****
Hello and welcome i am dr. amber can and today we’ll be reviewing fibroid disorders and the medical management of them before we talk about thyroid disorders it’s important to understand the hypothalamic pituitary axis you can think of the hypothalamus as the puppet master of the brain it sends signals to the pituitary and tells it which hormones and how much to
Secrete the pituitary then in turns secretes thyroid stimulating hormone if the hypothalamus indicates that it should and then thyroid stimulating hormone says to the thyroid gland to secrete thyroid hormones both t3 and t4 then in a feedback loop t3 and t4 circulating in the bloodstream will send a message back to the hypothalamus and let the body know whether or
Not more thyroid hormone needs to be secreted the whole system is designed to maintain homeostasis driven by signals from the pituitary the thyroid produces stores and secretes two different thyroid hormones one is t3 and one is t4 t3 is more potent than t 4 t4 is produced by the thyroid and then converted to t3 a key component in this process is iodine we usually
Get enough iodine in our diet to make this system work and we get that iodine in the form of iodized salt in the days before we had iodine added to our salt supply it was pretty common for people to have graters which is a sign of low thyroid hormone production now there are many reasons why someone’s thyroid might go into overproduction of thyroid hormone there
Could be a tumor on the thyroid that produces excess hormone there could be too much signaling coming from the pituitary or too much signaling coming from the hypothalamus if the patient develops this condition the patient has hyperthyroidism some of the hallmark signs of this are enlarged thyroid pretibial myxedema and exophthalmos i’ll show you a photograph
Of those in a moment the symptoms experienced by people that have hyperthyroidism are attacking cardia weight loss heat intolerance diarrhea anxiety and some of the common causes and in addition to a tumor could be graves disease or toxic adenoma here are some of the signs that you may see in a patient that has hyperthyroidism we have but a few drugs to treat
Hyperthyroidism but they are quite effective for symptomatic relief of tachycardia we often use beta blockers but of course not a anti thyroid medication but it does treat the fast heart rate associated with hyperthyroidism the anti thyroid medications that we commonly use are propylthiouracil or abbreviated often as ptu and methimazole radioactive iodine is also
A option for treating certain types of overproduction of thyroid hormone and certainly if medication management is not an option the patient may require surgery ptu and methimazole work in the same way the mechanism of action is that they inhibit thyroid formation by preventing aya donation so even though we have the iodine in our diet these two drugs prevent
Formation of thyroid tissue and therefore prevent production of thyroid hormone they can be used alone or in conjunction with radioactive iodine they can also be used to shrink the thyroid as a preparation for surgical intervention i will note that methimazole is the preferred agent except in the first trimester of pregnancy in that case we use ptu patients often
Experience gastrointestinal discomfort in the first few weeks when starting ptu or methimazole they may also feel a fever experienced a rash or joint pain but those tend to stabilize after a few weeks the serious side effects i want you to know about specifically are a granulosa ptosis that typically develops in the first three months of therapy and then hepato
Toxicity ptu is more likely to cause hepatic toxicity than methimazole but for both drugs you do need to monitor liver function tests in the patient for six months after starting therapy now let’s transition to talking about hypothyroidism that is the case where the body does not get enough thyroid hormone from the thyroid harm are signs of this condition are
Dry skin hair loss bradycardia mix edema and peripheral edema patients also may complain about brain fog memory problems feeling general fatigue they also will tell you that they’re very cold intolerant they’re constipated they’ve gained weight and they may even have irregular or stopped periods some of the common causes of hypothyroidism are autoimmune disease
Such as hashimoto’s and there could be no known cause again we have but a few medications that treat hypothyroidism but the ones we have are very effective the first drug that was used for this condition is desiccated thyroid it was derived from pigs or cows as technology advanced we were able to synthesize t3 and t4 hormone and that is the first-line treatment
For us today synthetic levothyroxine or t4 is the gold standard of treatment for hypothyroidism some of the brand names of this medication are synthroid livox ol and unit roid when we begin a patient on t4 levothyroxine therapy we want to monitor their tsh levels and t4 levels every three to six weeks until there’s levels have stabilized the patients should take
The medication on an empty stomach about thirty minutes prior to any food and it should be noted that milk certain foods and acids and iron can impair absorption of t4 this is the preferred agent in pregnancy however if a patient is taking too much the patient may experience tachycardia inside yeah and over the long term a very high dose could put the patient at
Risk for osteoporosis there is 83 product on the market called leo thyroid een brand names of that include sytem l which is the oral version and trio stat which is the iv version the iv version is only used for mix edema coma so very few cases of use for that except in an emergency situation when we elect to use t3 we should also monitor tsh levels and t4 hormone
Every four to six weeks as with t4 milk food and acids and iron can impair absorption it should be noted that t3 is never first-line therapy it is always recommended that the patient be started on t4 levothyroxine for any trial of leo thorny some of the adverse events of t3 are similar to t4 tachycardia insomnia over the long term a high dose could lead to osteoporosis
And at high doses there is a high risk of cardiovascular excitation there is a levothyroxine leo thyromine combo product on the market it has a combination of t4 to t3 in a four to one ratio however this product is no longer considered a valuable option endocrinologist do not use it do not recommend it and it is not included in the guidelines the last product you
May see is called armored thyroid or desiccated animal thyroid it has a variable mix of t3 to t4 from lot to lot it’s usually derived from cow or pig sources and because of this it may be disagreeable to people that are averse to using animal products and it may have antigenic affects because it is of animal origin as a result desiccated animal thyroid is never
First-line therapy and it is not recommended for use in the guidelines thank you for joining me dr. amber can for this review of thyroid disorders and the medical management of them
Transcribed from video
Medication Options for Hypothyroidism and Hyperthyroidism – ThePharmacyCoach.com By The Pharmacy Coach
