1. Thyroid and Antithyroid Drugs
Chapter 31
Thyroid and Antithyroid Drugs
['θairɔid]甲状腺
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2. Thyroid and Thyroid system
促甲状腺素释放激素
促甲状腺激素
Thyroid and Thyroid system
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3. Synthesis of the thyroid hormones
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4. Physiological effects
1 Growth and development
2 Calorigenic effects
3 Cardiovascular effects
4 Metabolic effects
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5. Functional disorders of thyroid紊乱相关疾病
Hypofunction: hypothyroidism
 [,haipəu'θairɔidizəm]
甲状腺功能减退
Simple goiter
Cretinism
['kri:ti,nizəm]
呆小症
Myxoedema
 甲状腺肿
[,miksə'di:mə]
粘液性水肿
Hyperfunction: hyperthyroidism
[,haipə‘θairɔidizəm] 甲亢

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7. Thyroid hormone: T3 and T4
Clinical applications: thyroid hormone replacement therapy Hypothyroidism:
Cretinism
Simple goiter
Myxoedema
Subclinical hypothyroidism
Adverse effects: cardiac effects

8. 1 Thioureas [,θaiəu‘juəriə]硫脲类 2 Iodine/Iodide [‘aɪədaɪd] 碘化物
Antithyroid drugs
Drugs：
1 Thioureas [,θaiəu‘juəriə]硫脲类
2 Iodine/Iodide [‘aɪədaɪd] 碘化物
3 Radioactive iodine
4 β blocking drugs

9. Synthesis of the thyroid hormones
Effects
Damage
Thioureas
Radioactive iodine
Iodine/Iodide
β blocking drugs

10. Drugs： Thioureas Characteristics：takes effect slowly
Propylthiouracil (丙硫氧嘧啶), Methimazole (甲巯咪唑)
Methylthiouracil (甲基硫氧嘧啶), Carbimazole (卡比马唑)
Characteristics：takes effect slowly
Pharmacological effects:
1 block the uptake of iodine;
2 block the peripheral converting of T4 to T3;
3 inhibit the organification of iodine (inhibit peroxidase)

11. Clinical applications
1 Mild to moderate hyperthyroidism;
2 Prior to the surgical treatment of hyperthyroidism;
3 Thyroid storm: as adjuvant

12. 1. Agranulocytosis [ei'ɡrænju,ləusai'təusis]粒性白血球缺乏症
Adverse reactions
1. Agranulocytosis [ei'ɡrænju,ləusai'təusis]粒性白血球缺乏症
2. Transient leukopenia [,lju:kəu'pi:niə] 白血球减少症
3. Maculopapular rush [,mækjulə'pæpju:lə]斑丘疹的
4. Others: fever, urticarial rash, vasculitis, joint pain
[,ə:ti‘kεəriəl]荨麻疹的
[,væskju'laitis]血管炎

13. Iodine/Iodide Characteristics：takes effect rapidly
Pharmacological effects (>6 mg/d) :
1 inhibit iodination of thyroglobulin;
2 inhibit the release of TH

14. Clinical applications
1.Hyperthyroidism: in the preoperative period in preparation for thyroidectomy;
2.Thyroid storm: in conjunction with antithyroid drugs and propranolol

15. Adverse reactions
1 Acute hypersensitivity reaction: angioedema, cutaneous hemorrhages, drug fever, arthralgia [ɑ:'θrældʒiə]关节痛
2 Chronic intoxication with iodide: related to the dose.

16. Pharmacological effects:
Radioactive iodine
Pharmacological effects:
131I is rapidly and efficiently trapped by the thyroid
1 the originated β-ray (99%) damages exclusively upon the parenchymal cells of the thyroid;
2 the originated γ-ray (1%) passes through the tissue and can be quantified by external detection
[pə‘reŋkimə]实质的

17. Clinical applications
1 hyperthyroidism
2 diagnosis of disorders of thyroid function
Adverse reactions
High incidence of delayed hypothyroidism (3%-6%)

18. β blocking drugs Drugs: propranolol, alprenolol
Pharmacological effects:
1 inhibit the conversion of T4 to T3;
2 improve the symptoms induced by sympathetic activation
Clinical applications: thyroid storm, in conjunction with thioureas and iodine/iodide.