Drugs used in Thyroid

conditions
 OUTLINE

• HYPOCALCEMIA
• HYPOTHYROIDISM
• HYPERTHYROIDISM
 OUTLINE

• HYPOCALCEMIA
• HYPOTHYROIDISM
• HYPERTHYROIDISM
HYPOCALCEMIA
 CALCIUM HOMEOSTASIS
• ECF Ca range: 8.9–10.1 mg/dL [2.2–2.5 mM])
• ↓ extracellular (ECF) Ca  ↑ PTH secretion  ↑
tubular reabsorption of calcium by the
kidney, ↑ resorption of calcium from bone and ↑
renal 1,25(OH)2D production  ↑ intestinal
calcium absorption  restoration of Ca levels to
normal
CAUSES OF HYPOCALCEMIA
S/SX OF HYPOCALCEMIA
• Mild to Moderate
– perioral or extremity
paresthesia, cramps,
myalgia, and muscular
weakness
• Severe
– seizures, laryngospasm,
bronchospasm, cardiac
failure, and altered mental
status
 Mild to Moderate Hypocalcemia

CALCIUM CARBONATE
(Drugmakers)
500 mg tablet
# 180

Sig: take 1-2 tabs three times a day

between or after meals
Refill: 0
Warning: WOF hypersensitivity
reaction, stomach upset, syncope,
bradycardia and arrythmias
 For Severe hypocalcemia

CALCIUM GLUCONATE
(Calcinate)
100 mg/ml (10%) x 10 ml ampule
#6

Sig: Administer 20 ml via slow IV push at a

rate of 1 ml/min. Follow with slow IV
infusion of 39 ml Ca Gluconate diluted in
1 L PNSS at a rate of 11 gtts/miin for 24
hours. Monitor serum calcium every 6
hours. Stop infusion if Ca+ >0.9 mg/dl
Refill: 0
Warning: watch out for bradycardia and
hypotension. d/c immediately in HR <60
bpm. Nausea and vomiting, flushing and
chalky taste may also be experienced
For Mild, moderate and severe hypocalcemia
(adjunct to Ca supplementation)

CALCITRIOL
(Rocaltrol)
0.25 mcg capsule
#7

Sig: Take 1 capsule once daily in the

morning
Refill: 0
Warning: seek consult if GI
discomfort arises
 For Hypocalcemia (used to reduce
hypercalciuria)

HYDROCHLOROTHIAZIDE
(Hydro)

Sig: Take 1 capsule twice daily

Refill: 0
Warning: hypersensitivity
HYPOTHYROIDISM

Hypothyroidism is a
syndrome resulting from
deficiency of thyroid
hormones and is manifested
largely by a reversible
slowing down of all body
functions.
 CAUSES OF
HYPOTHYROIDISM

Source: Jameson J, Mandel SJ, Weetman AP (2015). Disorders of the Thyroid

Gland.. In DL Kasper, SL Hauser, et.al. (ed.), Harrison’s Principle of Internal
Medicine, 19th edition. United States: McGraw-Hill Education.
 S/SX OF
HYPOTHYROIDISM
In descending frequency.

Source: Jameson J, Mandel SJ, Weetman AP (2015). Disorders of the Thyroid

Gland.. In DL Kasper, SL Hauser, et.al. (ed.), Harrison’s Principle of Internal
Medicine, 19th edition. United States: McGraw-Hill Education.
 EVALUATION OF HYPOTHYROIDISM

Source: Jameson J, Mandel SJ, Weetman AP (2015). Disorders of the Thyroid Gland.. In DL Kasper, SL Hauser, et.al. (ed.),
Harrison’s Principle of Internal Medicine, 19th edition. United States: McGraw-Hill Education.
 Mild Hypothyroidism

LEVOTHYROXINE Na
(Eltroxin/Euthyrox/Synthroid/Thyr
ax Duotab)
50 mcg tablet
# 30
Sig:
ID: 25-50 mcg PO daily. Increase by 25-50
mcg at 2-4 weekly intervals.
MD:Take 1.7mcg/kg/day or 100-125 mcg
OD.Take with full glass of water 30 min
or 1 hr before breakfast on empty
stomach.Not to exceed 300mcg/day
Refill: 0
Warning: Excessive dosage may cause
chest pain, palpitation and cramps of
the muscles, diarrhea and vomiting
Mild Hypothyroidism for < 50 years with CV
disease

