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14 common thyroid disease medications, one article to clarify!

 Last Update: 2022-11-05
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Thyroid disease medication is macrototal

hypothyroidism

Hypothyroidism (hypothyroidism) is a syndrome
of systemic hypometabolism caused by decreased synthesis and secretion of thyroid hormones or underutilization of tissues.

Drug treatment of hypothyroidism: levothyroxine sodium tablets (L-T₄), thyroid tablets [containing three Iodothyronine (T₃), clinically not commonly used].

The dose of levothyroxine sodium tablets depends on the age and body weight of the patient and follows the principle
of individualization.

patient	Levothyroxine sodium tablet dose
child	2. 0-4. 0μg/kg/day
adult	1. 6-1. 8μg/kg/day
old age	1. 0μg/kg/day
pregnancy	30%-50% increase
After thyroid cancer surgery	2. 2μg/kg/day
Directions: Take the medicine once a day in the morning

Monitoring time: review every 4-6 weeks at the beginning of treatment; Review every 6-12 months after compliance
.
Goal of treatment: clinical signs and symptoms of hypothyroidism disappear, and the pituitary gland of the brain secretes thyroid-stimulating hormone (TSH) and serum total thyroxine (TT_4).Free thyroxine (FT₄) values are maintained within the normal range
.

Note: For central hypothyroidism, TSH cannot be used as a monitoring indicator, and serumT 4 and FT₄ should be used as monitoring targets
.
Central hypothyroidism should control FT₄ at the upper limit
of normal.
Remember! Before hypothyroidism, especially central hypothyroidism, adrenal insufficiency must be excluded, otherwise adrenal crisis may be induced, which is life-threatening
.
If the patient's condition worsens with L-T₄, it often indicates the possibility
of adrenal insufficiency.
Precautions for taking medication for hypothyroidism:
1.
Age < 50 years old, no heart disease patients can reach the complete replacement dose as soon as possible; Age> 50 years, routine check of heart status
before replacement.

L-T4 generally starts at 25-50 μg/day and increases by 25 μg every 1-2 weeks until therapeutic goals
are reached.

The initial dose for heart disease should be small, and the dose should be adjusted slowly to prevent inducing and aggravating heart disease
.

2.
The half-life of tetraiodothyronine (T₄) is as long as 7 days, so it can be taken once a day, usually on
an empty stomach in the morning.

Some patients have palpitations and other reactions to take the drug, which can be taken
in the morning on an empty stomach and before going to bed.

Certain drugs such as iron and calcium affect L-T 4 absorption and should be taken
₄ hours apart.

3.
Drugs that accelerate L-T₄ clearance: phenobarbital, phenytoin, carbamazepine, rifampicin, isoniazid, lovastatin, amiodarone, sertraline, chloroquine, etc
.

4.
Drugs that inhibit TSH secretion: besarotene, metformin, somatostatin such as octreotide, dopamine/bromocriptine, glucocorticoids, tretinoin (can cause clinically significant central hypothyroidism).

Subclinical hypothyroidism
hormone replacement therapy: TSH> 10mIU/L, L-T₄ replacement therapy is
。 The goals and approach of treatment are consistent
with clinical hypothyroidism.
TSH is between 4 and 10 mIU/L, L-T₄ therapy is not advocated, and changes in
TSH are monitored regularly.
Patients with TSH 4 to 10 mIU/L and positive thyroid peroxidase antibody (TPOAb) should be closely monitored for changes in TSH (these patients are prone to clinical hypothyroidism).

。 Treatment of hypothyroidism in pregnancy: L-T₄ is the preferred alternative therapy
.
Hypothyroidism was diagnosed before pregnancy, the dose of L-T₄ was adjusted, and TSH was normal and then pregnant
.
Diagnosis of hypothyroidism during pregnancy and immediate treatment,_L-T4 dose is increased by 30% to 50%
compared with non-pregnancy.
Adjust the L-T₄ dose
according to the pregnancy-specific normal range of TSH.
(ATA guidelines recommend TSH indicators of 0.
1 to 2.
5 mIU/L for 1-3 months; 4-6 months at 0.
2-3.
0 mIU/L; 7-9 months in 0.
3-3.
0 mIU/L
。
Monitoring of thyroid work: If the dose of L-T 4 is adjusted, TSH, T 4/F T 4 are measured every_2-4 weeks ； The sooner the target is reached, the better (preferably within 8 weeks of gestation); After TSH is met, it is monitored every 6-8 weeks
.
Note: For hypothyroidism during pregnancy and lactation, proper iodine supplementation is important for fetal and pediatric thyroid glands
.
The amount of iodine supplementation is generally 250 μg/day, but not more than twice that is, 500 μg/day
.
The ideal range of urinary iodine is 150-250 μg/L
.
Neonatal hypothyroidism
is currently considered to be the most reliable screening method for measuring heel blood TSH, and specimens should be collected within 3 to 5 days
postpartum.
The criterion for suspected cases is TSH 20 to 25 mU/L, and serum thyroid hormone levels
are further measured in suspected cases.
TSH> 10 mU/L and tt 4<65 μg/dl at 1 to₄ weeks of neonates often indicate hypothyroidism
.
Treatment principles: early diagnosis, adequate treatment
.
Dose selection:
In order to ensure the accuracy of treatment, FT 4 is measured after the target is reached, so that FT₄ is maintained in the upper 1/3 range
of the normal value.

