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‫Thyroid gland disorders

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Thyroid Hormone Disorders lecture :- …

Thyroid Hormone Disorders lecture :-
-Thyroid gland & Thyroid hormones.
-How does Thyroid hormone is formed ?
-Regulation of secretion.
-Hypothyroidism.
-Treatment of hypothyroidism .
-Administration of Levothyroxin.
-Levothyroxin interactions.
-Levothyroxin cautions.
-Hyperthyroidism .
-Symptoms & treatment of Hyperthyroidism.
-Removal of part or all of the thyroid.
-Blockade of hormone release .
-Inhibition of thyroid hormone synthesis.
-Mechanism of action of antithyroid.
-Administration of antithyroid drugs.
-Antithyroid drugs interactions.
-Antithyroid drugs cautions.
-General notes.
-Practical notes on levothyroxin.
-Practical notes on antithroid drugs.
-Rapid review.
-Test yourself.

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  • 1. Pharmacist Development
    Group
  • 2. Scientific Department
    Easy Pharmacology
    programme
    Present
  • 3. Thyroid Hormone Disorders
    By
    Dr.MohamedAbdelrahman
  • 4. The Lecture In Points
  • 5. Thyroid gland & Thyroid hormones
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    pharmacist development website
  • 6. Thyroid gland & Thyroid hormones
    • Thyroidglandis a large gland in the neck, produces and secretes thyroid hormone and calcitonin.
    • 7. The thyroid gland facilitates normal growth and maturation by maintaining the level of metabolism in the tissues that is optimal for their normal function. The two major thyroid hormones are T3 (triiodothyronine, the most active form), and T4(thyroxine).
  • How does Thyroid hormone is formed ?
    • Under the influence of thyroid stimulating hormone (TSH) thyroid hormones are made by attaching iodine to tyrosine. The source of tyrosine is thyroglobulin, a protein synthesized in the thyroid gland. There are two hormones, thyroxine (T4) and triiodothyronine (T3), referred to together as thyroid hormone
    Tyrosine
    iodine
    TSH
    Thyroid hormone
    (T3 + T4)
  • 8. Regulation of secretion
    • Secretion of TSH by the anterior pituitary is stimulated by the hypothalamic TRH. Feedback inhibition of both TRH and TSH secretion occurs with high levels of circulating thyroid hormone or iodide. T3 and T4 are bound to thyroxine-binding globulin in the plasma.
    • 9. T4 is converted to T3 in the tissues. T3 combines with a receptor to stimulate subsequent protein synthesis necessary for normal metabolism.
  • Hypothyroidism
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  • 10. Hypothyroidism
    • Hypothyroidism (Hyposecretion of thyroid hormone) is due to absence or incompletedevelopment of the thyroid .
    • 11. in early life it causes cretinism, which is characterized by stuntedgrowth and mentaldeficiency.
  • Hypothyroidism
    • Hypothyroidism in adults results in myxoedema, a condition where there is a characteristic thickening of the skin together with low metabolic rate, slow speech, poor appetite, weight gain, lethargy, bradycardia, sensitivity to cold and mental impairment.
    • 12. One form is Hashimoto’s thyroiditis, an autoimmune condition where antibodies are produced against thyroglobulin.
    PretibialMyxedema
    Waxy infiltrative plaques and edema,
  • 13. Treatment of hypothyroidism
    • Hypothyroidism is treated by replacement therapy with levothyroxine (T4) .
    • 14. Hypothyroidism with goitrecan result (rarely) from deficiency of iodine in the diet; in which case treatment is with iodine supplementation.
  • Administration of Levothyroxin
    • levothyroxine (T4)(Eltroxin, Euthyrox) is given once daily because of its long half-life. Steady state is achieved at 6-8 weeks.
    • 15. Toxicity is directly related to thyroxine levels and manifests itself as nervousness, tachycardia, intolerance to heat and unexplained weight loss.
  • Levothyroxin interactions
    • oral anticoagulants :May increase anticoagulant effects .
    • 16. Cholestyramine : May decrease thyroid hormone efficacy .
    • 17. digitalis glycosides: May reduce effects of glycosides .
    • 18. Fasting :Increases absorption of levothyroxin from GI tract.
    • 19. Iron salts: May decrease efficacy of levothyroxine, resulting in hypothyroidism.
  • Levothyroxin cautions
    • Pregnancy: Category A.
    • 20. Lactation :Minimal amounts excreted in breast milk.
    • 21. Children :When drug is administered for congenital hypothyroidism, routine determinations of serum T4or TSH are strongly advised in neonates. In infants, excessive doses of thyroid hormone preparations may produce craniosynostosis. Children may experience transient partial hair loss in first few months of thyroid therapy .
  • Levothyroxin cautions
    • Infertility: Drug is unjustified for treatment of male or female infertility unless condition is accompanied by hypothyroidism.
