CHAPTER 31

Thyroid and Antithyroid Drugs

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Thyroid Gland

Secretes three hormones essential for proper regulation of metabolism

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the extracellular fluid

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Hypothyroidism: Deficiency in Thyroid Hormones

Primary: abnormality in the thyroid gland itself Secondary: results when the pituitary gland is dysfunctional and does not secrete TSH Tertiary: results when the hypothalamus gland does not secrete TRH, which stimulates the release of TSH

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Hypothyroidism

Cretinism

Hyposecretion of thyroid hormone during youth Low metabolic rate, retarded growth and sexual development, possible mental retardation

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Hypothyroidism (contd)

Myxedema

Hyposecretion of thyroid hormone during adulthood Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the skin

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Hypothyroidism (contd)

Goiter

Enlargement of the thyroid gland Results from overstimulation by elevated levels of TSH TSH is elevated because there is little or no thyroid hormone in circulation

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Hypothyroidism (contd)

Common symptoms

Thickened skin Hair loss Constipation Lethargy Anorexia

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Thyroid Preparations

levothyroxine (Synthroid, Levothyroid)

Synthetic thyroid hormone T4

liothyronine (Cytomel)

Synthetic thyroid hormone T3

Synthetic thyroid hormone T3 and T4 combined Desiccated (dried) animal thyroid gland

liotrix (Thyrolar)

thyroid

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Mechanism of Action

Thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid) Thyroid drugs work the same way as thyroid hormones

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Indications

To treat all three forms of hypothyroidism Levothyroxine is the preferred drug because its hormonal content is standardized; therefore, its effect is predictable Euthyroid

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Indications (contd)

Also used for thyroid replacement in patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism

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Adverse Effects

Cardiac dysrhythmia is the most significant adverse effect May also cause:

Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, others

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Hyperthyroidism: Excessive Thyroid Hormones

Caused by several diseases

Graves disease Multinodular disease Plummers disease (rare) Also called toxic nodular disease Thyroid storm (induced by stress or infection) Severe and potentially life-threatening

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Hyperthyroidism

Affects multiple body systems, resulting in an overall increase in metabolism

Diarrhea Flushing Increased appetite Muscle weakness Sleep disorders Altered menstrual flow

Fatigue Palpitations Nervousness Heat intolerance Irritability

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Treatment of Hyperthyroidism

Radioactive iodine (I131) works by destroying the thyroid gland Surgery to remove all or part of the thyroid gland

Lifelong thyroid hormone replacement will be needed

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Treatment of Hyperthyroidism (contd)

Antithyroid drugs: thioamide derivatives

methimazole (Tapazole) propylthiouracil (PTU)

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Antithyroid Drugs

Used to palliate hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical treatment or during radioactive iodine treatment for hyperthyroidism May cause liver and bone marrow toxicity

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Nursing Implications

Assess for drug allergies, contraindications, potential drug interactions Obtain baseline vital signs, weight Cautious use advised for those with cardiac disease, hypertension, and pregnant women

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Nursing Implications (contd)

During pregnancy, treatment for hypothyroidism should continue Fetal growth may be retarded if maternal hypothyroidism is untreated during pregnancy

Adjust dosage every 4 weeks to keep TSH at the lower end of the normal range

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Nursing Implications (contd)

Teach patient to take thyroid drugs once daily in the morning to decrease the likelihood of insomnia if taken later in the day Teach patient to take the medications at the same time every day and not to switch brands without physician approval

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Nursing Implications (contd)

Teach patients to report any unusual symptoms, chest pain, or heart palpitations Teach patients not to take over-the-counter medications without physician approval Teach patients that therapeutic effects may take several months to occur

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Nursing Implications (contd)

Teach patients the importance of alerting health care providers of thyroid medication use

May enhance activity of anticoagulants Diabetic patients may need increased dosages of hypoglycemic meds May decrease serum digoxin levels

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Nursing Implications (contd)

Antithyroid medications

Better tolerated when given with food Give at the same time each day to maintain consistent blood levels Never stop these medications abruptly Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)

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Nursing Implications (contd)

Monitor for therapeutic response Monitor for adverse effects

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