding agent, which is free of antioxidants or further auxiliaries. Auxiliaries are substances which prevent formation of iodine, e.g. potassium hydroxide. A thyroxine preparation stabilized with thiosulfate as an antioxidant is described in DE 195 41 128. Web site: http://www.delphion.com/details?pn=US06491946__

Patents 55

•

Stabilized composition of levothyroxine sodium medication and method for its production Inventor(s): Groenewoud; Pieter J. (Charlotte, NC), Wang; Hai (Charlotte, NC) Assignee(s): Vintage Pharmaceuticals, Inc. (Charlotte, NC) Patent Number: 5,635,209 Date filed: October 31, 1995 Abstract: The invention discloses a medication which requires the combination of levothyroxine sodium and potassium iodide, with the potassium iodide acting as a stabilizing excipient, the presence of which results in a more stable levothyroxine sodium medication and provides for longer shelf life of the medication. A method for manufacturing the disclosed medication is also provided. Excerpt(s): Levothyroxine sodium is prescribed in thyroid replacement therapy. It is often prescribed in tablet form. Clinically, levothyroxine sodium serves as specific replacement therapy for reduced or absent thyroid function of any etiology, including human ailments such as myxedema, cretinism and obesity, in non-exclusive particular. The levothyroxine sodium is normally expressed chemically as C.sub.15 H.sub.10 I.sub.4 NaO.sub.4 XH.sub.2 O. Levothyroxine sodium is not a very stable compound. It is well known that the stability of the levothyroxine sodium hormone is quite poor, since it is hygroscopic and degrades rapidly under conditions of high humidity or in the presence of other moisture sources or light and under conditions of high temperature, especially in the presence of other pharmaceutical excipients such as carbohydrates, including lactose, sucrose, dextrose and starch, as well as certain dyes. Due to this inherent instability, tablet formulations of levothyroxine sodium tend to degrade rapidly, particularly under conditions of high humidity and temperature. Gupts, et al, have reported that some tablets decompose by approximately 1% per month, while others decompose by up to 40% in 30 days once the bottles containing the tablets are opened. It is not uncommon for levothyroxine sodium tablets to be dispensed in quantities for up to 100 days' supply at a time. "Effect of Excipients on the Stability of Levothyroxine Sodium Tablets," Journal of Clinical Pharmacy and Therapeutics, (1990) 15, 331-336. It is, therefore, desirable to manufacture levothyroxine sodium tablets which are more stable than those known in the prior art, so that the percentage of the active ingredient of levothyroxine sodium will not diminish over time as quickly as with the more unstable tablets. Various dry dosage formulations containing levothyroxine sodium, as well as processes of manufacture, are known in the art. U.S. Pat. No. 2,889,363, issued Jun. 2, 1959, to Ginger, et al and U.S. Pat. No. 2,889,364, dated Jun. 2, 1959, also to Ginger, et al., detail processes for producing thyroxine sodium. These prior art formulations experience stability problems. One disclosure of a claimed stable dosage of levothyroxine sodium is found in U.S. Pat. No. 5,225,204, issued Jul. 6, 1993, to Chen, et. al., which details the use of polyvinylpyrrolidone or Poloxamer as a stabilizing complexing agent. The present invention differs from Chen's in several respects, not the least of which is in the use of potassium iodide as the stabilizing excipient. Web site: http://www.delphion.com/details?pn=US05635209__

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•

Levothyroxine

Stabilized thyroxine medications Inventor(s): Groenewoud; Pieter J. (4 Westover Ct., Yardley, PA 19067) Assignee(s): none reported Patent Number: 6,190,696 Date filed: June 7, 1999 Abstract: Thyroxine medications which include combinations of levothyroxine, and/or liothronine, or dextrothyroxine, or thyroid, and one or more iodine salts, or iodine donor compounds are described, which produce a stable thyroxine medication, with a long shelf life. A method for manufacturing the medications is also described. Excerpt(s): Thyroxine and Liothyronine containing medications are and have been used for many years to treat thyroid deficiency and related illnesses. In administering thyroxine and or liothyronine products it is important to assure that the patient is receiving the correct dose, customized to his or her particular needs. Many individual tablet strengths are available to allow the physician to titrate their patients accurately. An example is Levothyroxine Sodium that is available in 10 individual strengths ranging from 25-300 mcg per tablet. Web site: http://www.delphion.com/details?pn=US06190696__

•

Stable dosage of levothyroxine sodium and process of production Inventor(s): Chen; Jivn-Ren (7614 Brookhaven, Shreveport, LA 71105), Papadimitriou; Dimitri C. (231 Preston Ave., Shreveport, LA 71106) Assignee(s): none reported Patent Number: 5,225,204 Date filed: November 5, 1991 Abstract: A stable dosage form of levothyroxine sodium which includes a stable complex of levothyroxine sodium and a cellulose compound, polyvinylpyrrolidone or a Poloxamer, which complex is adsorbed on the surface of a cellulose compound carrier. In a first embodiment the stable complex of levothyroxine sodium is prepared by mixing the levothyroxine sodium with a complexing agent such as polyvinylpyrrolidone or a Poloxamer, dissolving the resulting mixture in a polar organic solvent such as water, methanol, ethanol, propanol, isopropyl alcohol, methylene dichloride or butanol, adding a cellulose carrier to the liquid and subsequently drying the resulting mixture to obtain a powdery, stabilized complex of levothyroxine sodium and polyvinylpyrrolidone or Poloxamer adsorbed on the cellulose carrier. In a second embodiment the levothyroxine sodium is at least partially dissolved directly in the polar organic solvent and a cellulose carrier is added to the solution to produce the stabilized levothyroxine sodium complex. In a third embodiment the levothyroxine sodium is dry mixed with a cellulose complexing agent and a cellulose carrier to produce the stabilized levothyroxine sodium complex. The complexes can be mixed with pharmaceutically acceptable excipients for compression into tablets or placed in capsules to define stable levothyroxine sodium dosage formulations. Excerpt(s): This invention relates to therapeutic agents and more particularly, to stabilized pharmaceutical compositions, preparations and formulations containing levothyroxine sodium, the sodium salt of the levo isomer of thyroxine, an active

