Abstract
Functional thyroid disorders (hypothyroidism and hyperthyroidism) are amongst the most common endocrine disorders pharmacists encounter on a daily basis. They are highly prevalent in iodine-replete areas, and affect women about 10 times more often than man. Hypothyroidism (thyroid hormone deficiency) is usually caused by Hashimoto’s thyroiditis, an autoimmune disorder that leads to gradual thyroid destruction. The drug-of-choice for treating hypothyroidism is levothyroxine, a synthetic form of thyroxine. Key points which need to be discussed with patients who are prescribed levothyroxine for the first time are when/how to administer this drug, how its effects are monitored, what drugs may affect its efficacy, and the importance of properly treating hypothyroidism during pregnancy. Hyperthyroidism (increased production of thyroid hormones) is most often caused by Graves’ disease, another thyroid autoimmune disorder in which stimulatory autoantibodies against the TSH receptor lead to increased thyroid function. Graves’ disease is most commonly treated with thionamide drugs (thiamazole, carbimazole or propylthiouracil) and patients using these drugs should be advised on the monitoring requirements, duration of treatment, and how to recognize possible serious adverse effects (agranulocytosis and hepatotoxicity), and informed that these drugs must be used during pregnancy in order to reduce the risk of adverse outcomes for the mother and baby.
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References
1. Vanderpump MPJ. Epidemiology of Thyroid Disorders. In: Luster M, Duntas L, Wartofsky L, editors. The Thyroid and Its Diseases. Cham (Switzerland): Springer; 2019; p. 75-85.
2. Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022;8(1):30.
3. Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, et al. Graves' disease. Nat Rev Dis Primers. 2020;6(1):52.
4. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al.; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-751.
5. Jameson JL, Mandel SJ, Weetman AP. Hypothyroidism. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 2698-703.
6. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-89.
7. Wiesner A, Gajewska D, Paśko P. Levothyroxine Interactions with Food and Dietary Supplements-A Systematic Review. Pharmaceuticals (Basel). 2021;14(3):206.
8. Guzman-Prado Y, Vita R, Samson O. Concomitant Use of Levothyroxine and Proton Pump Inhibitors in Patients with Primary Hypothyroidism: a Systematic Review. J Gen Intern Med. 2021;36(6):1726-33.
9. Electronic Medicines Compendium (eMC) [Internet]. Datapharm Ltd; c2022 [cited 2022 Aug 28]. Available from: https://www.medicines.org.uk/emc/.
10. Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013;2(4):215-28.
11. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390(10101):1550-62.
12. Jameson JL, Mandel SJ, Weetman AP. Hyperthyroidism. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 2703-10.
13. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-421.
14. Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism. Eur Thyroid J. 2018;7(4):167-86.
15. Mooij CF, Cheetham TD, Verburg FA, Eckstein A, Pearce SH, Léger J, van Trotsenburg ASP. 2022 European Thyroid Association Guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022;11(1):e210073.
16. Methimazole and risk of acute pancreatitis [Internet]. European Thyroid Association; c2020 [cited 2022 Aug 28]. Available from: https://www.eurothyroid.com/news/methimazole-risk-of-acute-pancreatitis.html.
17. Bartalena L, Kahaly GJ, Baldeschi L, Dayan CM, Eckstein A, Marcocci C, et al.; EUGOGO. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021;185(4):G43-G67.
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