In this episode, I’ll discuss adjunctive cholestyramine therapy for thyroid storm.
Both thyroxine (T4) and triiodothyronine (T3) undergo enterohepatic recycling. Cholestyramine is known to bind many medications in the lumen of the GI tract that undergo enterohepatic recycling. Studies of thyrotoxicosis and Grave’s hyperthyroidism have evaluated the effect of cholestyramine on T3 and T4 levels. Both T3 nd T4 levels decreased more rapidly and to a greater extent in the cholestyramine-treated groups.
While the clinical benefit in thyroid storm has not been evaluated, cholestyramine is given at a dose of 4 g orally four times daily with the expectation that it will lower T3 and T4 and help in the overall treatment of thyroid storm.
Members of my Hospital Pharmacy Academy have access to practical training on the treatment of thyroid storm and myxedema coma from a pharmacist’s point of view, in addition to over 100 other practical trainings and resources to make hospital pharmacy practice and precepting easier. To get immediate access, go to pharmacyjoe.com/academy.
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