Patents 57

physiological thyroid hormone obtained from the thyroid gland of domesticated animals or prepared synthetically. Clinically, levothyroxine sodium serves as specific replacement therapy for reduced or absent thyroid function of any etiology, including human ailments such as myxedema, cretinism and obesity, in non-exclusive particular. The levothyroxine sodium is normally expressed chemically as C.sub.15 H.sub.10 I.sub.4 NaO.sub.4.XH.sub.2 O. It is well known that the stability of the levothyroxine sodium hormone is quite poor, since it is hygroscopic and degrades rapidly under conditions of high humidity or in the presence of other moisture sources or light and under conditions of high temperature, especially in the presence of other pharmaceutical excipients such as carbohydrates, including lactose, sucrose, dextrose and starch, as well as certain dyes. Accordingly, commercially available levothyroxine sodium tablet preparations exhibit a very short shelf life, particularly as a unit dose, blister pack product. Occasional recalls of such tablet products have been ordered by the FDA due to tablet subpotency within the product expiration date. Due to this inherent instability, tablet formulations of levothyroxine sodium tend to degrade rapidly, particularly under conditions of high humidity and temperature. It is therefore desirable to provide stable formulations of levothyroxine sodium tablets and capsules which may be employed in the treatment of human thyroid hormone deficiency conditions. This objective is achieved in a first embodiment by mixing a commercial grade of levothyroxine sodium with polyvinylpyrrolidone, also known as "PVP" or "Povidone USP", in the form of Plasdon C-15, K-29-32, K-90 (trademarks) or K-120 or Kolloidon 12 PF or 17 PF (trademarks) and at least partially dissolving the resulting mixture in a polar organic solvent such as water, methanol, ethanol, propanol, isopropyl alcohol, methylene dichloride or butanol, or a combination of these solvents, and adding a cellulose carrier component such as microcrystalline cellulose to the solution or mixture. The solvent component or components of the solution or mixture are removed by drying and the resulting fine powder is identified as a stable complex of levothyroxine sodium and polyvinylpyrrolidone dispersed on the surface of the cellulose carrier component. In an alternative embodiment the levothyroxine sodium is mixed with a Poloxamer such as Pluronic F-68 or Pluronic F-127, (trademarks) and the mixture is dissolved in one or more of the solvents identified above. The microcrystalline cellulose or alternative cellulose carrier component is then added, the resulting solution or mixture is dried to remove the solvent or solvents and the fine powder product is characterized by a stable complex of levothyroxine sodium and Poloxamer adsorbed on the cellulose carrier. Web site: http://www.delphion.com/details?pn=US05225204__ •

Stable thyroid hormone preparations and method of making same Inventor(s): Bruno; Maria S. (Guaynabo, PR), Frontanes; Ramon A. (Caguas, PR), Garcia; Hector L. (Cidra, PR), Perez; Maria A. (Aguas Buenas, PR), Simamora; Pahala (Cardova, TN) Assignee(s): Mova Pharmaceutical Corp. (Caguas, PR) Patent Number: 6,399,101 Date filed: March 30, 2000 Abstract: Provided is a pharmaceutical preparation of thyroid hormone and a process of making a tablet formulation of the pharmaceutical preparation using direct compression. In a preferred embodiment, the pharmaceutical preparation comprises levothyroxine sodium and silicified microcrystalline cellulose.

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Levothyroxine

Excerpt(s): The present invention is directed to therapeutic agents for the treatment of hormone disorders and the method for preparing those agents. More specifically, the present invention relates to stable pharmaceutical preparations containing thyroxine drugs, especially levothyroxine sodium, which is the sodium salt of the levo isomer of thyroxine. L-thyroxine is the principal hormone secreted by the normal thyroid gland. The thyroid gland is stimulated to secrete thyroid hormones by the action of thyroid stimulating hormone (TSH), which is produced in the anterior pituitary gland. TSH secretion is then controlled by thyrotropin-releasing hormone (TRH), produced in the hypothalamus. Thyroid hormones circulating in the blood act as feedback inhibitors of both TSH and TRH secretion. Thyroxine may be obtained from the thyroid gland of domesticated animals, or alternatively, the hormone can be prepared synthetically. Levothyroxine and other thyroid hormones are known to serve as specific replacement therapy when the thyroid function has been reduced or is completely absent for a variety of disease states, including, for instance, myxedema, cretinism and obesity. Levothyroxine is also indicated as a pituitary TSH suppressant in the treatment or prevention of euthyroid goiters. Pharmaceutical preparations containing levothyroxine hormone are known to exhibit deficiencies with regard to uniformity, stability and shelf life. More specifically, levothyroxine sodium hormone is hygroscopic and degrades rapidly under conditions of high humidity or in the presence of other moisture sources or light and under conditions of high temperature. Moreover, levothyroxine is known to degrade in the presence of certain pharmaceutical excipients such as carbohydrates, including lactose, sucrose, dextrose and starch, as well as certain dyes. Web site: http://www.delphion.com/details?pn=US06399101__

Patent Applications on Levothyroxine As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to levothyroxine: •

Levothyroxine compositions having unique triiodothyronine Tmax properties Inventor(s): DiMenna, Philip A.; (St. Petersburg, FL), Franz, G. Andrew; (St. Louis, MO), Gemma, Rocco L.; (Dover, OH), Strauss, Elaine A.; (Seminole, FL) Correspondence: Edwards & Angell, Llp; P.O. Box 9169; Boston; MA; 02209; US Patent Application Number: 20030165564 Date filed: October 29, 2002 Abstract: The present invention generally relates to stable pharmaceutical compositions, and methods of making and administering such compositions. In one aspect, the invention features stabilized pharmaceutical compositions that include pharmaceutically active ingredients such as levothyroxine (T4) sodium and liothyronine (T3) sodium (thyroid hormone drugs), preferably in an immediate release solid dosage form. Also provided are methods for making and using such immediate release and stabilized compositions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

6

This has been a common practice outside the United States prior to December 2000.

