Transcript thyroid disorder

Clinical pharmacology
Thyroid disorders
Thyroid Function Tests
"TSH" Test -- Thyroid
Stimulating
Hormone / Serum
thyrotropin
Under .4 can indicate
possible
hyperthyroidism.
Over 6 is considered
indicative of
hypothyroidism.)
Thyroid Function Tests
Free T4 / Free Thyroxin - FT4
Less than 0.7 is considered indicative
of possible hypothyroidism.
T3 / Serum triiodothyronine
Less than 80 can indicate
hypothyroidism.
Thyroid disorders
Imbalance in production of thyroid hormones arises from dysfunction of the
thyroid gland itself, the pituitary gland ,which produces thyroid-stimulating
hormone (TSH), or the hypothalamus ,which regulates the pituitary gland via
thyrotropin-releasing hormone (TRH). Concentrations of TSH increase with age,
requiring age-corrected tests. Hypothyroidism affects between three and ten
percent of adults, with incidence higher in women and the elderly.
Hypothyroidism may cause cretinism and myxodema.
Hyperthyroidism causes Graves’ disease.
Thyroid disorder
*Hyperthyroidism is a condition in which the thyroid
gland makes too much thyroid hormone,over long or
short period.
Causes.
Getting too much iodine
Graves disease
Inflammation (thyroiditis).
Noncancerous growths of the thyroid gland Symptoms,.
Fatigue-Goiter-Heat intolerance-Increased appetiteIncreased sweating-Weight loss -High blood
pressure-exophthalmos-(palpitations)
Diagnosis & treatment
Blood tests are also done to measure levels of
thyroid hormones.
TSH (thyroid stimulating hormone) level is
usually low
T3 and free T4 levels are usually high
Treatment
Antithyroid medications
Radioactive iodine
Surgery
Thyroid disorder
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland
does not make enough thyroid hormone.
Causes
The most common cause of hypothyroidism is
inflammation of the thyroid gland.
Autoimmune in which the immune system attacks the
thyroid gland.
Other common causes of hypothyroidism include:
Radiation treatments to the neck to treat different
cancers
Radioactive iodine used to treat an overactive thyroid.
Hypothyroidism
Surgical removal of part or all of the
thyroid gland.
Certain drugsAmiodarone.
Symptoms,:weakness,lethargy,memory
loss, weight gain.hair loss,
Treatment, : thyroxine replacement
therapy.
Case 1
Miss SM is 25 year old with Grave disease.She was treated with
carbimazole but developed severe rash, so the drug was
withdrawn.Rash also occured with propylthiouracil.She is
thyrotoxic with blood pressure 160/60.Pulse rate 110 bpm and
very large thyroid gland.Lab test shows elevated T4.Surgery is
indicated.
What are the indications for surgery?
What therapy would you recommend to alleviate some of her
symptoms?
What preoperative thyroid preparation is needed?
What postoperative complications are associated with
thyroidectomy
Answer
1-Surgery is the treatment of choice when malignancy is suspected,
and when patient has features of local compression,as difficulty
swallowing,for removal of goitre, ( cosmetic),when thionamides
have caused side effects, and when patient is pregnant.
2-B-blockers, relieve tremors,palpitations,
3-All patients should be euthyroid at time of surgery to avoid rapid
elevation of T4 and precipitation of thyroid crysis.
She should recieve Lugol solution,B blocker,
4-Postoperative complications, are risk of anaesthesia,and surgery
itself.
Hypoparathyrodism,infection and poor wound healing,
Case 2
Mr BC is 66.He has been commenced on
thyroxine.He has a prescription for
carbamazepine too , and FeSO4 in the
morning.
What issues should be covered when
counseling Mr BC about his medicines?
Answer
There are two potential drug interactions,
Ferrous sulphate has been shown to cause reduction in the effect
of thyroxine in patients with hypothyrodism.
So separate thyroxine and ferrous sulphate doses by two hours at
least.
Anticonvulsants have been reported to increase the metabolism of
thyroid hormones, but this is not very important.
Mr BC should attend for regular monitoring.
It should be explained to him that it may be several weeks or
months before symptoms are fully controlled.
Mr BC should also be told that he may need lifelong therapy,it is
also important to reinforce this when the patient has become
asymptomatic from his thyroid disease.