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Thyroid Disorders (etiology and pathophysiology (the thyroid gland uses…

- - - - low free T4: <0.9ng/dL
      - high serum TSH: >3mIU/L
    - - high free T4: >2.3ng/dL
      - low serum TSH: <0.3mIU/L
- - - - take with water on an empty stomach
      - avoid w/in 4hrs of taking calcium or iron products
      - AEs: may ↓ bone mineral density
      - levothyroxine (Levoxyl, Synthroid), desiccated thyroid (Armour Thyroid, Nature-Thyroid), liothyronine (Cytomel)
        
        desiccated thyroid is made from pork products!
      - MOA: bind to thyroid receptor proteins in the cell nucleus and exert metabolic effects
      - if dose requirements are much higher than expected, evaluate pt for GI disorders (e.g. celiac disease)
- - - - propylthiouracil (PTU)
        
        highly protein bound (~70%)
        
        preferred pharmacological treatment for thyroid storm
        
        AEs:
        
        MOA:
      - methimazole (MMI)
        
        MOA: block biosynthesis of TH by competitively inhibiting thyroid peroxidase
        
        AEs: pruritic rashes, arthralgia, fever, agranulocytosis
    - - AEs: rash, metallic taste, sore throat and gums, GI upset
      - MOA: temporarily inhibit secretion of both thyroid hormones
      - potassium iodide and iodine solution (Lugol’s solution), saturated iodide solution (SSKI, ThyroShield)
    - - may be provided for hyperthyroidism symptom control (tachycardia, nervousness, tremor)
    - - will destroy the thyroid's function, lifelong supplements will be needed
  - - - considered for pts w/ a large thyroid gland (>80g), severe ophthalmopathy, and nonresponsive on antithyroid drug treatment
      - surgical prep includes MMI until the patient is biochemically euthyroid (usually 6-8 weeks), followed by iodides (500mg/day) for 10-14d before surgery