Patents 59

•

Liothyronine sodium and levothyroxine sodium combination Inventor(s): Gault, Robert; (Grosse Pointe Woods, MI), Ritter, Steven C.; (Canton, MI), Springer-Wilson, Steven E.; (Dearborn, MI) Correspondence: John Conway; Basf Bioresearch Corporation; 100 Research Drive; Worcester; MA; 01605; US Patent Application Number: 20020193440 Date filed: February 20, 2002 Abstract: Novel formulations useful for thyroid hormone replacement and suppression therapy are described herein. While dosage formulations containing iodinated thyronines, levothyroxine sodium (T4) or liothyronine sodium (T3), as the active pharmaceutical ingredient (API) dispersed in a polymeric solid are known, manufacturing such formulations with acceptable dose content uniformity is difficult due to the high biological activity of T4 and T3. Described herein is the preparation of a single API formulation containing both T4 and T3 in a pharmaceutically effective ratio, wherein the dose content uniformity is the same for T3 as for T4 even if the T3 dose is extremely low. The present invention provides a method for the preparation of an API wherein T3 is uniformly distributed within the crystal lattice of T4 to form a solid solution by cooling suitable solutions of levothyroxine sodium and liothyronine sodium, a pharmaceutical composition containing such an API, and a method to use such an API in the treatment of thyroactive disorders. Excerpt(s): This application claims priority to U.S. provisional application No. 60/269,992, filed Feb. 20, 2001. This invention relates to preparations useful in replacement therapy for thyroactive material normally supplied by the thyroid gland. The thyroid gland releases various iodinated thyronines and by doing so modulates a body's energy metabolism. Two of the iodinated thyronines are levothyroxine and liothyronine. Dosage forms containing as the active pharmaceutical ingredient (API) either levothyroxine sodium (T4) or liothyronine sodium (T3) are widely used for thyroid hormone replacement and suppression therapy. The usefulness of a dosage form containing both APIs is recognized, and tablets with a T4/T3 molar ratio of 3.37:1 (weight ratio 4:1) are marketed under the generic name liotrix. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Pharmaceutical preparation Inventor(s): Nischwitz, Marion; (Darmstadt, DE), Schreder, Sven; (Heidelberg, DE) Correspondence: Millen, White, Zelano & Branigan, P.C.; 2200 Clarendon BLVD.; Suite 1400; Arlington; VA; 22201; US Patent Application Number: 20040063611 Date filed: September 15, 2003 Abstract: The invention relates to a pharmaceutical preparation comprising levothyroxine sodium, gelatine and fillers, which is free of organic solvent residues, and to processes for its production. Excerpt(s): The invention relates to a novel stable pharmaceutical preparation comprising levothyroxine sodium, gelatine and fillers and which is free of organic

