Medical Pharmacology Chapter 30:  Thyroid and Antithyroid Drugs

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Thyroid Hormones

 

Thyroid Hormone Effects*

Physiological system

Hyperthyroidism (thyrotoxicosis)

Hypothyroidism

Skin, appendages

Warm, moist skin; sweating; fine, thin hair; Plumber's nails; pretibial dermopathy (Graves' disease)

Pale, cool, puffy skin; brittle hair and nails

Eyes, face

Upper lid retraction (wide stare); periorbital edema; exophthalmos, diplopia (Graves' disease)

Eyelid drooping; periorbital edema; puffy, nonpitting facies; large tongue

Cardiovascular

Decreased peripheral resistance, increased cardiac output, stroke volume, heart rate, pulse pressure; congestive heart failure (high-output); increased contractility, arrhythmogenic; angina

Increased peripheral resistance, decreased cardiac output, stroke volume, heart rate, pulse pressure; congestive heart failure (low output); bradycardia (low voltage ECG with prolonged PR interval, flat T wave); pericardial effusion

Respiratory

Dyspnea; reduced vital capacity

Hypoventilation (CO2 retention) pleural effusions

Gastrointestinal

Increased appetite; increased bowel movement frequency; hypoproteinemia

Decreased appetite, decreased bowel movement frequency; ascites

CNS

Nervousness, hyperkinesia, variable emotional states

Lethargy, neuropathy

Musculoskeletal

Weakness; fatigue; hypercalcemia, osteoporosis, increased deep tendon reflex

Muscle fatigue, reduced deep tendon reflex, increased alkaline phosphatase, LDH, AST

Renal

Increased renal blood flow; increased GFR; mild polyuria

Decreased renal blood flow; decreased GFR; reduced water excretion

Hematopoietic

Anemia (increased RBC turnover); increased erythropoiesis

Anemia (decrease production rate, decreased iron absorption, decreased folate acid absorption, autoimmune pernicious anemia),decreased erythropoiesis

Reproductive

decreased fertility; menstrual irregularity; enhanced gonadal steroid metabolism

Infertility;hypermenorrhea, decreased libido; impotence, decreased gonadal steroid metabolism

Metabolic

Increased basal rate; negative nitrogen balance, hyperglycemia; increased free fatty acids, decreased cholesterol and triglycerides; increased hormone degradation; increased requirement for fat-and water-soluble vitamins; enhanced drug detoxification

Decreased basal rate; delayed insulin degradation, with increased sensitivity; enhanced cholesterol and triglyceride levels; decreased hormone degradation; decreased requirements for fat-and water-soluble vitamins; decreased drug detoxification.

 

 * Adapted from Table 38-4, Greenspan, F.S., and Dong, B. J.. Histamine, Thyroid and Antithyroid Drugs, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, p 625.

Greenspan, F.S., and Dong, B. J.. Histamine, Thyroid and Antithyroid Drugs, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 619-633.

Wartofsky, L., Diseases of the Thyroid, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2012-2034

 

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