1. Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 31 Thyroid and Antithyroid Drugs

2. 2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Thyroid Gland  Secretes three hormones essential for proper regulation of metabolism  Thyroxine (T 4 )  Triiodothyronine (T 3 )  Calcitonin  Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the extracellular fluid

3. 3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

4. 4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hypothyroidism  Cretinism  Hyposecretion of thyroid hormone during youth  Low metabolic rate, retarded growth and sexual development, possible mental retardation

5. 5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hypothyroidism (cont’d)  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

6. 6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hypothyroidism (cont’d)  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

7. 7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hypothyroidism (cont’d)  Common symptoms  Thickened skin  Hair loss  Constipation  Lethargy  Anorexia

8. 8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Thyroid Preparations  levothyroxine (Synthroid, Levothyroid)  Synthetic thyroid hormone T 4  liothyronine (Cytomel)  Synthetic thyroid hormone T 3  liotrix (Thyrolar)  Synthetic thyroid hormone T 3 and T 4 combined  thyroid  Desiccated (dried) animal thyroid gland

9. 9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

10. 10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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”

11. 11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d)  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

12. 12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

13. 13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hyperthyroidism: Excessive Thyroid Hormones  Caused by several diseases  Graves’ disease  Multinodular disease  Plummer’s disease (rare) Also called toxic nodular disease Also called toxic nodular disease  Thyroid storm (induced by stress or infection) Severe and potentially life-threatening Severe and potentially life-threatening

14. 14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

15. 15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Treatment of Hyperthyroidism  Radioactive iodine (I 131 ) works by destroying the thyroid gland  Surgery to remove all or part of the thyroid gland  Lifelong thyroid hormone replacement will be needed

16. 16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Treatment of Hyperthyroidism (cont’d)  Antithyroid drugs: thioamide derivatives  methimazole (Tapazole)  propylthiouracil (PTU)

17. 17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

18. 18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

19. 19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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

20. 20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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

21. 21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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

22. 22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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

23. 23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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)

24. 24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic response  Monitor for adverse effects