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solvent residues. This novel preparation has an improved stability and can be used as a thyroid hormone preparation. This novel preparation furthermore has an improved release of active compound in vitro. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Storage stable thyroxine active drug formulations and methods for their production Inventor(s): Hanshew, Dwight D. JR.; (Morgantown, WV), Wargo, David John; (Pittsburgh, PA) Correspondence: Rothwell, Figg, Ernst & Manbeck, P.C.; 1425 K Street, N.W.; Suite 800; Washington; DC; 20005; US Patent Application Number: 20030099698 Date filed: November 13, 2001 Abstract: This invention provides a storage-stable dosage form of a thyroxine active drug composition which exhibits an improved stability. The formulation contains a thyroxine active drug substance, an alditol, and a saccharide, and, optionally, additional pharmaceutically accepted excipients. Levothyroxine sodium is the preferred active drug substance, mannitol is the preferred alditol, and sucrose is the preferred saccharide. Additional preferred excipients include, for example, microcrystalline cellulose, crospovidone, magnesium stearate, colloidal silicon dioxide, and sodium lauryl sulfate. Excerpt(s): The invention relates generally to the field of medicinal formulations, and more particularly to methods of preparing storage stable pharmaceutical compositions in unit dosage form of levothyroxine sodium with increased shelf life and compositions made by these methods. Thyroxine active drugs are known for both therapeutic and prophylactic treatment of thyroid disorders. For example, levothyroxine sodium is prescribed for thyroid hormone replacement therapy in cases of reduced or absent thyroid function in e.g., ailments such as myxedema, cretinism and obesity. See, for example, Post and Warren in Analytical Profiles of Drug Substances, Vol. 5, Florey (ed.); Academic Press, New York (1976), pp. 226-281. Levothyroxine sodium is quite unstable, hygroscopic and degrades rapidly when subjected to high humidity, light or high temperature. See, for example, Won, Pharm. Res. 9(1):131-137, 1992. Because of the chemicophysical properties of the drug, formulations of levothyroxine sodium have extremely short stability duration, worsened under conditions of high humidity and temperature. Tablets may decompose approximately 1 percent per month. Gupta et. al., J. Clin. Pharm. Ther. 15:331-335, 1990. The stability problem has been so widespread that some drug companies marketing levothyroxine sodium tablets have been forced to recall various batches due to lack of stability. Formulations containing levothyroxine sodium have been known in the art since the late 1950s. There have been recent attempts to develop more stable dosage formulations of levothyroxine sodium. For example, U.S. Pat. No. 5,635,209 discloses levothyroxine sodium in combination with potassium iodide as part of a stabilizing excipient. In the manufacture of this formulation, levothyroxine sodium was first mixed with microcrystalline cellulose, and then added to a dried granulation of potassium iodide and microcrystalline cellulose. The formulation purportedly provided increased active drug potency over a three month period in comparison to then commercially available formulations. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Thyroid hormone formulations Inventor(s): Chrai, Suggy S.; (Cranbury, NJ), Murari, Ramaswamy; (Hillsborough, NJ) Correspondence: Allen Bloom, ESQ.; Dechert; Princeton Pike Corporate Center; P.O. Box 5218; Princeton; NJ; 08543-5218; US Patent Application Number: 20020077364 Date filed: July 6, 2001 Abstract: A method is disclosed for formulating a solid dosage of thyroid hormone, while avoiding instability caused by interaction of the active ingredient with excipients. The thyroid hormone may be levothyroxine sodium or triiodothyronine. The method comprises depositing the active ingredient, preferably electrostatically, as a dry powder substantially free of excipients, onto a pharmaceutically acceptable polymer substrate. Solid pharmaceutical dosage forms also are disclosed. Excerpt(s): The present invention relates to improved solid dosage formulations of thyroid hormones. Active physiological thyroid hormones include levothyroxine sodium (the sodium salt of the levo isomer of thyroxine) and triiodothyronine. Thyroid hormone replacement is the therapy of choice for the treatment of primary hypothyroidism, and is also effective for the treatment of secondary hypothyroidism due to pituitary or hypothalamic disease. Solid pharmaceutical dosages traditionally have included capsules, tablets and other unit dosage forms, each form containing a pharmaceutically or biologically active ingredient and at least one additional "excipient" ingredient. The excipient, which is intended to be a therapeutically inert and non-toxic carrier, may function, for example, as a diluent, binder, lubricant, disintegrant, stabilizer, buffer or preservative. Thyroid hormone solid dosages historically have suffered from stability problems. For example, from 1994 through 1998, more than 100 million levothyroxine sodium tablets were recalled due to instability, because of an inability to assure adequate potency prior to product expiration. During an approximately one-year period spanning 1999 and 2000, more than 800 million levothyroxine tablets were recalled for similar reasons. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with levothyroxine, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “levothyroxine” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on levothyroxine. You can also use this procedure to view pending patent applications concerning levothyroxine. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. PERIODICALS AND NEWS ON LEVOTHYROXINE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover levothyroxine.

News Services and Press Releases One of the simplest ways of tracking press releases on levothyroxine is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “levothyroxine” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to levothyroxine. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “levothyroxine” (or synonyms). The following was recently listed in this archive for levothyroxine: •

Pregnancy indicates prompt levothyroxine boost in hypothyroid women Source: Reuters Medical News Date: July 14, 2004

•

No benefit seen with adding liothyronine to levothyroxine for hypothyroidism Source: Reuters Medical News Date: December 12, 2003

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•

Raloxifene may block levothyroxine absorption Source: Reuters Medical News Date: June 17, 2003

•

Lannett licenses levothyroxine for thyroid disorder from Jerome Stevens Source: Reuters Industry Breifing Date: April 23, 2003

•

Genpharm levothyroxine NDA approved Source: Reuters Industry Breifing Date: June 03, 2002

•

FDA says it will not immediately withdraw unapproved levothyroxine drugs Source: Reuters Industry Breifing Date: July 12, 2001

•

King gets FDA approval for oral levothyroxine product Source: Reuters Industry Breifing Date: May 25, 2001

•

FDA approves first levothyroxine drug for thyroid hormone replacement Source: Reuters Industry Breifing Date: August 23, 2000

•

List Of Drugs That Interact With Levothyroxine Grows Source: Reuters Medical News Date: November 02, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “levothyroxine” (or synonyms) into the search box, and click on “Search News.” As this service is technology

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oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “levothyroxine” (or synonyms). If you know the name of a company that is relevant to levothyroxine, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “levothyroxine” (or synonyms).

Academic Periodicals covering Levothyroxine Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to levothyroxine. In addition to these sources, you can search for articles covering levothyroxine that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for levothyroxine. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with levothyroxine. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to levothyroxine: Thyroid Hormones •

Systemic - U.S. Brands: Armour Thyroid; Cytomel; Levo-T; Levothroid; Levoxyl; Synthroid; Thyrar; Thyroid Strong; Thyrolar; Triostat; Westhroid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202566.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

7

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

8

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “levothyroxine” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 33662 200 2 8 19 33891

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “levothyroxine” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

11

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

15 Adapted 16

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on levothyroxine can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to levothyroxine. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to levothyroxine. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “levothyroxine”:

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Endocrine Diseases http://www.nlm.nih.gov/medlineplus/endocrinediseases.html Hormones http://www.nlm.nih.gov/medlineplus/hormones.html Pituitary Disorders http://www.nlm.nih.gov/medlineplus/pituitarydisorders.html Thyroid Cancer http://www.nlm.nih.gov/medlineplus/thyroidcancer.html Thyroid Diseases http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to levothyroxine. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to levothyroxine. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with levothyroxine. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about levothyroxine. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “levothyroxine” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “levothyroxine”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “levothyroxine” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “levothyroxine” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

18

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

87

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

89

LEVOTHYROXINE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Aluminum Hydroxide: Hydrated aluminum. A compound with many biomedical applications: as a gastric antacid, an antiperspirant, in dentifrices, as an emulsifier, as an adjuvant in bacterins and vaccines, in water purification, etc. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH)

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group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH]

Dictionary 91

Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Bioavailable: The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Blister pack: A package consisting of a clear plastic overlay affixed to a cardboard backing

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for protecting and displaying a product. [EU] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs.