Alternative treatment of primary hypothyroidism
L-T₄:
(1) the target value of TSH was set at 0.
2-2.
0 mIU/L; (2) Appropriate increase for the elderly, recommended to be 0.
5-3.
0 mIU/L; (3) pregnant women< 2.
5 mIU/L; (4) Avoid TSH<0.
1 mIU/L, otherwise increase the risk of osteoporosis and heart disease; (5) If the normal value of TSH is 0.
4-4.
0 mIU/L
.
The American Thyroid Association (ATA) recommends TSH control of 1.
0 to 2.
0 mIU/L
for all primary hypothyroidism.

If you clinically encounter an increase in the patient's T₃ and T₄ levels, but the TSH level is normal or increased, you must think of the possibility
of thyroid hormone resistance syndrome.
Treatment: (1) L-T₃, feedback inhibits TSH secretion; (2) L-T₄ treatment is ineffective; (3) Triiodothyroacetic acid, no obvious increase in metabolism, can feedback inhibit TSH secretion; (4) bromocriptine; (5) Prohibit the treatment of hyperthyroidism such as drugs, surgery, iodine 131, etc
.

hyperthyroidism

Hyperthyroidism (hyperthyroidism) is a clinical syndrome
of increased thyroid function and excessive thyroxine production due to a variety of causes.

Toxic diffuse goiter (Graves' disease) is most common
.
General treatment: pay attention to rest; adequate calorie and nutrition, sugar, protein and B vitamins; People with heavier insomnia can be given sedative sleeping agents; Patients with pronounced palpitations are given β receptor blockers
.
Main treatment: (1) drug treatment: suitable for mild and moderate patients; (2) Surgical treatment: suitable for moderate and severe patients; (3) Iodine 131 treatment: suitable for patients with
drug failure or postoperative.
Drugs for hyperthyroidism:

Antithyroid drugs need to be treated regularly for more than 1.
5-2 years, remember! Take medication regularly and communicate
with your doctor in time.
What are the side effects of anti-hyperthyroid drugs?
1.
Common side effects: granulocytopenia (generally do not need to stop the drug, reduce anti-thyroid drugs, add general leukocyte drugs), rash (With the use of antihistamines, severe rash should be discontinued).

2.
Serious side effects: agranulocytosis - life-threatening
.
(usually occurs within 2-3 months of the initial high-dose therapy; Within 1 month of re-administration; Prevention: In the early stages of treatment, leukocytes should be checked once a week, if the leukocytes are less than 2.
5×10 9/L, neutrophils are less than 1.
5 ×10⁹/L) Discontinuation should be considered; Inform the patient that if there are symptoms such as sore throat, fever, and general malaise, he should go to the hospital for examination
as soon as possible.

3.
Liver damage: low incidence (0.
1%-0.
2%) tapazole (MMI) mainly causes cholestasis, propylthiouracil (PTU) hepatocellular damage; Mild cases can be recovered after stopping the drug, and severe cases can cause liver necrosis
.

4.
Vasculitis: mainly caused by PTU, MMI can also be caused, more common in young and middle-aged women
.
Precautions for anti-drug treatment:

1.
Before treatment, it should be checked: blood cell level, liver function, etc
.
During treatment, regular follow-up and re-examination of thyroid function should be paid attention to whether there is inflammation of the oral mucosa and pharynx, such as sore throat, fever, and furuncle formation, such drugs
should be stopped immediately.
Check your blood routine regularly (pay attention to the neutrophil count).

2.
Patients with hyperthyroidism should be prohibited from spicy food, seafood, strong tea, coffee, tobacco and alcohol during medication; Keep your mind calm and prevent exertion
.

3.
Thyroid preparations can be used for hypothyroidism during antithyroid drug treatment; Thyroid preparations are also suitable for relieving symptoms of hyperthyroidism but the thyroid gland is enlarged or the exophthalmos is aggravated, usually starting
with a small dose.

4.
Indications for drug withdrawal: regular treatment of antithyroid drugs for more than 2 years, and decide whether to stop the drug after evaluation by a doctor: significantly shrinking of the thyroid gland and TSAb ( Thyroid stimulating antibodies) negative, the recurrence rate after stopping the drug is low; If the thyroid gland is still large or TSAb positive at the time of discontinuation, the recurrence rate is high after stopping the drug, and treatment should be extended for such patients
.

Follow-up frequency after drug withdrawal: The recurrence rate is the highest in the first year after stopping the drug, so the first year of follow-up is recommended: reexamination in the first month and 3 months after stopping the drug, and every three months thereafter
.
If symptoms of hyperthyroidism recur, see a doctor at any time; Half-yearly review in the 2nd to 3rd year; Review annually after
3 years.

