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endocrinepharm2.html
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<!DOCTYPE html>
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<h1>Endocrine Pharmacology II - Thyroid Hormones</h1>
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<ol>
<li><b>Thyroid agents</b></li>
<li>Thyrotropin RH -> Thyroid SH -> T3 + T4</li>
<li>Dopamine and somatostatin inhibit TSH</li>
<li>Levothyroxine (T4) and Liothyronine (T3) are used to treat hypothyroidism</li>
<li>Thioamides, Iodide, and Beta Blockers treat hyperthyroidism</li>
<li>Low thyroid hormone most commonly caused by Iodine deficiency</li>
<li>Hashimoto's thyroiditis is most common cause of hypothyroidism in US</li>
<li>Low thyroid hormone -> manifests as thick lips, large tongue, malocclusion, impacted mandibular molars</li>
<li>T3 = Triiodothyronine, T4 = Thyroxine</li>
<li>Levothyroxine is DOC for low thyroid -> long half-life (7 days), converted to T3 intracellularly</li>
<li>Can cause bone maturation, nervousness, heat intolerance</li>
<li>Inhibited absorption by soy, bran, and coffee</li>
<li>Liothyronine is synthetic T3 - more potent than levothyroxine, but only preferred for short term TSH suppression</li>
<li>Liotrix (combination T3 and T4) and dessicated thyroid sometimes used</li>
<li>Myxedema is a type of hypothyroidism that often coincides with coronary artery disease</li>
<li>Amiodarone can induce hypothyroidism from rT3 production</li>
<li>Hyperthyroidism is more common in women than men</li>
<li>Hyperthyroidism can cause facial osteoporosis, BMS, accelerated dental eruption</li>
<li>Thioamides include methimazole and propylthiouracil (PTU), and inhibit a peroxidase reaction that converts Iodine to TH</li>
<li>Methimazole 10x more potent than PTU, but PTU also inhibits peripheral deiodination of T3 and T4</li>
<li>Nausea, GI distress, and altered taste or smell occur as side effects for thioamides</li>
<li>Anion inhibitors - perchlorate, pertechnetate, and thiocyanate block Iodide uptake</li>
<li>I-131 treats thyrotoxicosis by destroying thyroid parenchyma, contraindicated in pregnant women as it can pass through the placental barriers</li>
<li>Iodides (potassium Iodide and Lugol's solution) were commonly used prior to thioamides, and are contraindicated in pregnancy</li>
<li>Hyperthyroidism increases sensitivty to Warfarin, decreases sensitivity to cardiac glycosides</li>
<li>PTU is safe in first trimester, but otherwise both thioamides are contraindicated in pregnancy</li>
<li>Beta blockers control cardiovascular issues in thyrotoxicosis</li>
<li>Graves' Disease - antibodies against TSH receptor sites</li>
</ol>
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