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[NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac Glycosides: Substances obtained from species of Digitalis, Strophanthus, and other plants that contain specific steroid glycosides or their semisynthetic derivatives and used in congestive heart failure. They increase the force of cardiac contraction without significantly affecting other parameters, but are very toxic at larger doses. Their mechanism of action usually involves inhibition of the Na(+)-K(+)-exchanging ATPase and they are often used in cell biological studies for that purpose. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cephalexin: A semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. It is effective against both gram-positive and gram-negative organisms. [NIH] Cephaloridine: A cephalosporin antibiotic. [NIH] Cephalothin: A cephalosporin antibiotic. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially

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the brain and spinal cord, and in animal fats and oils. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy,

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spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentifrices: Any preparations used for cleansing teeth; they usually contain an abrasive, detergent, binder and flavoring agent and may exist in the form of liquid, paste or powder; may also contain medicaments and caries preventives. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Dextrothyroxine: O-(4-Hydroxy-3,5-diiodophenyl)-3,5-diiodo-D-tyrosine. The dextrorotary isomer of thyroxine. It is used as an oral anticholesteremic agent, mainly to treat hypercholesteremia in euthyroid patients. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH]

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Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Diuretic: A drug that increases the production of urine. [NIH] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrinologist: A doctor that specializes in diagnosing and treating hormone disorders. [NIH]

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Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU]

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Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goiter: Enlargement of the thyroid gland. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of health-

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related institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hydrocodone: Narcotic analgesic related to codeine, but more potent and more addicting by weight. It is used also as cough suppressant. [NIH] Hydrofluoric Acid: A solution of hydrogen fluoride in water. It is a colorless fuming liquid which can cause painful burns. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypotension: Abnormally low blood pressure. [NIH]

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Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH]

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Intravenous: IV. Into a vein. [NIH] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Isopropyl: A gene mutation inducer. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Levo: It is an experimental treatment for heroin addiction that was developed by German scientists around 1948 as an analgesic. Like methadone, it binds with opioid receptors, but it is longer acting. [NIH] Liothyronine sodium: A thyroid hormone. Also called triiodothyronine or T-3. [NIH] Lipid: Fat. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries

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cells that help fight infection and disease. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH]

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Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myxedema: A condition characterized by a dry, waxy type of swelling with abnormal deposits of mucin in the skin and other tissues. It is produced by a functional insufficiency of the thyroid gland, resulting in deficiency of thyroid hormone. The skin becomes puffy around the eyes and on the cheeks and the face is dull and expressionless with thickened nose and lips. The congenital form of the disease is cretinism. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephrosis: Descriptive histopathologic term for renal disease without an inflammatory component. [NIH] Nephrotic: Pertaining to, resembling, or caused by nephrosis. [EU] Nephrotic Syndrome: Clinical association of heavy proteinuria, hypoalbuminemia, and generalized edema. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase

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(H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreatic: Having to do with the pancreas. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH]

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Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH]

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Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium hydroxide: A toxic and highly corrosive chemical used to make soap, in bleaching, and as a paint remover. It is used in small amounts as a food additive and in the preparatrion of some drugs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU]

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Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioactive iodine: A radioactive form of the chemical element iodine, often used for imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records

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and interviews with patients who already have or had a disease. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ritonavir: An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sella Turcica: A bony prominence situated on the upper surface of the body of the sphenoid bone. It houses the pituitary gland. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic

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number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Steady state: Dynamic equilibrium. [EU] Sterile: Unable to produce children. [NIH] Steroid:

A

group

name

for

lipids

that

contain

a

hydrogenated

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cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acid-binding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone,

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which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyroid Nodule: A small circumscribed mass of differentiated tissue associated with the thyroid gland. It can be pathogenic or non-pathogenic. The growth of nodules can lead to a condition of nodular goiter. Most nodules appear between the ages of 30 and 50 years and most are benign. [NIH] Thyroiditis: Inflammation of the thyroid gland. [NIH] Thyrotoxicosis: The clinical syndrome that reflects the response of the peripheral tissues to an excess of thyroid hormone. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH]

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Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasopressor: 1. Stimulating contraction of the muscular tissue of the capillaries and arteries. 2. An agent that stimulates contraction of the muscular tissue of the capillaries and arteries. [EU]

Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH]

113

INDEX A Adenoma, 34, 89 Adjuvant, 89 Adrenergic, 4, 16, 89, 97 Adsorption, 24, 31, 89 Adsorptive, 89 Adverse Effect, 3, 20, 89, 108 Aerosol, 4, 89 Affinity, 89, 109 Algorithms, 89, 91 Alkaline, 89, 92, 110 Alternative medicine, 64, 89 Aluminum, 21, 31, 89, 110 Aluminum Hydroxide, 21, 31, 89 Amenorrhea, 33, 89 Amino acid, 89, 90, 97, 104, 105, 106, 108, 110, 111 Amlodipine, 4, 90 Amoxicillin, 4, 90 Ampicillin, 90 Analgesic, 90, 94, 99, 101 Anaphylaxis, 25, 90 Anesthesia, 4, 90 Angina, 90 Angina Pectoris, 90 Antibiotic, 90, 91, 92, 93, 97 Antibodies, 90, 100 Antibody, 89, 90, 94, 100, 101, 103, 107, 112 Anticoagulants, 4, 90 Antigen, 89, 90, 94, 99, 100 Anti-infective, 90, 101 Anti-inflammatory, 4, 90 Antimicrobial, 91, 93 Antioxidant, 54, 91 Antipruritic, 91, 94 Anxiety, 30, 91 Arterial, 91, 99, 106 Arteries, 91, 92, 95, 102, 112 Assay, 8, 38, 41, 91 Atrioventricular, 15, 91 Atrium, 91, 112 Azithromycin, 4, 91 B Bacteria, 89, 90, 91, 97, 99, 102, 112 Bactericidal, 91, 97 Benign, 6, 7, 8, 26, 27, 28, 30, 31, 89, 91, 103, 107, 111

