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Hypo & hyperthyroidism pharmacotherapy

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Pharmacology

Publié dans : Santé & Médecine
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Hypo & hyperthyroidism pharmacotherapy

  1. 1. Hypo & Hyperthyroidism Dr. Salman Pharmacology
  2. 2. Hypothyroidism etiology • Something about the gland itself • Primary (95%) – Chronic thyroiditis (Hashimoto’s) – Post-ablative surgery (RAI) – Drugs (lithium) – Heritable biosynthetic defects – Iodine deficiency • Suprathyroid causes are rare
  3. 3. Hypothyroidism • It is treated with the hormone itself! – Thyroxine, or 3,5,3',5'-tetraiodothyronine (often abbreviated as T4) – Injected T4
  4. 4. Myxedema Coma • High doses of T4, T3 • Corticosteroid • Warming blankets • IV fluids
  5. 5. Antihyperthyroid Drugs
  6. 6. The synthesis of thyroid hormone and action and effects of antithyroid agents
  7. 7. Thyroid hormone synthesis and action Effects of antithyroid agents 1 Active accumulation of iodide into the gland Basis for selective cell destruction of 131I 2 Oxidation of iodide by peroxidases Inhibited by thioamides 3 Iodination of tyrosyl residues on thyroglobulin from MIT and DIT Inhibited by thioamides 4 Coupling of MIT and DIT to form T3 and T4 Inhibited by thioamides 5 Proteolytic release of T3 and T4 from thyroglobulin Inhibited by high doses of iodide 6 Conversion of T4 to T3 via 5’ deiodinase in peripheral tissues Inhibited by propranolol, and propylthioiracil
  8. 8. Thioamides: Propylthiouracil and Methimazole • Use in uncomplicated hyperthyroid conditions; • High-dose propylthiouracil inhibits 5' deiodinase • Common maculopapular rash • Less common  prothrombin, hypersensitivity, and immune-based arthralgia, • jaundice, lupus, and vasculitis • Both drugs cross the placental barrier, but PTU is safer in pregnancy because it is extensively protein bound
  9. 9. Common Causes of hyperthyroidism • Graves disease • Toxic multinodular goiter • Subacute thyroiditis • Extrathyroid source – Thyrotoxicosis factitia – Struma ovarii • Excess TSH (rare)
  10. 10. Treatment Graves disease • Immediate treatment – Propranolol – Antithyroid drugs • PTU • Methimazole • Long-term treatment – RAI ablation – Thyroidectomy
  11. 11. Rx Toxic multinodular goiter • Radioactive Iodine
  12. 12. Rx Thyroid Storm • Antithyroid drugs • Iodine • Beta-blockers • Dexamethasone • IV fluids, cooling blankets
  13. 13. Iodide • KI+ iodine (Lugol's solution) possible use in thyrotoxicosis: used preoperatively, →↓ gland size, fragility, and vascularity • No long-term use because thyroid gland "escapes" from effects after 10-14 days

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