A - 12. Thyroid and antithyroid drugs. Hypothalamic and pituitary hormones Flashcards
Hyperthyroidism: treatment options
Reduce thyroid levels or treat the symptoms
Main enzymatic player in formation of thyroid hormone
Thyroid peroxidase
Hyperthyroidism: diseases
Graves disease - autoimmune, antibodies stimulate follicles
Toxic multinodular goiter
Thyroiditis
Hyperthyroidism: severe complication
Thyroid storm
Hyperthyroidism: Radioiodine ablation therapy
Reactive destruction of thyroid
Patient must take LEVOTHYROXINE as hormone replacement to make up for destruction
Hyperthyroidism: thioamides
propylthiouracil (PTU) - inhibits 5’ deiodinase (enzyme converting T3 to T4) - good for thyroid storms
thiamazole
Both inhibit thyroid peroxidase in thyroid
Hyperthyroidism: thioamides SE
- hypothyroidism
- lupus like symptoms
- agranulocytosis
- hepatotoxicity (PTU only)
- Worsening of Graves opthalmopathy (periorbital swelling/edema)
- Crossing of placenta - hypothyroidism in fetus
Hyperthyroidism: iodine
Inhibits release of T3/T4 in large doses
Decreases blood flow
Thyroid can adapt to iodine levels
Hypothyroidism: primary and secondary
Primary
- iodine deficiency
- Hashimoto
- Post surgery/radioiodine therapy
Secondary
- pituitary tumors
t3/t4 feedback inhibits both hypothalamus (TRH) and pituitary (TSH)
Hypothyroidism: drugs to increase production
Iodine
Hypothyroidism: thyroid analogues
Levothyroxine (L-thyroxine) - must be processed by 5’-deiodinese
(liothyronine, isn’t in drug list)
Both per os or IV
Somatostatin analogues
Octreotide
Indication - acromegaly
Inhibits GH
ADH analogues
Desmopressin
DM insipidus
Hemophilia, von willebrands disease
Dopamine agonists
Bromocriptine
Hyperprolactinemia
Oxytocin
Uterine contractions
Labour induction