Bile, 91, 94, 101, 110 Biliary, 91, 94 Binding agent, 54, 91 Bioavailability, 8, 9, 20, 31, 35, 91, 100 Bioavailable, 35, 91 Biochemical, 6, 33, 91, 105, 108 Biotechnology, 6, 64, 73, 91 Bladder, 91, 95 Blister, 57, 91 Blister pack, 57, 91 Blood Coagulation, 92 Blood Glucose, 92, 99 Blood pressure, 92, 99, 109 Blood vessel, 92, 93, 97, 98, 109, 110, 112 Body Fluids, 92, 109 Brachytherapy, 92, 100, 101, 107, 112 Broad-spectrum, 90, 92 Buccal, 92, 110 Bulimia, 25, 92 C Calcium, 4, 13, 17, 21, 38, 48, 90, 92, 94, 99, 104, 110 Calcium Carbonate, 17, 21, 38, 48, 92 Calcium channel blocker, 4, 90, 92 Calcium Channel Blockers, 4, 92 Capillary, 92, 98 Capsules, 56, 57, 61, 92, 96, 98 Carbohydrates, 55, 57, 58, 92, 93 Carcinogenic, 92, 100, 110 Carcinoma, 7, 8, 12, 27, 37, 92 Cardiac, 4, 13, 18, 22, 93, 97, 103, 110 Cardiac Glycosides, 4, 93 Carnitine, 38, 93 Case report, 21, 33, 93, 94 Case series, 93, 94 Caudal, 93, 96, 100 Cell, 91, 92, 93, 94, 98, 99, 100, 102, 103, 104, 105, 107 Cell membrane, 92, 93 Cellobiose, 93 Cellulose, 54, 56, 57, 60, 92, 93, 105 Central Nervous System, 4, 93, 108 Cephalexin, 4, 93 Cephaloridine, 93 Cephalothin, 93 Cerebrovascular, 92, 93 Chin, 93, 102 Cholesterol, 91, 93, 94, 110

114

Levothyroxine

Cholestyramine, 29, 94 Chronic, 3, 14, 94, 97, 100, 101, 110 Clinical study, 37, 94 Clinical trial, 5, 73, 94, 95, 96, 106, 107 Cloning, 91, 94 Codeine, 94, 99 Cofactor, 94, 106 Collapse, 90, 94 Colloidal, 60, 94 Complement, 94, 95 Complementary and alternative medicine, 47, 49, 94 Complementary medicine, 47, 95 Compliance, 19, 95 Computational Biology, 73, 95 Congestive heart failure, 93, 95, 101 Conjugated, 4, 95 Consultation, 4, 95 Contraindications, ii, 95 Controlled study, 18, 30, 95 Coronary, 90, 95, 102 Coronary Thrombosis, 95, 102 Cortical, 95, 108 Cryptosporidiosis, 91, 95 Curative, 95, 110 D Density, 12, 18, 19, 95, 104, 109 Dental Care, 3, 95 Dentifrices, 89, 95 Depressive Disorder, 40, 95, 101 Dextrothyroxine, 15, 56, 95 Diagnostic procedure, 53, 65, 95 Diarrhea, 94, 95 Diencephalon, 96, 100 Digestion, 91, 96, 101, 105, 110 Direct, iii, 57, 67, 96, 98, 107, 110 Disinfectant, 96, 97 Disposition, 18, 48, 96 Diuretic, 96, 102, 109 Domesticated, 57, 58, 96 Dosage Forms, 61, 96 Double-blind, 18, 19, 33, 37, 96 Drug Interactions, 3, 68, 96 Dyes, 55, 57, 58, 96 Dysphoric, 95, 96 E Edema, 96, 101, 103 Efficacy, 13, 20, 96 Electrolyte, 96, 106, 109 Electrons, 91, 96, 101, 104, 107 Enalapril, 4, 96 Endemic, 16, 38, 39, 96, 109

Endocrine Glands, 96, 104 Endocrinologist, 5, 96 Endothelium, 22, 97 Endothelium, Lymphatic, 97 Endothelium, Vascular, 97 Environmental Health, 23, 72, 74, 97 Enzymatic, 90, 92, 94, 97 Enzyme, 96, 97, 101, 106, 110, 112 Epidemic, 97, 109 Epidermis, 91, 97 Epinephrine, 89, 97, 103, 111 Epithelial, 89, 97 Epithelium, 97 Erythrocytes, 97, 107 Erythromycin, 91, 97 Esophagitis, 97, 110 Estrogen, 4, 97 Ethanol, 56, 57, 97 Excipient, 55, 60, 61, 97 Exogenous, 89, 98 Expiration, 57, 61, 98 External-beam radiation, 98, 101, 107, 112 Extracellular, 98, 104, 109, 110 F Family Planning, 73, 98 Fluoxetine, 4, 98 Free Radicals, 91, 98 G Gastric, 89, 90, 93, 96, 98, 103, 105 Gastric Acid, 90, 98, 103 Gastrin, 98, 99 Gastritis, 98, 110 Gastrointestinal, 5, 21, 48, 97, 98, 108, 110 Gastrointestinal tract, 5, 97, 98, 108 Gene, 6, 91, 98, 101 Giardiasis, 14, 98 Gland, 58, 59, 98, 104, 105, 108, 110, 111 Glomerular, 34, 98, 101, 102, 107 Glomerular Filtration Rate, 34, 98, 102 Glomerulus, 98 Glucose, 92, 93, 98, 108, 109 Glycoprotein, 18, 48, 98 Goiter, 5, 7, 24, 27, 30, 32, 35, 36, 37, 40, 98, 111 Gonadal, 98, 110 Governing Board, 98, 106 Grade, 57, 99 Gram-negative, 93, 99 Gram-positive, 93, 99 H Half-Life, 6, 99 Heart failure, 99

