Pharm 5: Endocrine 2 (Thyroid)

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Most widely used thyroid drugs such as Synthroid and Levoxyl contain

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L-thyroxine (T4)

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T3 compound less widely used

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Cytomel

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Anti-thyroid drugs

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Thioamides, iodides, radioactive iodine, and ipodate

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Thioamide agents used in hyperthyroidism

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Methimazole and propylthiouracil (PTU)

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Thioamide less likely to cross placenta, inhibits peripheral conversion of T4 to T3 in high doses, and should be used with extreme caution in pregnancy

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PTU

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PTU (propylthiouracil) MOA

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Inhibits thyroid hormone synthesis by blocking iodination of the tyrosine residues of thyroglobulin

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Can be effective for short term therapy of thyroid storm, but after several weeks of therapy causes an exacerbation of hyperthyroidism

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Iodide salts

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Dose may need to be increased during pregnancy or with Ocs due to increased TBG in plasma

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Thyroxine

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Permanently cures thyrotoxicosis, patients will need thyroid replacement therapy thereafter. Contraindicated in pregnancy

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Radioactive iodine

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Radio contrast media that inhibits the conversion of T4 to T3

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Ipodate

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Block cardiac adverse effects of thyrotoxicosis such as tachycardia, inhibits the conversion of T4 to T3

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Beta-blockers such as propranolol

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Vitamins containing iron should NOT be taken simultaneously with levothyroxine because

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Iron deiodinates thyroxine

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Thyroxine dose may need to be increased in hypothyroid patient during pregnancy because

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Estogens increase maternal TBG