Transcript Thyroid Disease

Derrica Hawkins
2014 PharmD Candidate
Clinical and Research Seminar II
Dr. Charlie Colquitt
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Prevalence
Background
Define thyroid disease
Causes of thyroid disease
Clinical Presentation
Treatment options
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20 million Americans have some form of
thyroid disease
Women are five to eight times more likely
than men to have thyroid problems
60 percent of those with thyroid disease are
unaware of their condition
Older cats often get hyperthyroidism more
often than dogs
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Butterfly shaped organ in the front of the neck
Below the larynx (voice box)
One on each side of the windpipe, connected by
the isthmus
Two types of cells: follicular cells and parafollicular
cells
Follicular cells, which secrete iodine-containing
hormones called thyroxine (T4) and
triiodothyronine (T3)
Parafollicular cells secrete the hormone calcitonin
Hyperthyroidism
◦ antibody-mediated autoimmune reaction, but the
trigger for this reaction is
still unknown
Hypothyroidism
◦ deficiency of thyroid
hormones and is
manifested largely by a
reversible slowing down
of all body functions
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Graves Disease
Pituitary adenoma
Excessive doses of thyroid hormone
Thyroiditis
Iodide
Amiodarone
Interferon
Autoimmune disorder
 Eight times more common in women than
men
Signs:
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o Exophthalmos
o Pretibial myxedema
o Thyroid enlargement
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Nervousness
Anxiety
Increased perspiration
Heat intolerance
Hyperactivity
Palpitations
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Low TSH concentration
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Elevated free and total T3 and T4
concentrations
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Normal range 0.3-3.0 microIU/mL
Normal range 0.8-1.7 mcg/dL
Elevated radioactive iodine uptake (RAIU) by
the thyroid gland
Thyroid stimulating antibodies (TSAb)
Thyroid biopsy
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Thyroidectomy
Large thyroid gland(>80 g)
o Severe ophthalmopathy
o Lack of remission on antithyroid drug
treatment
Most common complication is hypothyroidism
o
Drug
MOA
Dose
Contraindicatio
ns/ Side Effect
Monitoring
Parameters/
Notes
Propylthiouracil (PTU)
Inhibit oxidation of
iodine in the thyroid
gland.
PTU inhibits the
peripheral conversion
of T4 to T3
50 mg TID until
euthyroid
Headache, rash,
itching, constipation
BBW(PTU) - Liver
damage and acute
liver failure
CBC, LFT’s, thyroid
function test every 4weeks /
Patients – abdominal
pain, yellow
skin/eyes, dark urine
Potassium Iodide and
iodine solution (lugol’s
solution)
Saturated solution of
potassium iodide
(SSKI)
Inhibit thyroid
hormone biosynthesis
by interfering with
intrathyroidal iodide
use
4-8drops Q8H
Rash, metallic taste,
sore throat, GI upset
Thyroid function test
Take with food
Radioactive Iodine
sodium iodide 131
(131I)
RAI disrupts hormone
synthesis by
incorporating into
thyroid hormones and
thyroglobulin
5 to 15 mCi
Methimazole (tapazole)
5-15 mg daily (10X
more potent than
PTU)
4-5 drops Q8H
Pregnancy/
Nausea/vomiting,
dry mouth
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Rare life-threatening medical emergency
Signs and Symptoms
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High fever (>39.4°C
[103°F]),
Tachycardia(>140 BPM)
Dehydration
Delirium
Nausea/vomiting
Coma
Treatment
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Propylthiouracil 900–1200
mg/day PO Q4-6H +
Lugol solution 5–10 drops
PO Q8H or SSKI 3-5 drops
PO Q8H +
Propranolol 40–80 mg PO
Q6H +
Dexamethasone 2-4
mg/day orally or IV Q6H +
Supportive therapy(fluids
etc
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Hashimoto’s disease
Iatrogenic hypothyroidism
Iodine deficiency
Thyroid hypoplasia
Thyroidectomy
Pituitary disease
Hypothalamic disease
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Dry skin
Cold intolerance
Weight gain
Constipation
Weakness
Depression
Loss of ambition and energy
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Elevated TSH concentration
o Normal range 0.3-3.0 microIU/mL
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Low free and/or total T4 and T3
concentration
o Normal range 0.8-1.7 mcg/dL
Drug
Dose
MOA
Contraindica Monitoring
tion/ Side
Parameters/
Effect
Notes
Levothyroxine T4
(Synthroid,
Levothroid, Levoxyl )
50–60 mcg
12.5-25 mg/day in
elderly and patients
with cardiac
disease
Synthetic thyroid
hormone that
increases cellular
metabolism and
plays an important
role in growth
Acute MI,
thyrotoxicosis,
Uncorrected renal
insufficiency/
Euthyroid- no side
effect
Hyperthroidpalpitations,
sweating, weight
loss
BBW-Should not
be used either alone
or with other
therapeutic agents
for the treatment of
obesity or weight
loss.
Check TSH and
cinical symptoms
every 6-8 weeks/
Empty stomach, 30
minutes before
breakfast, with a
full glass of water
Liothyronine(T3,
Cytomel, Triostat)
25-75 mcg/day
Same as above
Same as above
Same as above
Dessicated
thyroid(Armour
Thyroid)
60-120 mg
orally/day; increase
by 15 mg every 2 3 weeks
Dose in grains
Same as above
Same as above
Not safe and
effective (FDA)
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Brown S, Shapiro K. RxPrep Course Book. 2013 edition.
Dipiro J, Talbert B, Yee GC, Matzke GR, Wells BG, Posey LM (eds.). Pharmacotherapy: A
Pathophysiologic Approach, 7th edition, New York, McGraw-Hill, 2008.
Micromedex. http://www.micromedexsolutions.com/micromedex2/librarian. Accessed
October 1, 2013.