THYROID AGENTS

Thyroid gland is located in the middle of the neck and surrounds

the trachea like a shield. It produces two hormones: thyroid hormone and
calcitonin. The thyroid gland uses iodine to produce thyroid hormones that
regulate body metabolism. Thyroid agents either replace or remove
hormones to prevent deficiency and excess. Thyroid agents include thyroid
hormones (T3, T4, TSH)and antithyroid drugs (further classified
as thioamides and iodine solution).

Contents [hide]
 1 Table of Common Drugs and Generic Names
 2 Disease Spotlight: Thyroid Dysfunction
 3 Thyroid Hormones
o 3.1 Description
o 3.2 Therapeutic Action
o 3.3 Indications
o 3.4 Pharmacokinetics
o 3.5 Contraindications and Cautions
o 3.6 Adverse Effects
o 3.7 Interactions
o 3.8 Nursing Considerations
 4 Antithyroid Agents
o 4.1 Description
o 4.2 Therapeutic Action
o 4.3 Indications
o 4.4 Pharmacokinetics
o 4.5 Contraindications and Cautions
o 4.6 Adverse Effects
o 4.7 Interactions
o 4.8 Nursing Considerations
 5 Practice Quiz: Thyroid Agents
 6 See Also
 7 Further Reading and Resources
Table of Common Drugs and Generic Names

Here is a table of commonly encountered thyroid agents, their generic

names, and brand names:

Classification Generic Name Brand Name

Thyroid Agents

levothyroxine Synthroid, Levoxyl

liothyronine Cytomel, Triostat

Thyroid Hormones
liotrix Thyrolar

thyroid dessicated Amour Thyroid

Antithyroid Agents

methimazole Tapazole
Thioamides
propylthiouracil (PTU) –

sodium iodide I131 –

Iodine solutions
strong iodine
Thyro-Block
solution, potassium iodide

Disease Spotlight: Thyroid Dysfunction

 Thyroid dysfunction involves either under activity

(hypothyroidism) or overactivity (hyperthyroidism). This can
affect any age group.
 Hypothyroidism is a lack of sufficient levels of thyroid hormones to
maintain a normal metabolism. This is the most common type of
 thyroid dysfunction and is common among older women and men.
Symptoms include obesity and fatigue, among others. Severe
adult hypothyroidism is called
 Cretinism is a condition in children who are born without a thyroid
gland or who have a nonfunctioning gland. This can lead to poor
growth and development as well as mental retardation.
 Hyperthyroidism occurs when excessive amounts of thyroid
hormones are produced and released into circulation. Graves’
disease is the most common cause of hyperthyroidism.

Thyroid Hormones

Description

 Thyroid hormones are made available to replace the low or absent

levels of natural thyroid hormone and suppress the overproduction
of TSH by the pituitary.
 These can contain both natural and synthetic thyroid hormone.

Therapeutic Action

The desired and beneficial action of thyroid hormones:

 This is replacement hormone for hypothyroid states

like myxedema coma, goiters, and thyroid cancer increases the
metabolic rate of body tissues, increasing oxygen consumption,
respiration, heart rate, growth and maturation, and the metabolism
of fats, carbohydrates, and proteins.
 Levothyroxine, a synthetic salt of T4, is the most frequently used
replacement hormone because of its predictable bioavailability and
reliability.

Indications

Thyroid hormones are indicated for the following medical conditions:

  Replacement hormone for hypothyroid states like myxedema coma,
goiters, and thyroid cancer
 Treatment for thyroid toxicity in conjunction with antithyroid drugs
 Treatment for thyroid overstimulation during pregnancy

Pharmacokinetics

Here are the characteristic interactions of thyroid hormones and the body in
terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

PO Slow 1-3 wk 1-3 wk

IV 6-8 h 24-48 h Unknown

T1/2: 6-7 d
Metabolism: liver
Excretion: bile

Contraindications and Cautions

The following are contraindications and cautions for the use of thyroid
hormones:

 Allergy to any component of the drug. To prevent

hypersensitivity reactions.
 Acute thyrotoxicosis (unless used in conjunction with
antithyroid drugs). Can be exacerbated by the drugs
 Myocardial infarction. Can be exacerbated by the drugs
 Lactation. Drug enters breast milk and can suppress infant’s
thyroid production
 Addison disease. Body will not be able to deal with drug effects.
 Pregnancy. Potential adverse effects on the fetus
 Liothyronine and liorix have greater incidence of cardiac side
effects.
Adverse Effects

Use of thyroid and hormones may result to these adverse effects:

 Skin reactions and loss of hair

 Symptoms of hyperthyroidism

Interactions

The following are drug-drug interactions involved in the use of thyroid

hormones:

 Cholestyramine. Decreased absorption of thyroid hormones (take

two hours apart)
 Anticoagulants. Increased bleeding
 Digitalis glycosides. Decreased effectiveness
of digitalis glycosides.

Nursing Considerations

Here are important nursing considerations when administering thyroid

hormones:

Nursing Assessment

These are the important things the nurse should include in conducting
assessment, history taking, and examination:

 Assess for contraindications or cautions (e.g. history of allergy,

pregnancy, Addison disease, etc.) to avoid adverse effects.
 Assess skin lesions; orientation and affect; blood pressure, pulse,
peripheral perfusion, and vessel evaluation; respiration and
adventitious breath sounds; thyroid function test to determine
baseline status before beginning therapy and for any potential
adverse effects.

Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of
this drug for therapy:

 Decreased cardiac output related to CV effects

 Imbalanced nutrition: less than body requirements related to
changes in metabolism
 Ineffective tissue perfusion related to thyroid activity

Implementation with Rationale

These are vital nursing interventions done in patients who are taking thyroid
hormones:

 Administer a single daily dose before breakfast each day to ensure

consistent therapeutic levels.
 Administer with a full glass of water to prevent difficulty of
swallowing and esophageal atresia.
 Monitor cardiac response to detect cardiac adverse effects.
 Arrange for periodic blood tests of thyroid function to monitor the
effectiveness of the therapy.
 Provide comfort measures (temperature control, rest as needed,
safety precautions) to help patient cope with drug effects.
 Provide patient education about drug effects and warning signs to
report to enhance patient knowledge and to promote compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness

of drug therapy:

 Monitor patient response to therapy (return of metabolism to

normal, prevention of goiter).
 Monitor for adverse effects (tachycardia, hypertension, anxiety, skin
rash).
 Evaluate patient understanding on drug therapy by asking patient to
name the drug, its indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.
Antithyroid Agents

Description

 Antithyroid agents are drugs used to block the production of

thyroid hormone and treat hyperthyroidism.
 This include thioamides and iodide solutions. These groups of drugs
are not chemically related but they both block the formation of
thyroid hormones within the thyroid gland.

Therapeutic Action

The desired and beneficial action of antithyroid agents:

 Thioamides lower thyroid hormones by preventing the formation of

thyroid hormone in the thyroid cells. They also partially inhibit the
conversion of T4 to T3 at cellular level. Thioamides
include propylthiouracil (PTU) and methimazole.
 Iodine solutions in high doses block thyroid function. They cause
the cells to become oversaturated with iodine and stop producing
hormones.

Indications

Antithyroid agents are indicated for the following medical conditions:

 Treatment of hyperthyroidism
 Thyroid blocking in a radiation emergency

Pharmacokinetics

Here are the characteristic interactions of thioamides and the body in terms
of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

 PO 30-60 min – 2-4 h

T1/2: 6-13 h
Metabolism: –
Excretion: urine

Here are the characteristic interactions of iodine solutions and the body in
terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration

PO 24 h 10-15 d 6 wk

T1/2: unknown
Metabolism: liver
Excretion: urine

Contraindications and Cautions

The following are contraindications and cautions for the use of antithyroid
agents:

 Allergy to any component of the drug. To prevent

hypersensitivity reactions.
 Pregnancy. Development of cretinism. PTU is the drug of choice for
pregnant women.
 Lactation. Risk of antithyroid activity in the infant (neonatal goiter)
 Pulmonary edema or tuberculosis. Contraindicated with strong
iodine products.

Adverse Effects

Use of antithyroid agents may result to these adverse effects:

 Thioamides: drowsiness, lethargy, bradycardia, nausea, skin rash

 PTU: nausea, vomiting, GI complaints, severe liver toxicity
  Methimazole: bone marrow suppression
 Iodine solution: hypothyroidism; metallic taste and burning
sensation in the mouth, sore teeth and gums, diarrhea; staining of
teeth, skin rash, and development of goiter. I131 is only for patients
over 30 years old because of adverse effects associated with
radioactivity.

Interactions

The following are drug-drug interactions involved in the use of antithyroid

agents:

 Thioamides: increased bleeding with oral anticoagulants and PTU

 Iodine solutions: changes in the metabolism and level
of anticoagulants, theophylline, digoxin, metoprolol, and propranolol

Nursing Considerations

Here are important nursing considerations when administering antithyroid

agents:

Nursing Assessment

These are the important things the nurse should include in conducting
assessment, history taking, and examination:

 Assess for contraindications or cautions (e.g. history of allergy,

renal stone, pregnancy, etc.) to avoid adverse effects.
 Assess skin lesions; orientation and affect; liver evaluation;
serum calcium, magnesium, and alkaline phosphate levels; and
radiographs of bones as appropriate, to determine baseline status
before beginning therapy and for any potential adverse effects.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of
this drug for therapy:
  Imbalanced nutrition: more than body requirements related to
metabolic changes
 Risk for injury related to bone marrow suppression

Implementation with Rationale

These are vital nursing interventions done in patients who are taking
antithyroid agents:

 Administer PTU three times a day, around the clock to ensure

consistent therapeutic levels.
 Give iodine solution through a straw to decrease staining of teeth;
tables can be crushed.
 Provide comfort measures to help patient cope with drug effects.
 Provide patient education about drug effects and warning signs to
report to enhance patient knowledge and to promote compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness

of drug therapy:

 Monitor patient response to therapy (lowering of thyroid hormone

levels).
 Monitor for adverse effects (bradycardia, anxiety, blood dyscrasias).
 Evaluate patient understanding on drug therapy by asking patient to
name the drug, its indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.