1. Thyroid Drugs

4. Thyroid & Parathyroid Gland

7. Clinical Presentations Bradycardia Habitual abortion / sterility Impotence Anorexia Heat intolerance Diaphoresis Increased appetite Incidental Goiter Unexplained weight gain Constipation Myxedema Memory loss / impairment Tremor Muscle weakness & fatigue Dyspnea Dependant edema Impaired mentation (confusion) Later Depression & loss of concentration Dry skin (Pruritis) Cold intolerance Myalgias Somnolence & fatigue Menorrhagia Goiter Nervousness / Irritability Palpitations (tachycardia) Unexplained weight loss Diarrhea Sleep disturbances (insomnia) Vision changes (exopthalmos) Amenorrhea / oligomenorrhia Initial HYPOTHYROID HYPERTHYROID TYPE of S/S

12. Thyroid Supplements Thyrogen Thyrotropin Dx Tool for Thyroid Ca Tapazole Methimazole Various generic Propylthiouracil (PTU) Thyroid Suppressants Thyrolar, Euthroid Liotrix (T 4 : T 3 = 4:1) Cytomel, Triostat Liothyronine (synthetic T 3 ) Synthroid, Levothroid, Levo-T Levothyroxin sodium (synthetic T 4 ) Thyroid Supplements TRADE GENERIC CLASS

15. Myxedema

16. Pharmacokinetics: Supplements Biliary / Renal 99% T3: 3-5 days T4: 1-3 wk T3: 2-3 days T4: 6-7 days T3: 24-72 hr T4: 1-3 wk T3: 12-36 hr T4: ? Variable in GI but T3 > T4 Liotrix Biliary / Renal 99% PO: 3-5 days 2-3 days PO: 24-72 hr PO: 12-36 hr Complete in GI (95% in 4 hr) Liothyro-nine Biliary 99% (T4>T3) PO: 1-3 wk IV: ? 6-7 days PO: 1-3 wk IV: 24 hr PO: ? IV: 6-8 hr Variable in GI (50-80%) Levothy-roxine METABOLISM PROTEIN- BINDING DURA TION ½-LIFE PEAK ONSET ABSOR-PTION DRUG

22. Thyroid Hormones: Adverse Effects Weight loss Heat intolerance Weight loss Heat intolerance Weight loss Heat intolerance Metabolic Diarrhea, Abdominal cramps, N / V Diarrhea, Abdominal cramps, N / V Diarrhea, Abdominal cramps, N / V GI Irregular menses Hyperglycemia Hypocholesterolemia Irregular menses Hyperglycemia Hypocholesterolemia Irregular menses Endocrine Diaphoresis Alopecia (children) Diaphoresis Diaphoresis, Alopecia (children) Derm Irritability, Nervousness, Insomnia Nervousness, Headache, Insomnia Irritability, Nervousness, Insomnia CNS Tachycardia, Arrhythmias, Angina Angina, Arrhythmias, Palpitations Tachycardia, Arrhythmias, Angina CV LIOTRIX LEVOTHYROXINE LIOTHYRONINE SYSTEM

30. Pharmacokinetics: Suppressants Hepatic Hepatic METABOLISM Renal 80% Weeks 1-2 hr 6-10 wk 10-21 days Rapid Good in GI Propyl- thiouracil Renal Min Weeks 5-6 hr 4-10 wk 1 wk Rapid Good in GI Methima-zole (Tapazol) EXCRETION PROTEIN - BINDING DURA- TION ½-LIFE PEAK ONSET ABSORPTION DRUG

34. Thyroid Suppressants: Adverse Effects Arthralgia Arthralgia Musculoskeletal Agranulocytosis Aplastic anemia Leukopenia Thrombocytopenia Hypoprothrombinemia Agranulocytosis Aplastic anemia Leukopenia Thrombocytopenia Hypoprothrombinemia Hematologic N/V, Hepatitis (maybe FATAL!) Diarrhea, Diminished taste N/V, Hepatitis (maybe FATAL!) GI Rash, Urticaria, Skin Discoloration Rash, Urticaria, Pruritis Derm Headache, Drowsiness, Vertigo Paresthesia, Headache, Vertigo CNS PTU METHIMAZOLE (Tapazole) SYSTEM