Thyroid hormones patients

Thyroid hormones are used as replacement therapy when the patient is hypothyroid. By supplementing the decreased endogenous thyroid production and secretion with exogenous thyroid hormones, an attempt is made to create a euthyroid (normal thyroid) state Levotliyroxine (Synthroid) is the drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosages, and lias a more uniform potency than do other thyroid hormone replacement drugs. 

These drugp are contraindicated in patients with known hypersensitivity to the drug or to any constituents of the drug, after a recent myocardial infarction (heart attack), or in patients with thyrotoxicosis. When hypothyroidism is a cause or contributing factor to a myocardial infarction or heart disease, the physician may prescribe small doses of thyroid hormone... 

These drugs are used cautiously in patients with Addison s disease and during lactation. The thyroid hormones are classified as Pregnancy Category A and are considered safe to use during pregnancy. 

The dosage is individualized to the needs of the patient. The dose of thyroid hormones must be carefully adjusted according to the patient s hormone requirements. At times, several upward or downward dosage adjustments must be made until the optimal therapeutic dosage is reached and the patient becomes euthyroid. 

Thyroid hormone replacement therapy in patients with diabetes may increase the intensity of the symptoms or the diabetes. The nurse closely monitors the patient with diabetes during thyroid hormone replacement therapy for signs of hyperglycemia (see Chap. 49) and notifies the primary health care provider if this problem occurs. 

The nurse carefully observes patients with cardiovascular disease taking the thyroid hormones. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the patient may require a reduction in the dosage of the thyroid hormone. 

Lithium is concentrated in the thyroid gland and can impair thyroid hormone synthesis. Although goiter is uncommon, as many as 30% of patients develop at least transiently elevated thyroid-stimulating hormone values. Lithium-induced hypothyroidism is not usually an indication to discontinue the drug. Patients can be supplemented with levothyroxine if continuation of lithium is desired.30... 

O In most patients with thyroid hormone disorders, the measurement of a serum thyroid-stimulating hormone (TSH) level is adequate for the diagnosis of hypothyroidism and hyperthyroidism. The target TSH for most patients being treated for thyroid disorders should be the mean normal value of 1.4 milliunits/L or 1.4 microunits/mL (target range 0.5-2.5 milliunits/L or 0.5-2.5 microunits/mL). 

Despite the availability of a wide array of thyroid hormone products, it is clear that synthetic levothyroxine (LT4) is the treatment of choice for almost all patients with hypothyroidism. LT4 mimics the normal physiology of the thyroid gland, which secretes mostly T4 as a prohormone. As needed, based on metabolic demands, peripheral tissues convert thyroxine (T4)... 

The assessment of patients for thyroid disorders entails a history and physical examination. In many patients with subclinical or mild thyroid disease, there may be an absence of specific signs and symptoms, and the physical examination may be normal. Various diagnostic tests can be used, including serum thyroid hormone(s), TSH, and thyroid antibody levels and imaging techniques to evaluate patients for thyroid disorders. Normal values for selected laboratory tests are given in Table 41-1. 

Large doses of iodide inhibit the synthesis and release of thyroid hormones. Serum T4 levels may be reduced within 24 hours, and the effects may last for 2 to 3 weeks. Iodides are used most commonly in Graves disease patients prior to surgery and to quickly reduce hormone release in patients with thyroid storm. Potassium iodide is administered either as a saturated solution (SSKI) that contains 38 mg iodide per drop or as Lugol s solution, which contains 6.3 mg iodide per drop. The typical starting dose is 120 to 400 mg/day. Iodide therapy should start 7 to 14 days prior to surgery. Iodide should not be... 

In patients with excess thyroid hormone production, reduce hormone production with an antithyroid drug and/or radioactive iodine. Choose therapy based on patient-specific factors and preference. 

Lithium is associated with hypothyroidism in up to 34% of patients, and hypothyroidism may occur after years of therapy. Lithium appears to inhibit thyroid hormone synthesis and secretion. Patients with underlying autoimmune thyroiditis are more likely to develop lithium-induced hypothyroidism. Patients may require LT4 replacement even if lithium is discontinued. 

The failure of proteins to fold into their functional forms can occasionally lead to "misfolding" or "conformational" diseases.140 Many of these diseases are associated with the formation of amyloid protein, an insoluble material that is deposited as fibrils or plaques in different tissues and organs of the body. They include amyloid Ap protein as the major constituent of the plaques in Alzheimer patients, PrPc associated with neuro-degenerative diseases, a-synuclein (AS) associated with Parkinson s diseases, transthyretin (TTR) as a homotetrameric protein that is involved in the transport of thyroid hormones and retinol in human serum. In particular, the Ap protein is a peptide of 39-43 amino acids that is the... 

Thyroid hormones are still available, with a prescription, for patients with an underactive thyroid (hypothyroidism). These drugs are never given for weight loss. 

The answers are 450-a, 451-b, 452-b. (Katzung, p 652. Hardman, pp 1397—1406.) Agents that can interfere directly or indirectly with the synthesis of thyroid hormone are called thyroid inhibitors. Perchlorate, an ionic inhibitor, interferes with the ability of the thyroid to concentrate F by acting as a competitive inhibitor. It is used in patients with iodide-induced hypothyroidism, such as can occur with the antiarrhythmic agent amio-darone. 

The answer is d. (Hardman, p 1401.) In patients who are suspected of having hyperthyroidism, propranolol can be administered to provide temporary relief of the peripheral manifestations of the disease while the patient is further evaluated. Propranolol suppresses adrenergic symptoms such as tremors and tachycardia it has no effect on the release of thyroid hormones from the gland. 

Reports of the effects of Li+ upon the thyroid gland and its associated hormones are the most abundant of those concerned with the endocrine system. Li+ inhibits thyroid hormone release, leading to reduced levels of circulating hormone, in both psychiatric patients and healthy controls [178]. In consequence of this, a negative feedback mechanism increases the production of pituitary TSH. Li+ also causes an increase in hypothalamic thyroid-releasing hormone (TRH), probably by inhibiting its re-... 

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