    • 22. Endocrine disorders: Therapy in patients with concomitant diabetes mellitus, diabetes insipidusor adrenal insufficiency (Addison's disease) exacerbates intensity of their symptoms.
  • Levothyroxin cautions
    • Myxedema coma: Patients are particularly sensitive to thyroid preparations. Sudden administration of large doses is not without cardiovascular risks and may cause myxedema coma. so, small initial doses are indicated.Therapy of myxedemacoma requires simultaneous administration of glucocorticoids.
  • Levothyroxin cautions
    • Cardiovascular disease : Use caution when integrity of cardiovascular system, particularly coronary arteries, is suspect (eg, angina, elderly). Development of chest pain or worsening cardiovascular disease requires decrease in dosage.
    • 23. Obesity :Drug should not be used for weight reduction; may produce serious or life-threatening toxicity in large doses, particularly when given with anorexiants .
  • Hyperthyroidism
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  • 24. Hyperthyroidism
    • Hyperthyroidism (hypersecretion of thyroid hormone)= (thyrotoxicosis) is associated with a number of disease states, including Graves' disease, toxic adenoma, and goiter, among others, due to autoimmune stimulation of the thyroid gland mimicking the effects of TSH .
    Graves’s disease
    Goiter
  • 25. Symptoms & treatment of Hyperthyroidism
    • Symptoms are high metabolic rate, increased temperature,sweating, nervousness, tremor, tachycardia,increased appetite, loss of weight,goitre and protrusion of the eyeballs (exophthalmia).
    • 26. The goal of therapy is to decrease synthesis and/or release of additional hormone. This can be accomplished by removing part or all of the thyroid gland, by inhibiting synthesis of the hormones, or by blocking release of the hormones from the follicle.
  • Removal of part or all of the thyroid
    • This can be accomplished either surgically or by destruction of the gland by beta particles emitted by radioactive iodine , which is selectively taken up by the thyroid follicular cells.
  • Blockade of hormone release
    • A pharmacologic dose of iodide inhibits the iodination of tyrosines, thus decreasing the supply of stored thyroglobulin. Iodide also inhibits thyroid hormone release by mechanisms not yet understood. Today, iodide is rarely used as sole therapy. However, it is employed to treat potentially fatal thyrotoxic crisis (thyroid storm), or prior to surgery, since it decreases the vascularity of the thyroid gland. Iodide is not useful for long-term therapy, because the thyroid ceases to respond to the drug after a few weeks. Iodide is administered orally. Adverse effects are relatively minor and include sore mouth and throat, rashes, ulcerations of mucous membranes, and a metallic taste in the mouth.
  • Inhibition of thyroid hormone synthesis
    • Propylthiouracil (PTU)(Thyrocil) and carbimazole (neo-mercazol), are concentrated in the thyroid where they inhibit thyroid hormone synthesis .
    • 27. The effects of these drugs are slow in onset and thus they are not effective in the treatment of thyroid storm.
  • Additive drugs
    • Propranolol: beta-Blockers are effective in blunting the widespread sympathetic stimulation that occurs in hyperthyroidism .
  • Mechanism of action of antithyroid
    • Propylthiouracil and carbimazole are concentrated in the thyroid where they inhibit the iodination of tyrosyl groups and the coupling of iodotyrosines to form T3 and T4 . PTU can also block the conversion of T4 to T3. [Note: These drugs have no effect on the thyroglobulin already stored in the gland; therefore observation of any clinical effect of these drugs may be delayed until thyroglobulin stores are depleted.]
  • Administration of antithyroid drugs
    • Propylthiourathil (PTU) is given each 8 hr (to maintain serum drug levels) whereas a single dose of carbimazole is sufficient due to the long duration of its antithyroid effect.
    • 28. Carbimazole and PTU are taken with meals (to minimize GI irritation) and with same amount of food to facilitate uniform absorption.
    • 29. Encourage fluid intake of 3 to 4 L/day, unless contraindicated .
    • 30. Carbimazole and PTU have relatively rare adverse effects include agranulocytosis, rash, and edema. this is rare and reversible on stopping drug therapy.
  • Antithyroid drugs interactions
    • Anticoagulants: Altered anticoagulant action.
    • 31. Beta blockers: Increased effects of beta blockers.
    • 32. Digitalis glycosides: Increased digitalis levels, resulting in toxicity.
    • 33. Theophylline: Altered theophylline clearance in hyperthyroid or hypothyroid patients.  
  • Antithyroid drugs cautions
    • Pregnancy: Category D
    • 34. Lactation:Avoid nursing. However, if antithyroid drug is essential, PTU is preferred antithyroid agent while nursing.
    • 35. Children:Hepatotoxicity has occurred in pediatric patients. Discontinue drug immediately if signs and symptoms of hepatic dysfunction develop
    • 36. Agranulocytosis: Potentially most serious side effect. Discontinue drug if agranulocytosis, aplastic anemia, hepatitis, fever, or exfoliative dermatitis occur. Hemorrhagic effects:May cause hypoprothrombinemia and bleeding.
