Pharmacotherapy anterior part of the neck and

 

 

 

 

 

 

 

 

Pharmacotherapy
for Thyroid Diseases

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Pharmacotherapy
for Thyroid Diseases

Introduction

The thyroid is a gland found in the
anterior part of the neck and secretes T3 and T4 hormones that act as the
body’s metabolic regulator. Its functions are regulated by the pituitary gland
in the brain through a negative and positive feedback mechanism.  The hormone involved in this regulation is
the thyroid stimulating hormone (Brent, 2012). 
As such, it is an important organ in the body whose pathology can lead
to serious morbidity and, therefore, proper management is paramount.

Background

According to Ross et al., (2016), diseases
that affect the thyroid are classified as either primary (the pathology is
intrinsic to the gland) or secondary (pathology is extrinsic to the gland;
commonly in the pituitary gland). The diseases symptoms can range from
debilitating to sub-clinical to asymptomatic and each can lead to either an
increase in the serum levels of thyroid hormones (Hyperthyroidism) or decrease
in levels of thyroid hormones (Hypothyroidism).  Both these disease states express different
signs and symptoms for example weight loss, excessive sweating, heat
intolerance and ophthalmopathy among others for hyperthyroidism while hypothyroidism
could cause weight gain, cold intolerance, myxedema just to mention. Examples
of disease that affect  the thyroid gland
include grave’s disease, thyroiditis, tumors, auto-immune conditions like
hashimoto’s thyroiditis according to, iodine deficiencies and many others (Stathatos & Daniels, 2012).

Drugs
used in Treatment of Symptoms

As stipulated by Jonklaas et al. (2014),
the treatment of thyroid diseases is dependent on the specific etiology and the
clinical signs apparent on the patient and range from surgical, medical and
conservative in sub-clinical cases. Medications used to manage Hyperthyroidism
include anti-thyroid drugs such as Carbimazole, methimazole and
propylthiouracil started at high doses. These can help achieve euthyroid states
within 14 days of use. Beta-blockers like propranolol are also used to control
the hyper-metabolic symptoms. Other treatment options include oral radioactive
iodide that is absorbed by the thyroid gland and results in down-regulation of
thyroid hormone synthesis.Hypothyroidism that due is to iodine deficiency is
treated by giving iodine supplements either in food or in tablets. The drug
levothyroxine is also used to bring the serum levels of thyroid hormone to
baseline levels.

Other causes of thyroid disease such as
hashimoto’s and infections that cause inflammation of the thyroid gland can be
treated with NSAIDs, levothyroxine, prednisolone to reduce the levels of
inflammation.

Effects
of age of thyroid Medications

Age affects the pharmacodynamics and
pharmacokinetics of a drug and as such, in the extreme age-groups, differences
in the elimination rates, metabolism, and body compositions might affect the
bioavailability, duration of action, the route of administration and even the
dosage of drugs which affects how the drugs work in those groups. The drugs
that are primarily eliminated via the kidneys end up remaining in the body for
longer if the renal system is impaired in any way such as in the geriatric
population. This enhances the magnitudes of side effects and prolongs their
durations of action. In addition, the elderly have reduced body water and as
such, some drugs might be administered differently, which will directly or
indirectly impact on bioavailability.

Reducing
Side Effects of Drugs

As with any other drug, drugs used in
the treatment of thyroid disease also do have side-effects. The corticosteroids
use in autoimmune thyroid disease can have many effects on almost all systems
in the body including but not limited to osteoporosis, hypertension, gastrointestinal
symptoms and increased susceptibility to infections (Pandya, Puttanna, & Balagopal,
2014).
The commonest side-effects of the anti-thyroid drugs is a rash that subsides as
soon as the medication is stopped.  Propylthiouracil
has a little risk for hepatotoxicity and as such, liver function tests are
necessary to ensure it is not damaged. Methimazole can cause aplastic anemia
and thrombocytopenia; reducing this effect involves doing full blood counts to
identify problems with the marrow as soon as possible. Other side effects of
thyroid medications like headaches and gastrointestinal symptoms can be managed
by educating the patients on the expected effects and advising them to visit a
hospital if the side effects persist or become worse..

Conclusively, it is important to educate
the patient on the possible side effects of the drugs given and advise them to
seek immediate medical help in case of any unusual symptoms. Thyroid diseases
are chronic and require adequate cooperation between the health care provider
and the patient in order to achieve proper remission.

 

 

 

 

 

 

 

 

References

Brent, G. A. (2012). Mechanisms of
thyroid hormone action. The Journal of clinical

 

investigation, 122(9), 3035.

 

Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C.,
Laurberg, P., Maia, A. L., … & Walter, M. A.

(2016). 2016 American thyroid
association guidelines for diagnosis and management of hyperthyroidism and
other causes of thyrotoxicosis. Thyroid, 26(10), 1343-1421.

 Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman,
K. D., Cappola, A. R., Celi, F. S., … & Sawka,

 

A. M. (2014). Guidelines for the treatment of
hypothyroidism: prepared by the american thyroid association task force on
thyroid hormone replacement. Thyroid, 24(12), 1670-1751.

 

Pandya, D., Puttanna, A., &
Balagopal, V. (2014). Suppl 1: M2: Systemic Effects of Inhaled

 

Corticosteroids: An Overview. The
open respiratory medicine journal, 8, 59.

 

Stathatos, N., & Daniels, G. H.
(2012). Autoimmune thyroid disease. Current opinion in

 

rheumatology, 24(1), 70-75.

 

 

 

 

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