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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - Thyroid Disease Disease State Management - March 21, 2018

Thyroid Disease State Management

Pharmacists Focus on Thyroid Disease
by Darrell Hulisz, RPh, PharmD
Associate Professor
Case Western Reserve University
School of Medicine

The thyroid gland is one of the largest endocrine glands in the body, and is responsible for controlling how quickly the body uses energy, synthesizes proteins, regulates metabolism, and controls the sensitivity of organs and tissues to other hormones. The thyroid gland is located in the neck, inferior to the Adam’s apple. The thyroid gland produces hormones such as triiodothyronine (T3) and thyroxine (T4), as well as calcitonin which regulates calcium homeostasis. The most common diseases of the thyroid gland are hypothyroidism and hyperthyroidism.

Hypothyroidism develops when the body lacks substantial thyroid hormone production. This disease slows down the body’s metabolism. Approximately 10 million Americans suffer from this disease and 10% of women have some level of thyroid hormone deficiency. The symptoms of hypothyroidism include fatigue, weakness, weight gain, dry hair, rough skin, hair loss, muscle cramps, constipation, depression, memory loss, irritability, and abnormal menstrual cycles.

There are two distinct causes of hypothyroidism. The first is a past or present inflammation of the thyroid gland where most of the cells are deceased or damaged. As a result of these damaged cells, the thyroid gland produces insufficient hormones. The inflammation is caused by the patient’s own immune system (i.e. an autoimmune disease). The most common type of inflammation is called Hashimoto’s thyroiditis, whereby the cells cannot convert iodine into thyroid hormone. The second cause of hypothyroidism comes from surgery where part or all of the thyroid gland must be removed, usually due to a thyroid tumor. Similar to the lack of functional cells of the thyroid gland, the decreased mass of the gland will result in the body’s inability to produce hormones. Even though this is a rare occurrence, hypothyroidism can result from a normal size thyroid gland, but the pituitary gland cannot produce sufficient thyroid stimulating hormone (TSH). Post-partum thyroiditis can also be a form of hypothyroidism, affecting about 7% of women after giving birth in the United States. Other causes of hypothyroidism include iodine deficiency, and use of medications, such as lithium and amiodarone.

The most common method of treating hypothyroidism is administration of levothyroxine once daily. This medication is a synthetic form of T4 used to replace the lack of endogenous T4. The dosage must be individualized to a patient’s symptoms and thyroid function tests. If necessary doses are adjusted usually on a monthly basis until the proper levels are reached. Blood samples can also determine if anti-thyroid antibodies exist to rule out Hashimoto’s thyroiditis. Patients should be counseled to communicate any change in symptoms with their physicians, follow-up at prescribed intervals when thyroid function tests are due, and be adherent to daily thyroid supplements.

Hyperthyroidism is a disease where the body overproduces thyroid hormone. The body’s metabolism increases and causes patients to lose weight even though they may not be overeating. Graves’ disease is a most common cause of hyperthyroidism because an enlargement of the entire thyroid occurs. This enlargement is known as a goiter of the neck. The autoimmune response to hyperthyroidism occurs when antibodies attach to specific activating sites where they speed up the production of the thyroid hormones. Women are eight times more likely to be diagnosed with Graves’ disease than men and there is a genetic predisposition to this disorder. The most common age of occurrence is between 30-40. Signs and symptoms of hyperthyroidism include tachycardia and/or heart palpitations, heat intolerance, nervousness, insomnia, breathlessness, increased bowel movements, light or absent menstrual periods, fatigue, hair loss, stare gazing, weight loss, and muscle weakness. Graves’ disease also makes the eyes look enlarged and pushes the eye forward so it bulges, a condition known as exophthalmos. Another cause of hyperthyroidism is an enlargement of a single nodule on the pituitary gland. Hashimoto’s thyroditis can also lead to overproduction of thyroid hormone along with post-partum thyroiditis. Taking excess doses of levothyroxine (or other thyroid supplement) can cause hyperthyroidism.

The main treatments for hyperthyroidism include taking anti-thyroid medication, radioactive iodine treatment, and surgical removal of the gland or nodule. The two main drugs to counteract the overproduction of hormones are methimazole and propylthiouracil (PTU). Within a few weeks of taking these drugs, they can be very effective in eliminating symptoms. Some of the uncommon but possible side effects of these drugs include a rash, fever, and itching. There have also been very rare occurrences of hepatitis and leukopenia. If jaundice or persistent fever develops in patient on these medications, they should be counseled to seek medical attention immediately. Another treatment of hyperthyroidism is radioactive iodine treatment. This is the most often recommended procedure to eliminate hyperthyroidism permanently. This type of treatment eliminates the thyroid cells that are overproducing the hormones. Since iodine isn’t absorbed by other parts of the body, the radiation doesn’t yield severe side effects like most types of radiation. Radioactive iodine can be taken orally without hospital admission. It takes one or two months to completely eradicate the thyroid and the radioactive medicine exits the body after a few days. The most common side effect is inactivity of the production of hormones which can often lead to hypothyroidism because of excessive destruction of thyroid cells. The surgical removal of the gland or nodule is another form of treatment for hyperthyroidism.

Links - Thyroid Disease
National Grave’s Disease Foundation

American Thyroid Association

American Association of Clinical Endocronologists

Thyroid cancer Survivor’s Association

All Thyroid

Thyroid Federation International

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