  • Practical notes
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  • 37. General notes
    • Explain to patient that medication will probably need to be taken for life. Instruct patient not to discontinue taking medication or change dosage without consulting physician.
    • 38. Caution patient not to take OTC or other prescribed medications without consulting physician .
    • 39. Instruct patient to check pulse daily
    • 40. Do not switch from one brand to another without comparison studies of bioavailability.
    Lipid lowering agents : rapid review
  • 41. General notes
    • Teach patient how to monitor for signs and symptoms of thyroid deficit or excess. Instruct patient to notify physician of following persistent signs and symptoms: Headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate and palpitations
    • 42. Advise patient to monitor weight at least 2 to 3 times/wk or per physician instruction, obtaining weight at same time, using same scale. Encourage patient to keep recorded chart.
    • 43. Instruct patient to notify dentist or physician of drug regimen before surgical or dental procedures.
    secretion of thyroxin hormone : video
  • 44. Practical notes on levothyroxin
    • Instruct patient to take levothyroxine at same time each day, To maintain steady blood levels, preferably in morning before breakfast.
    • 45. Caution patient not to take levothyroxine for weight control.
    • 46. Explain that partial hair loss may be experienced by child in first few months of therapy but that this side effect is transient
    • 47. In pregnancy, dosage may need to be increased to maintain TSH in desired range.
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  • 48. Practical notes on levothyroxin
    • Do not give sooner than 4 hr after administration of cholestyramine because it reduces effectiveness of levothyroxine.
    • 49. For infants and children who cannot swallow intact tablets, crush proper dose tablet and suspend freshly crushed tablet in small amount offormula or water; give by spoon or dropper. Do not store suspension for any period of time. Crushedtablet may also be sprinkled over small amount of food (eg, cooked cereal, applesauce(
    • 50. IV therapy is preferred in emergency treatment of myxedema coma.
    Understanding of diabetes : video
  • 51. Practical notes on antithroid drugs
    • Advise patient to avoid foods high in iodine as shellfish, iodized salt and others .
    • 52. Inform patient that response to therapy may take months.
    • 53. Instruct patient to report these symptoms to physician: rash, fever, sore throat, bruising or signs of infection or jaundice.
    • 54. Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
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  • 55. Rapid review
  • 56. Rapid review
    • Thyroid gland secret thyroid hormone (T3+T4) from tyrosine and iodine under the influence of TSH (which is inhibited by high levels of circulating thyroid hormone or iodide).
    • 57. Hypothyroidism (Hyposecretion of thyroid hormone) causes cretinism in children ,and myxoedema in adults .
    • 58. Hypothyroidism is treated by levothyroxine (T4) once daily.
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  • 59. Rapid review
    • Hyperthyroidism (hypersecretion of thyroid hormone)= (thyrotoxicosis) is associated with a number of disease states, including Graves' disease and goiter, due to autoimmune stimulation of the thyroid gland mimicking the effects of TSH .
    • 60. Treatment can be by surgery or with drugs, for example carbimazole, to reduce the amount of thyroid hormone being produced.
    • 61. Radioactive iodine is also used to treat thyrotoxicosis and to assess thyroid function.
    Gallstones : rapid review
  • 62. Test yourself
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  • 63. Test yourself
    • Symptoms of hyperthyroidism include all of following EXCEPT:
    • 64. A. tachycardia.
    • 65. B. nervousness.
    • 66. C. poor resistance to cold.
    • 67. D. body wasting.
    • 68. E. tremor.
    Understanding of myocardial infarction : video
  • 69. Test yourself
    • Which of the following best describes the effect of propylthiouracil on thyroid hormone production?
    • 70. A. It blocks the release of thyrotropin-releasing hormone.
    • 71. B. It inhibits uptake of iodide by thyroid cells.
    • 72. C. It prevents the release of thyroid hormone from thyroglobulin.
    • 73. D. It blocks iodination and coupling of tyrosines in thyroglobulin to form thyroid hormones.
    • 74. E. It blocks the release of hormones from the thyroid gland.
    Erectile dysfunction : video
  • 75. Test yourself
    • Hyperthyroidism can be treated by all of the following except :-
    • 76. A. Triiodothyronine
    • 77. B. Surgical removal of the thyroid gland
    • 78. C. Iodide
    • 79. D. Propylthiouracil
    • 80. E. carbimazole
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  • 81. resources
    • A to Z drug facts .
    • 82. Master (2008) .
    • 83. Lippincott review in pharmacology .
    • 84. Colour atlas of disease .
    • 85. Drugs and Drugs: A Practical Guide to the Safe Use of Common Drugs in Adults .
    • 86. Pharmacology for the Health Care Professionals .
  • Easy pharmacology programme
    Thyroid hormone disorders
    Preparation
    Dr. Mohamed Abdelrahman
    Edited by
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