LEVOTHYROXINE Na
(Eltroxin/Euthyrox/Synthroid/Thyr
ax Duotab)
50 mcg tablet
# 30
Sig:
ID: 25-50 mcg PO daily. Increase by 12.5-
25 mcg at 6-8 weekly intervals.
MD:Take 1.7mcg/kg/day or 100-125 mcg
OD.Take with full glass of water 30 min
or 1 hr before breakfast on empty
stomach.Not to exceed 300mcg/day
Refill: 0
Warning: Excessive dosage may cause
chest pain, palpitation and cramps of
the muscles, diarrhea and vomiting
Mild Hypothyroidism for > 50 years with CV
disease

LEVOTHYROXINE Na
(Eltroxin/Euthyrox/Synthroid/Thyr
ax Duotab)
50 mcg tablet
# 30
Sig:
ID: 25-50 mcg PO daily. Increase by 12.5-
25 mcg at 4-8 weekly intervals.
MD:Take 1.7mcg/kg/day or 100-125 mcg
OD.Take with full glass of water 30 min
or 1 hr before breakfast on empty
stomach.Not to exceed 300mcg/day
Refill: 0
Warning: Excessive dosage may cause
chest pain, palpitation and cramps of
the muscles, diarrhea and vomiting
 Severe Hypothyroidism

LEVOTHYROXINE Na
(Eltroxin/Euthyrox/Synthroid/Thyr
ax Duotab)
50 mcg tablet
# 30
Sig:
ID: 12.5-25 mcg PO daily. Increase by 12.5-
25 mcg at 2-4 weekly intervals.
MD:Take 1.7mcg/kg/day or 100-125 mcg
OD.Take with full glass of water 30 min
or 1 hr before breakfast on empty
stomach.Not to exceed 300mcg/day
Refill: 0
Warning: Excessive dosage may cause
chest pain, palpitation and cramps of
the muscles, diarrhea and vomiting
 For Subclinical Hypothyroidism

LEVOTHYROXINE Na
(Eltroxin/Euthyrox/Synthroid/Thyr
ax Duotab)
50 mcg tablet
# 30
Sig:
ID: 1mcg/kg PO daily
MD:Take 1.7mcg/kg/day or 100-125 mcg
OD.Take with full glass of water 30 min
or 1 hr before breakfast on empty
stomach.Not to exceed 300mcg/day
Refill: 0
Warning: Excessive dosage may cause
chest pain, palpitation and cramps of
the muscles, diarrhea and vomiting
 Myxedema Coma

LEVOTHYROXINE Na
(Synthroid)
50 mcg tablet
# 30
Sig: Inject 200-500 mcg
intravenously once then 100-300
mcg 1 day later as needed
Refill: 0
Warning: Excessive dosage may
cause chest pain, palpitation and
cramps of the muscles, diarrhea
and vomiting
 Drug-Induced Hypothyroidism

Can be satisfactorily managed by

levothyroxine therapy if offending
agent cannot be stopped
 Pregnancy

• Take an extra 25mcg thyroxine

tablet as soon as the
recognition of pregnancy.

• Take thyroxine tablet at least 4

hours from prenatal vitamins.

• Due to elevated maternal TBG,

• Adequate maternal thyroxine
dosage maintenance of TSH:
0.5 and 3.0 mU/L
• Total T4 level: at or above
upper range of normal
HYPERTHYROIDISM
 HYPERTHYROIDISM
• Graves’s disease causes most of
hyperthyroidism, especially in
young patients.
• Toxic multinodular goiter (MNG) is
a common cause of
hyperthyroidism in older patients
• Unusual causes include
– Iodine-induced hyperthyroidism
(precipitated by amiodarone or
radiographic contrast media)
– Thyroid adenomas
– Subacute thyroiditis
– Painless thyroiditis
– Surreptitious ingestion of thyroid
hormone
• TSH-induced hyperthyroidism is
extremely rare
 Hyperthyroidism
(Grave’s disease)

PROPYLTHIOURACIL
(Rhea propylthyrouracil)
50 mg/tab
# 120 tablets
Sig: take 2 tablets every 6 hours
daily. Return for follow-up after 4
weeks
Refill: 0
Warning: Stop medication when
abdominal pain, changes in bowel
habits or fever occurs
 Hyperthyroidism
(Also prep for Thyroid surgery)

METHIMAZOLE
(Tapazole)
5 mg
# 90
Sig: Take 3 tablets daily. Return for
follow-up after 4 weeks
Refill: 0
Warning: Stop medication when
skin rashes, itchiness, nausea,
vomiting, epigastric pain, joint
pains, paresthesia, headache,
edema and jaundice occurs.
 Myxedema Coma

CARBIMAZOLE
(Neomerdin)
20 mg
# 60 tablets
Sig: Take 2 tablets daily. Return for
follow-up after 4 weeks.
Refill: 0
Warning: Stop medication when
skin rashes, itchiness, nausea,
vomiting, epigastric pain, joint
pains, paresthesia, headache,
edema and jaundice occurs.