Extemporaneous preparation of a 25 mcg/mL levothyroxine oral suspension:
NOTE: Levothyroxine is not available as an FDA-approved oral suspension.
With a mortar and pestle, grind twenty-five mg levothyroxine tablets into a fine powder.
In a separate container, measure 40 mL glycerol.
Add a small amount of the glycerol to the fine powder and mix into a uniform paste. Add geometric amounts of the glycerol until the suspension is pourable.
Transfer suspension to a calibrated 100 mL amber bottle. In approximately 10 mL portions, rinse the mortar with the remaining glycerol and transfer washings into the amber bottle trying to leave no levothyroxine in the mortar.
Add water to the amber bottle to bring the total volume to 100 mL.
Label the bottle appropriately, including 'Shake well before each use' and 'Refrigerate'. The suspension is stable for 8 days when stored at 4 degrees Celsius.
Medications such as diuretics, phenytoin, niacin, and high-dose corticosteroids can produce hyperglycemia that is reversible once the drugs are discontinued or when diuretic-induced hypokalemia is corrected. Chronic pancreatitis or subtotal pancreatectomy reduces the number of functioning B cells and can result in a metabolic derangement very similar to that of genetic type 1 diabetes except that a concomitant reduction in pancreatic A cells may reduce glucagon secretion so that relatively lower doses of insulin replacement are needed. Insulin-dependent diabetes is occasionally associated with Addison’s disease and autoimmune thyroiditis ( Schmidt’s syndrome , or polyglandular failure syndrome ). This occurs more commonly in women and represents an autoimmune disorder in which there are circulating antibodies to adrenocortical and thyroid tissue, thyroglobulin, and gastric parietal cells.