Languha Ngati

Pharmacology discussion Question

Chapter 37, Thyroid and Parathyroid Agents

Instructor: CarolAnn Marchand

3-12-2020
Written Assignments

1. Briefly describe how thyroid and parathyroid hormones are controlled.

- Thyroxine (T4) and triiodothyronine (T3) is primarily regulated by thyroid-

stimulating hormone (TSH) that is released from the anterior pituitary gland.

- When thyroid levels in the blood are elevated TSH and TRH production is reduced.

Provide negative feedback, inhibiting secretion of TRH and TSH when blood levels

are high.

- Several other factors have been shown to influence thyroid hormone secretion. In

rodents and young children, exposure to a cold environment triggers TRH secretion,

leading to enhanced thyroid hormone release. This Parathyroid hormone works in

with another hormone, called calcitonin which is produced by the thyroid to maintain

blood calcium levels.

 2. Thyroid hormones increase metabolism. Why is giving thyroid hormones not recommended

to treat obesity?

- Thyroid function has been often described as a change or break in obese children and

adult, though it is not certain if the altered thyroid function is the cause or the effect

of fat excess in the body.

- On the other hand, thyroid structure seems also to be affected. Nevertheless, both

functional and structural alterations seem to improve after weight loss and therefore

no treatment is needed. And a lot of factors could have contributed to the excess fat in

the body.
 Group Assignments

1. As a group, prepare a table describing the therapeutic actions, indications, pharmacokinetics,

most common adverse reactions, contraindications, and important drug—drug interactions for

thyroid and parathyroid agents.

- Therapeutic: Hormone is used in the treatment of deficiency states like

hypothyroidism (thyroid hormones), and menopause (estrogens or

estrogens/progestin). Hormones may be used to treat hormonally sensitive tumors

(androgens, estrogens) and in other selected situations.

- Actions: Increases the metabolic rate of body tissues, increasing oxygen consumption,

respiration, and heart rate; the rate of fat, protein, and carbohydrate metabolism; and

growth and maturation

- Indications: Replacement therapy in hypothyroidism; pituitary TSH suppression in

the treatment of thyroid goiters, management of thyroid cancer; thyrotoxicosis in

conjunction with other therapy; myxedema coma

- Pharmacokinetics: Absorbed in GI tract and binds to serum proteins; Eliminated in

bile; Does not cross the placenta

- Contraindications: Known allergy, Thyrotoxicosis, Acute MI

- Cautions: Lactation, Hypo adrenal conditions such as Addison's

- Adverse Effects: Skin reactions, Symptoms of hyperthyroidism, Cardiac stimulation,

CNS effects

- Drug-to-Drug Interactions: Cholestyramine, Oral anticoagulants, Digitalis, theophylline.

2. Divide the class into three groups. Assign each group an age group: children, adults, or older

adults. Each group is to discuss the use of thyroid and parathyroid agents in the assigned age

group. What are the most likely reasons that each age group is receiving one of these drugs?

Prepare a presentation describing special considerations for using these agents in the assigned

age _group.

- Children: Thyroid replacement therapy is required when a child is hypothyroid.

Levothyroxine is the drug of choice in children. Dose is determined based on serum

thyroid hormone levels and the response of the child, including growth and

development.

- Dose in children tends to be higher than in adults because of the higher metabolic rate

of the growing child. Regular monitoring, including growth records, is necessary to

determine the accurate dose as the child grows.

- Adults: Adults who require thyroid replacement therapy need to understand that this

will be a lifelong replacement need. An established routine of taking the tablet first

thing in the morning may help the patient to comply with the drug regimen.

- If anti-thyroid drugs are needed, the patient’s underlying problems should be

considered.- Methimazole is associated with bone marrow suppression and more

gastrointestinal and central nervous system effects than is PTU.

- Sodium iodide I 131 should not be used in adults in their reproductive years unless

they are aware of the possibility of adverse effects on fertility. Alendronate and

risedronate are commonly used drugs for osteoporosis and calcium lowering. Serum

calcium levels need to be monitored carefully with any of the drugs that affect

calcium levels.
 - Older Adults: it is important to screen older adults for thyroid disease carefully before

beginning any therapy. The dose should be started at a very low level and increased

based on the patient response. Levothyroxine is the drug of choice for

hypothyroidism.

- Periodic monitoring of thyroid hormone levels, as well as cardiac and other responses,

is essential with this age group. If antithyroid agents are needed, sodium iodide I 131 may

be the drug of choice because it has fewer adverse effects than the other agents and

surgery.

3. Construct a table that compares and contrasts the prototype drugs levothyroxine,

propylthiouracil, strong iodine products, calcitriol, alendronate, and calcitonin with other thyroid

or parathyroid agents in their class. Look for similarities and differences among groups.

Answer:

- Construct a table that compares and contrasts the prototype drugs levothyroxine,

propylthiouracil, strong iodine products, calcitriol, alendronate, and calcitonin with

other thyroid or parathyroid agents in their class. Look for similarities and differences

among groups.

- Levothyroxine: Absorption is slightly increased when the hormone is taken on an

empty stomach, and it is associated with less variability in the TSH when taken this

way regularly.

- Strong iodine: These drugs are rapidly absorbed from the GI tract and widely

distributed throughout the body fluids therefore low doses of iodine are needed in the
 body for the formation of thyroid hormone. High doses, however, block thyroid

function.

- Propylthiouracil: Treatment of hyperthyroidism which inhibits the synthesis of

thyroid hormones, also partially inhibits the peripheral conversion of T4 to T       3.

metabolized in the liver and excreted in the urine.

- Calcitriol: Management of hypocalcemia in patients on chronic renal dialysis,

management of hypocalcemia associated with hypoparathyroidism. vitamin D

compound that regulates the absorption of calcium and phosphate from the small

intestine, mineral resorption in bone, and reabsorption of phosphate from the renal

tubules, increasing the serum calcium level.

- Alendronate: Treatment and prevention of osteoporosis in postmenopausal women

and in men treatment of glucocorticoid induced osteoporosis treatment of Paget

disease in certain patients. Slows normal and abnormal bone resorption without

inhibiting bone formation and mineralization. Not metabolized but excreted in the

urine.
 Citation

Jacob, J., Chopra, S. and Cherian, D., 2020. The Thyroid Hormone, Parathyroid Hormone And

Vitamin D Associated Hypertension.