Thyroid Gland Drugs

Synthetic
thyroid
hormones

Levothyroxine (T4)

(others:
Liothyronine
(T3) & Liotrix)

Anti-thyroid drugs
Thioamides
*All 3 cross the
placenta;
though PTU
crosses it the
least

Anion
inhibitors
*These are less
important
know AE
Iodine &
Iodides
*Wolf-Chaikoff
effect: large
doses of iodine
(-) further
synthesis of
iodine
Radioactive
Iodine
*Outpatient tx,
permanent
cure, but slow
response &
80% become
hypothyroid

Propythiouracil
(PTU)
Methimazole
Carbimazole
*Methimazole is longer
acting & more potent thus
is the DOC for
hypothyroidism

Perchlorate (ClO4-)
Pertechnetate
(TcO4-)
Thiocyanate (SCN-)
Lugols Iodine (I2 +
KI)
Na Iodide
K Iodide
Iodinated contrast
media: Diatrizoate

Use: Hypothyroidism
- Congenital: Cretinism
- Childhood hypothyroidism
- Adult hypothyroidism: Hashimotos thyroiditis
- Myxedema coma
o Occurs in elderly during the winter
o Medical emergency
o Hypothermia, resp. distress, loss of
consciousness
o May also try IV Liothyronine
Use: Hypothyroidism
- Graves disease: DOC is Methimazole
Toxicity:
- Maculopapular rash
- Agranulocytosis (<500)
- Hepatitis (PTU)
MOA: (-) thyroid peroxidase No iodine oxidation/ no
MIT/DIT coupling
*PTU can also (-) peripheral conversion of T4 to T3
MOA: competitive (-) Na+/Iodide transporter (-) uptake of
iodide
AE: aplastic anemia (thus no longer used)
Use: Amiodarone-induced thyrotoxicosis
MOA: (-) hormone release & dec. vascularity, size, &
fragility of a hyperplastic gland
Use: pre-operative preparation
Thyroid escape: gland escapes from the iodide block in 2-8
weeks
Use: Diagnosis of hypothyroidism

Iohexol
131

I (oral)

123

MOA: emits radiation destruction of thyroid gland from

w/in
Contraindications: pregnancy, young patients
Use: toxic adenoma (uninodular goiter), DOC for patients
>21
Use: Diagnosis of hypothyroidism

Adrenorecepto
r blocking
agents

Metoprolol
Propanolol
Atenolol

Use: (-) symptoms of thyrotoxicosis; palpitation,

nervousness, tremors

Propanol in high doses: (-) peripheral conversion of T4 to T3

Toxic storm: sudden acute exacerbation of all of the symptoms of thyrotoxicosis (opposite of
myxedema coma)
Treatment: (3 Ps)
To rapidly control cardiac manifestations:
o Propranolol IV: also (-) peripheral conversion of T4 to T3
o Or Diltiazem IV (Ca2+ channel blocker): give instead of propranolol if the
patient has CHF or asthma
To rapidly (-) release of T3 and T4 from the thyroid gland: Oral Potassium iodide
To (-) synthesis of T3 and T4:
o Propylthiouracil: DOC b/c it also (-) peripheral conversion of T4 to T3
o Or Methimazole
To treat the shock: Hydrocortisone IV: also (-) peripheral conversion of T4 to T3
Supportive therapy for fever, heart failure, or any underlying disease that may have
precipitated the storm.
Amiodarone induced thyrotoxicosis (Amiodarone causes hyperthyroidism b/c it has iodine.
Large doses of iodine can cause hyperthyroidism in a patient who previously had
hypothyroidism)
Type I: iodine induced
o Treatment: PTU
Type II: inflammatory
o Treatment: Steroids
Radiation exposure containing radioactive iodine taken up into the gland thyroid cancer
Prophylaxis: Oral Potassium iodide