Thyroid Pharm

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1
What does thyroid hormone have an effect on?
metabolism
cardiac function
growth
2
What hormones do the thyroid produce?
Triiodothyronine (T3)
Thyroxine (T4, tetraiodothyronine) = synthetic T4 is levothyroxine
3
What is elevated thyroid-stimulating hormone (TSH) indicate?
hypothyroidism
4
Myxedema (adults)
replacement therapy with thyroid hormones
in almost all cases, treatment must continue life long
5
Congenital hypothyroidism (infancy)
replacement therapy with thyroid hormones
6
Clinical presentation of hypothyroidism (adults)
pale, puffy, and expressionless face
cold and dry skin
brittle hair or loss of hair
heart rate and temperature are lowered
lethargy and fatigue
intolerance to cold
impaired mentality
7
What typically causes hypothyroidism?
usually due to malfunction of the thyroid
Hashimoto's disease: chronic autoimmune thyroiditis
8
What is used for lifelong replacement therapy?
levothyroxine (T4) standard TX = synthetic
9
Interactions with hypothyroidism in pregnancy
permanent neuropsychologic deficits
10
Two forms of hyperthyroidism
Graves' disease = most common form, affects women 20-40 years old, causes exophthalmos (protruding/large eyes)
Toxic nodular goiter (Plummer's disease) = makes them nervous and develop insomnia, everything is excelerated
11
Hyperthyroidism treatment
surgical removal of thyroid tissue (can partially remove)
destruction of thyroid tissue (give meds)
12
Thyrotoxic Crisis (Thyroid Storm)
patient with thyrotoxicosis who undergo significant stress (surgery, illness, etc.)
signs: hyperthermia (105 F or higher), severe tachycardia
13
Thyrotoxic Crisis Treatment
potassium iodide, methimazole, and beta blocker = slow the HR down
sedation, cooling (cooling blanket to get temperature down), glucocorticoids, IV fluids
14
Methimazole (Tapazole)
first line drug for hyperthyroidism
class: thionamides
may take 3-12 weeks for euthyroid state
can't take during pregnancy and need to wear gloves when handling
can be used for Graves Disease
15
Levothyroxine (Synthroid)
synthetic preparation of thyroxine (T4) and drug of choice for hypothyroidism
conversion to T3
half-life: 7 days - very strong drug
used for all forms of hypothyroidism
adverse: tachycardia, angina, tremors, can intensifiy effects of warfarin
should take in the morning at least 30 to 60 minutes before breakfast (won't sleep if given at night/later in day
16
Propylthiouracil (PTU)
severe liver damage
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