This document contain summery of treatment options hyperthyroidism and hypothyroidism.Document contain tables ,mind maps so it is easier to revise again and again.I think they will come useful in exam since I have marked important MCQ points in green colour
I
Carbimazole Propylthiouracil iodine
Mechanism Its a prodrug Its not a prodrug Inhibits release of stored Blunt Hypersensitivity of tissues Absorbed into thyroid gland
of action thyroxine to catecholamines and RAI-131 leads to the
Competitive Inhibitors of the I Competitive Inhibitors of
destruction of thyroid
thyroid peroxidase enzyme the thyroid peroxidase Reduces vascularity of the
follicular cells
(TPO) enzyme (TPO) gland – useful in surgery
decreases serum T3 by inhibition
Reduce peripheral conversion of of peripheral conversion of T4 to
T4 → T3 T3
Does not affect existing Does not affect existing
hormones in circulation hormones in circulation
Indications Graves’ disease-18-24 Uses to treat hyperthyroidism • Thyroid storm Initial symptomatic control as • Preferred therapy in most
months(not lifelong) in pregnant women during (Thyrotoxic crisis) adjunct to anti-thyroid drugs, patients with high-risk
1st trimester one to use • Onset of action quick comorbidities ; at high risk for
toxic multinodular goiter / placental crossing and (within 24 hours) surgery and need definitive
toxic nodules(until patient teratogenicity is rare compared Sole treatment in subacute management
become euthyroid ,then proceed to carbimazole/methimazole thyroiditis
for surgery Adjunct to anti-thyroid • Patients with
drugs prior to surgery contraindications for the use of
thionamides
To alleviate symptoms of Thyroid storm
hyperthyroidism
• Toxic MNG
Make a patient euthyroid in
preparation for • Grave’s disease: specially
Thyroid storm (Thyrotoxic crisis) relapsed disease
thyroidectomy (surgery) or
radioactive iodine therapy
• onset of action quicker than with
carbimazole
Thyrotoxicosis / thyroid storm
Contraindica- Past history of major adverse effects If beta blockers are
tions contraindicated Pregnancy
Baseline absolute neutrophil count <500/mm3
• non-dihydropyridine CCB eg. Females planning a pregnancy <
Hypersensitivity to drug diltiazem, verapamil 6/12
Breast feeding
Children
-
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