If the TSH is low and the thyrotropin receptor antibody (TRAb) is positive during lactation, antithyroid drug (ATD) therapy
is recommended.
Appropriate iodine supplementation is required for children's needs, 250 μg
per day.
Patients with hyperthyroidism can breastfeed after childbirth:
(1) PTU is preferred because of the short half-life and low milk concentration; (2) Methionazole can be selected; (3) Antithyroid drugs should be taken immediately after breastfeeding, 4 hours before the next breastfeeding time; (4) Take in divided doses to reduce the concentration
of the drug in the milk.
Hyperthyroid crisis rescue
1, inhibition of thyroid hormone synthesis: PTU is preferred, the first dose of 600mg, the second 200mg tid oral, after the symptoms are reduced, change to the general treatment dose
.

2.
Inhibit the release of thyroid hormone: add compound iodine solution or sodium
iodide 1-2 hours after taking PTU.

3.
Inhibit the conversion of tissue T 4 to T 3 and inhibit the binding of T₃ to cell receptors (PTU, iodine, β blockers, glucocorticoids), propranolol hydrochloride 30mg q6h orally, hydrogen test 100mg q6-8h added to the liquid intravenous drip
.

4.
Reduce blood thyroxine concentration: hemodialysis
if necessary.

5.
Supportive treatment and symptomatic treatment
.

Treatment of thyroid nodules: basic treatment measures include follow-up observation, surgery, alcohol interventional therapy, radioactive iodine therapy, laser coagulation therapy, radiofrequency ablation therapy, and thyroid hormone suppression therapy
.
TSH suppressive therapy: routine use of TSH suppression for benign thyroid nodules is not recommended; May be considered in young patients with micronodular goiter; If used, the target is TSH partial inhibition
.
Side effects: Long-term inhibition of TSH can lead to subclinical hyperthyroidism, cardiovascular adverse reactions and a decrease
in bone mineral density in postmenopausal women.
Benign nodules of the thyroid gland, regular follow-up
.
Review ultrasound every 3-6 months for the first year; If there is no change in the nodule, repeat every 6-12 months starting the following year
.
If symptoms of local compression appear, such as airway or digestive tract compression, nodule growth is too rapid, and ultrasound may be malignant, surgery is
recommended.
Postoperative treatment: (1) Total thyroidectomy: L-T₄ supplementation immediately after surgery, and regular follow-up thyroid function
.
(2) Partial thyroid resection: follow-up thyroid function, supplementation of L-T₄
when hypothyroidism is found.
(3) Parathyroid injury: calcium supplementation and vitamin D
.

Treatment of subacute thyroiditis: mild cases, non-steroidal anti-inflammatory drugs, course of treatment for 2 weeks
.
In severe cases, glucocorticoids, initial prednisone 20-40 mg / day, maintained for 1-2 weeks, slowly reduce the dose, the total course of treatment is not less than 6-8 weeks
.
Reducing the dose too quickly and stopping the drug too early will cause the disease to recur.

Treatment of painless thyroiditis: avoid antithyroid drugs and radioactive iodine therapy
.
β-blockers or sedatives relieve clinical symptoms
in most patients.
Although glucocorticoids can shorten the course of thyrotoxicosis, they cannot prevent the occurrence of hypothyroidism and are generally not recommended
.

Postpartum thyroiditis

Treatment: self-limited course
in most cases.
Antithyroid drug intervention is generally not required during hyperthyroidism, and symptomatic treatments
such as β blockers can be given to patients with severe hyperthyroidism.
Hypothyroid serum TSH< 10 mIU/L does not require thyroid hormone replacement therapy and can recover
spontaneously.
Once persistent hypothyroidism occurs, it should be treated promptly or, if another pregnancy is planned, treated as hypothyroidism of pregnancy
.

Thyroid adenoma

Treatment: mainly
surgery.

Thyroid cancer treatment: surgical and non-surgical treatment
.

Non-surgical treatments include:

(1) radiation therapy;

(2) Endocrine therapy: All patients with thyroid cancer undergoing total thyroidectomy should take thyroxine for life to prevent hypothyroidism and inhibit TSH increase
.

TSH inhibition is an important adjunctive measure
to reduce the recurrence rate of differentiated thyroid cancer.

It is recommended not only for patients after bilateral thyroidectomy, but also for patients after partial resection, and is also a treatment modality
for metastatic disease.

Patients receiving long-term TSH suppression therapy should take calcium and vitamin D
.

Monitoring L-T₄ suppressive therapy for differentiated thyroid cancer: target TSH, 0.
1-0.
5 mIU/L in low-risk patients; High-risk patients < 0.
1 mIU/L
.

(3) Chemotherapy treatment: chemotherapy is not ideal for the treatment of thyroid cancer, only as palliative care or other means of ineffective treatment after trying treatment
.

Common chemotherapy drugs are mitomycin, cyclophosphamide, 5-fluorouracil, and doxorubicin
.

Source of this articleResponsible editor of Thyroid Lecture HallTangerine

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