115

Hemodialysis, 92, 99, 101 Hepatic, 8, 99 Heredity, 98, 99 Hormonal, 4, 99 Hormone, 5, 6, 7, 8, 11, 14, 17, 19, 31, 39, 48, 54, 55, 57, 58, 59, 60, 61, 64, 96, 97, 98, 99, 101, 103, 106, 110, 111 Hormone Replacement Therapy, 54, 60, 99 Hydrocodone, 4, 99 Hydrofluoric Acid, 99, 109 Hydrogen, 92, 99, 102, 103, 104 Hypercalcemia, 5, 99 Hypersensitivity, 90, 99 Hypertension, 90, 92, 96, 99, 101 Hyperthyroidism, 4, 14, 21, 29, 99 Hypoglycemic, 4, 99 Hypoglycemic Agents, 4, 99 Hypotension, 4, 99 Hypothalamic, 5, 61, 100 Hypothalamus, 58, 96, 100, 105 I Immunoglobulins, 38, 100 Implant radiation, 100, 101, 107, 112 In vitro, 24, 60, 100 In vivo, 23, 100 Indinavir, 23, 100 Infarction, 95, 100, 102 Infection, 23, 95, 98, 100, 102, 110, 111 Inflammation, 4, 90, 97, 98, 100, 105, 110, 111 Ingestion, 8, 30, 39, 47, 100, 102, 105, 110 Inhalation, 89, 100, 105 Initiation, 34, 100 Internal radiation, 100, 101, 107, 112 Interstitial, 92, 100, 101, 107, 112 Intestinal, 14, 16, 18, 21, 24, 31, 38, 95, 100, 102 Intestines, 98, 100 Intoxication, 36, 100 Intracellular, 92, 100, 106 Intravenous, 13, 37, 101 Inulin, 98, 101 Iodine, 5, 16, 24, 32, 38, 39, 40, 54, 56, 101, 107 Ions, 94, 96, 99, 101 Irradiation, 5, 37, 101, 112 Isopropyl, 56, 57, 101 K Kb, 72, 101 Kidney Failure, 101, 102

L Lesion, 101, 111 Lethargy, 100, 101 Levo, 56, 58, 61, 68, 101 Liothyronine sodium, 54, 59, 101 Lipid, 15, 18, 101 Lisinopril, 4, 101 Lithium, 34, 101 Liver, 22, 29, 91, 93, 99, 101 Localization, 14, 101 Localized, 100, 101, 105, 111 Lymph, 97, 101, 102 Lymphatic, 97, 100, 101, 102 M Malabsorption, 14, 21, 34, 40, 48, 102 Malignant, 102, 103, 107 Mania, 40, 102 Manic, 40, 101, 102 Mannitol, 60, 102 Medical Records, 102, 107 MEDLINE, 73, 102 Membrane, 93, 94, 99, 102, 103, 104 Meninges, 93, 102 Menopause, 102, 106 Menstruation, 89, 102 Mental, iv, 4, 5, 72, 74, 93, 96, 100, 102, 107, 111 Metastasis, 102 Metastatic, 25, 102 Methanol, 56, 57, 102 MI, 59, 87, 102 Microbe, 102, 111 Modification, 90, 102, 107 Molecular, 73, 75, 91, 95, 102 Molecule, 90, 94, 102, 104, 107 Monoclonal, 101, 103, 107, 112 Mood Disorders, 36, 103 Mucosa, 103, 110 Myocardium, 90, 102, 103 Myxedema, 8, 54, 55, 57, 58, 60, 103 N Nausea, 96, 103, 111 Necrosis, 100, 102, 103 Neonatal, 5, 103 Neoplasm, 32, 103 Nephrosis, 103 Nephrotic, 23, 103 Nephrotic Syndrome, 23, 103 Nerve, 89, 90, 93, 103 Nervous System, 93, 103, 110 Neutrons, 101, 103, 107 Norepinephrine, 89, 103

116

Levothyroxine

O Ointments, 96, 103 Oliguria, 101, 102, 103 Omeprazole, 4, 103 Opacity, 95, 104 Optic Chiasm, 100, 104 Orbit, 37, 104 Orthostatic, 4, 104 Osmolarity, 102, 104 Osteoblasts, 104 Osteocalcin, 35, 104 Osteoporosis, 12, 28, 104 Overdose, 26, 30, 104 Oxidation, 91, 104 P Palate, 104, 110 Palliative, 104, 110 Pancreatic, 93, 104 Papilla, 104 Papillary, 25, 104 Parathyroid, 5, 104, 110 Parathyroid Glands, 5, 104 Parathyroid hormone, 104 Parietal, 104, 105 Paroxetine, 4, 105 Peptic, 105, 110 Peptide, 90, 105, 106, 111 Periodontal disease, 4, 105 Pharmaceutical Preparations, 54, 58, 93, 97, 105 Pharmaceutical Solutions, 96, 105 Pharmacodynamics, 3, 105 Pharmacokinetic, 4, 105 Pharmacologic, 3, 90, 99, 105, 111 Phosphorus, 92, 104, 105 Physical Examination, 5, 105 Physiologic, 6, 20, 99, 101, 102, 105, 107 Pituitary Gland, 58, 105, 108 Plants, 93, 98, 101, 103, 105, 108, 111 Plasma, 32, 90, 93, 97, 98, 101, 105 Pneumonia, 95, 105 Poisoning, 27, 100, 103, 105 Polysaccharide, 90, 93, 105 Postmenopausal, 12, 104, 106 Potassium, 4, 26, 54, 55, 60, 106 Potassium hydroxide, 54, 106 Practice Guidelines, 74, 106 Premenopausal, 12, 14, 19, 106 Progesterone, 106, 110 Progressive, 32, 103, 106, 107 Prospective study, 12, 106 Protease, 100, 106, 108

