Drugs Affecting Thyroid Hormones
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This document discusses thyroid conditions and their treatments. Hypothyroidism can cause constipation while hyperthyroidism can cause diarrhea. Medications used to treat hyperthyroidism include propylthiouracil, methimazole, and carbimazole which inhibit thyroid hormone production. Iodine and radioactive iodine can also be used. Less potent treatments include thiocyanate, perchlorate, and nitrates. Propylthiouracil has a shorter half-life and crosses the placenta less than methimazole. Beta blockers, calcium channel blockers like diltiazem and verapamil, and medications to bind thyroid hormone in the gut were also historically used but are
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Drugs Affecting Thyroid Hormones
- 26. Increased peristalsis Constipation: Hypothyroidism Diarrhoea: Hyperthyroidism
- 28. Haemopoesis
- 49. - Propylthiouracil, Methimazole, Carbimazole - Iodine, NaI, KI I131 - Thiocynate (SCN-), Perchlorates(ClO4 -), Nitrates -) (NO3
- 52. Less Potent T1/2- 75 minutes Strongly PPB Less crossing by placenta and in milk No active metabolite inhibit peripheral conversion 3 times more potent 6-8 hours Less PPB readily cross placenta and secreted in milk Active metabolite – Methimazole No effect on peripheral conversion
- 69. Were used, Not Now
- 70. β Blockers
- 71. Calcium Channel Blockers: Diltiazem and Verapamil To inhibit peripheral conversion To bind thyroid hormone in Gut
Notes de l'éditeur
- Rober james Grave (Irish), Karl Adolph Von Basedow (German), Caleb Hillier Parry (1785)
- Transport of iodide by NIS into gland At the apical cell membrane Pendrin controls the flow
- NIS – Sodium Iodide symporter NIS can be inhibited by Thiocynate (SCN-), Pertechnetate (TcO4-) and perchlorate (ClO4-) Pendrin is also found in cochlea – whenever deficient Deafness with goiter – pendred’s syndrome
- Produce action by combining with TR (Nuclear Thyroid hormone receptor) TR reside in nucleus bound to Thyroid Hormone Response Element (TRE). When T3 Bind to TR it heterodimerizes with Retinoid X receptor (RXR) undergoes conformational change and bind to Coactivator Induces gene transcription – Produces specific mRNA and Specific Protein synthesis
- Causes – faulty Development, Ectopic Thyroid, Antibody to TSH receptors, Iodine deficiency Early Diagnosis is necessary, Routine Screening should be done When Detected after mental retardation,rare to recover fully
- Treatment should be started asap within first few weeks for normal development Thyroid Hormone is required for dev of myelin sheath Prognosis depends on severity of disease Chances of recovery after 6 months are doubhfull
- Idiopathic, Iodine deficiency, Endemic or Exposure to Antithyroid substance, Thyroiditis, Thyroidectomy, Overdose of Radioactive iodine
- 6 weeks are required to achieve steady state level In elderly suspect undiagnosed heartdisease so lower dose If Suspected heart disease – 12.5, and in diagnosed heart disease
- Typical thickening of skin - Myxoedema
- Deficiency of iodine, or consumption of foods inhibiting iodine uptake. Treatment can be withdrawn if Iodine demand is taken care by supplementation
- Nodules Grow under influence of TSH, Thyroxine reduces size of Nodule.
- Uncommon but serious, Untreated or partially treated thyrotoxicosis Causes – Stress, Infections, Trauma, Surgery, DKA, Heart disease and radioactive iodine
- Onset requires 3-4 weeks for depletion of hormones already formed
- - Rashes – Purpura, Urticaria,
- PTU 200-400mg B blocker/CCB
- Preop – before 7-10 days, Carbimazone can be used For CVS symptoms Propranolol or Diltiazem.