Thyroid Disorder

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Definition

Thyroid gland function: The thyroid gland produces the thyroid hormones, which
regulate metabolism, including the chemical processes needed to maintain life:
cardiac and nervous system functions, body temperature, muscle strength, skin
dryness, menstrual cycles, weight and cholesterol levels.

Thyroid gland is the only organ that can absorb iodine

Thyroid hormones: triiodothyronine (T3) and thyroxine (T4). The production of

both hormones requires iodine and tyrosine.
T3 is primarily formed from the breakdown of T4. A small percentage (< 20%) is
produced by the thyroid gland directly.T3 is more potent than T4 but has a
shorter half-life.

Regulated by: Thyroid-stimulating hormone (TSH) and thyrotropin from pituitary

gland.

Negative Feedback Loop: When the level of circulating (free) T4 increases, the
circulating T4 inhibits the secretion of TSH. Less TSH will decrease T4
production.

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 Thyroid hormones negative feedback loop

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Thyroid Disorder 3
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Types

Hyperthyroidism (overactive thyroid)

Free T4 is high and TSH is low.

No one should use thyroid hormone to lose weight; it can lead to psychiatric
issues and severe cardiac complications.

Causes: Graves' disease is an autoimmune disorder the antibodies

stimulate the thyroid to produce too much T4, Less common causes include
thyroid nodules and thyroiditis or some drugs like: iodine, amiodarone and
interferons

Can treated by drugs or radioactive iodine (RAI-131) or surgery

The patient can be treated with beta blockers first for symptom control.

Hypothyroidism (underactive thyroid)

A deficiency in T4, and consequently, an elevation in TSH.

Common cause: Hashimoto's disease, an autoimmune condition in which a

patient’s own antibodies attack the thyroid gland.

Complication: Depression, Infertility and Cardiovascular disease,

hyperlipidemia, (Myxedema coma is an uncommon, but potentially fatal)

Diagnosis

Based of two laboratory tests:

1. Low free thyroxine (FT4): normal range 0.9 - 2.3 ng/dL

2. High thyroid -stimulating hormone (TSH): normal range (0.3-3 mlU/L)

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 Symptoms

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 Thyroid Storm

Definition

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 Life-threatening medical emergency characterized by decompensated
hyperthyroidism.
Precipitated by infection, trauma, surgery, radioactive iodine treatment or non-
adherence to antithyroid medication.

Symptoms:

Tachycardia - Fever - dehydration - sweating - delirium - coma

Drug Treatment

Antithyroid drug therapy (PTU is preferred)

Inorganic iodide therapy such as KI

+

Beta blocker (propranolol)

+
Systemic steroid (dexamethasone)

+
Aggressive cooling with acetaminophen and cooling blankets and other
supportive treatments (antiarrhythmics, insulin, fluids, electrolytes)

Pregnancy

Hyperthyroidism
PTU preferred in 1* trimester

Methimazole for 2nd and 3rd trimesters

Untreated leads to pregnancy loss, prematurity and low birth weight, thyroid
storm, maternal hypertension and congestive heart failure.

Can also be lasting effects in the baby, including seizure disorders and
neurobehavioral disorders.

Hypothyroidism
Untreated leads to loss of pregnancy, low birth weight, premature birth and
lower IQ in children.

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 Levothyroxine is safe in pregnancy and is the recommended treatment and
require a 30 - 50% increase in the dose throughout the course of their
pregnancy and for several months after giving birth.

Hypothyroidism Treatment
Levothyroxine (T4)

⚕ Drug of choice for hypothyroidism due to chemical stability, once-daily

dosing, low cost lack of antigenicity and more uniform potency.

⚕ CI: Uncorrected adrenal insufficiency

⚕ SE: If dose is too high leads to increase HR, palpitations, sweating,

weight loss, arrhythmias and irritability

⚕ Monitor: TSH levels

⚕ Drug-Drug intraction: All thyroid hormone can change the concentration

or effect
1- Increase effect of anticoagulants
2- Decrease levels of digoxin and theophylline and antidiabetic drugs.

⚕ Note: taken with water consistently at least 60 minutes before breakfast

or at bedtime (at least three hours after the last meal)

Thyroid, Desiccated USP (T3 and T4)

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 ⚕ Natural porcine-derived thyroid that contains both T3 and T4; less
predictable potency and stability. Not preferred, but some feel better
using it.

Liothyronine (T3)

⚕ Shorter half-life causes fluctuations in T3 levels

Hyperthyroidism Treatment
Thionamides

⚕ Propylthiouracil (PTU) - Methimazole

⚕ MOA: inhibit synthesis of thyroid hormones by blocking the oxidation of

iodine in the thyroid gland
PTU also inhibits peripheral conversion of T4 to T3

⚕ CI: Severe liver injury and acute liver failure

⚕ SE: Gl upset, fever, constipation, loss of taste, bleeding.

⚕ Monitor: CBC, LFTs, PT and thyroid function tests (TSH, FT4, total T3)

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 ⚕ Note: PTU is preferred in thyroid storm Take with food to reduce Gl upset,
PTU is not a first line treatment for hyperthyroidism except in patients
who cannot tolerate other options

Iodides

⚕ Potassium iodide - iodine solution

⚕ MOA: temporarily inhibit secretion of thyroid hormones; T4 and T3 levels

will be reduced for several weeks but effect will not be maintained

⚕ CI: Hypersensitivity to iodide or iodine, dermatitis herpetiformis,

hypocomplementemic vasculitis, nodular thyroid condition with heart
disease

⚕ SE: Rash, metallic taste, sore throat/gums, Gl upset, urticaria.

⚕ Monitor: Thyroid function tests

⚕ Note: Potassium iodide (Kl) blocks the accumulation of radioactive iodine

in the thyroid gland; thus preventing thyroid cancer.

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