Protective Agents, 92, 106 Protein C, 104, 106 Protein S, 48, 91, 97, 104, 106 Proteins, 90, 93, 94, 97, 102, 105, 106, 108, 111, 112 Proteinuria, 103, 106 Protocol, 4, 106 Protozoan, 95, 98, 106 Psychic, 102, 107, 108 Public Policy, 73, 107 Q Quality of Life, 13, 16, 30, 107 R Radiation, 90, 98, 100, 101, 107, 112 Radiation therapy, 98, 100, 101, 107, 112 Radioactive, 5, 7, 99, 100, 101, 107, 112 Radioactive iodine, 5, 7, 107 Radiolabeled, 101, 107, 112 Radiotherapy, 92, 101, 107, 112 Randomized, 7, 12, 15, 19, 30, 33, 34, 96, 107 Receptor, 4, 48, 90, 107, 108 Recurrence, 32, 33, 107 Red blood cells, 22, 97, 107, 108 Refer, 1, 92, 94, 101, 103, 107 Reflective, 6, 107 Reflux, 107, 110 Refractory, 21, 34, 36, 107 Regimen, 96, 107 Remission, 107 Renal failure, 32, 107 Retrospective, 36, 107 Retrospective study, 36, 107 Risk factor, 106, 108 Ritonavir, 24, 108 S Salivary, 108, 112 Saponins, 108, 110 Screening, 94, 108 Secretion, 23, 58, 100, 103, 108 Secretory, 104, 108 Seizures, 26, 108 Sella Turcica, 105, 108 Semisynthetic, 90, 93, 108 Senile, 104, 108 Serotonin, 98, 105, 108 Serous, 97, 108 Serum, 6, 14, 18, 19, 28, 32, 35, 38, 90, 94, 104, 108 Shock, 90, 108 Side effect, 3, 5, 67, 89, 108, 111 Signs and Symptoms, 4, 107, 108

117

Silicon, 60, 108, 109 Silicon Dioxide, 60, 108, 109 Skeletal, 5, 8, 109 Skeleton, 109 Skull, 104, 109 Small intestine, 98, 99, 100, 109 Smooth muscle, 92, 109, 110 Social Environment, 107, 109 Sodium, 8, 11, 19, 21, 27, 31, 32, 36, 51, 54, 55, 56, 57, 58, 59, 60, 61, 109 Solvent, 56, 57, 59, 60, 97, 102, 105, 109 Sorbitol, 102, 109 Sound wave, 107, 109 Specialist, 79, 109 Species, 93, 96, 97, 103, 109, 112 Spinal cord, 93, 94, 102, 103, 109 Sporadic, 7, 109 Stabilizer, 61, 109 Steady state, 11, 109 Sterile, 104, 109 Steroid, 37, 93, 108, 109 Stomach, 98, 99, 100, 103, 107, 109, 110 Stomatitis, 4, 110 Stress, 3, 4, 103, 110, 111 Subacute, 100, 110 Subclinical, 12, 18, 21, 22, 29, 30, 100, 108, 110 Substance P, 97, 108, 110 Substrate, 61, 110 Sucralfate, 17, 26, 110 Supplementation, 21, 48, 110 Suppression, 19, 26, 27, 32, 59, 110 Suppressive, 7, 12, 13, 14, 16, 17, 18, 19, 22, 27, 28, 30, 31, 32, 33, 36, 37, 38, 110 Synapse, 89, 110 Systemic, 68, 90, 92, 97, 100, 101, 107, 110, 112 T Tachycardia, 15, 110 Tetany, 104, 110 Therapeutics, 18, 19, 22, 55, 68, 110 Thrombosis, 106, 110

Thyroid Gland, 4, 6, 57, 58, 59, 98, 99, 103, 104, 111 Thyroid Hormones, 5, 6, 49, 58, 61, 68, 111 Thyroid Nodule, 7, 14, 18, 19, 27, 28, 30, 31, 37, 41, 111 Thyroiditis, 5, 31, 33, 111 Thyrotoxicosis, 24, 39, 111 Thyrotropin, 13, 22, 26, 35, 41, 58, 100, 111 Thyroxine, 6, 15, 19, 28, 32, 35, 54, 55, 56, 58, 60, 61, 95, 111 Tissue, 7, 11, 90, 91, 92, 96, 97, 98, 100, 101, 102, 103, 105, 108, 111, 112 Topical, 97, 111 Toxic, iv, 5, 33, 61, 93, 102, 106, 111 Toxicity, 30, 96, 110, 111 Toxicology, 23, 24, 74, 111 Toxins, 90, 100, 111 Trace element, 108, 111 Trachea, 110, 111 Transfection, 91, 111 Tyrosine, 95, 111 U Ulcer, 110, 111 Uremia, 101, 107, 111 Urticaria, 90, 111 V Vaccines, 89, 112 Vascular, 90, 92, 97, 100, 111, 112 Vasodilatation, 22, 112 Vasopressor, 4, 112 Vein, 101, 112 Venous, 106, 112 Ventricle, 91, 100, 112 Veterinary Medicine, 73, 112 Virulence, 111, 112 Viruses, 89, 112 Vitro, 112 Vivo, 112 W Windpipe, 110, 112 X Xerostomia, 4, 112 X-ray, 101, 107, 109, 112 X-ray therapy, 101, 112

118

Levothyroxine

119

120

Levothyroxine

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