Description of Thyroid, Parathyroid

Session 33: Description of Thyroid, Parathyroid

Hormones and Their Antagonists

Total Session Time: 120 minutes

Prerequisites

Learning Tasks

By the end of this session students are expected to be able to:

antagonists

Resources Needed:

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning Tasks

Presentation/ Indications of Thyroid and Parathyroid

2 10 minutes

Buzzing Hormones and Antagonists

Presentation/ Contraindications of Thyroid and Parathyroid

3 10 minutes

Brainstorming Hormones and Antagonists

Dose, Dosage and Course of Thyroid and

4 20 minutes Presentation

Parathyroid Hormones and Antagonists

Presentation/ Side Effects and Adverse Effects of Thyroid

5 20 minutes

Brainstorming and Parathyroid Hormones and Antagonists

Interactions and Precautions of Thyroid and

6 35 minutes Presentation

Parathyroid Hormones and Antagonists

7 10 minutes Presentation Key Points

8 10 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Thyroid, Parathyroid Hormones and their Antagonists (10

minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

o Hyperthyroidism

o Hyperthyroidism (thyrotoxicosis)

o Hypothyroidism (decreased production or secretion of thyroid hormone)

STEP 3: Contraindications of Thyroid, Parathyroid Hormones and their

Antagonists (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

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o Thyrotoxicosis

o Severe blood disorders

o Potassium iodide is contraindicated in patients with hypersensitivity to iodine

o Potassium iodide should be avoided in patients with hyperthyroidism Hyperkalaemia,

and acute bronchitis also during pregnancy (category D) and lactation

STEP 4: Dose, Dosage and Course of Thyroid and Parathyroid Hormones

and Antagonists (20 minutes)

o Available as Levothyroxine Tablets (sodium salt) 0.05g

o To maintain normal TSH levels

o Hypothyroidism after treatment of grave disease

 Levothyroxine 75µg to 125µg/day

o Available as carbimazole tablets 5mg

 Carbimazole 40mg (O) once daily for 3 weeks then 20mg daily for 3 weeks

 Maintenance dose 5mg for up to one year

o Available as Iodine (Lugol's solution) Solution containing 5 percent iodine and 10

percent potassium iodide

o Three (3) drops (21mg) once each month for up to one year

STEP 5: Side Effects and Adverse Effects of Thyroid, Parathyroid

Hormones and their Antagonists (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

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o Side-effects

 Nausea, mild gastro-intestinal disturbances, taste disturbance, headache, fever,

malaise, rash, pruritus, arthralgia; rarely myopathy, alopecia, bone marrow

suppression (including pancytopenia and agranulocytosis

o Side-effects usually at excessive dosage

 Diarrhoea, vomiting, anginal pain, arrhythmias, palpitation, tachycardia, tremor,

restlessness, excitability, insomnia; headache, flushing, sweating, fever, heat

intolerance, weight-loss, muscle cramp, and muscular weakness and transient hair

loss in children

o Hypersensitivity reactions

 Rash, pruritus and oedema

o Side-effects

 Headache, lacrimation, conjunctivitis, pain in salivary glands, laryngitis,

bronchitis, rashes; on prolonged treatment depression, insomnia, impotence; goitre

in infants of mothers taking iodides

STEP 6: Interactions and Precautions of Thyroid, Parathyroid Hormones

and their Antagonists (35 minutes)

o Precaution

 Potassium iodide should be used cautiously in patients with renal impairment,

cardiac disease, pulmonary tuberculosis, and Addison‘s disease

 Iodine and iodide should be used with cautions in children

 Can cause neonatal goitre and hypothyroidism in pregnancy

 Iodine and iodide appears to be concentrated in milk thus stop breast-feeding due

to danger of neonatal hypothyroidism or goitre

o Drug Interactions

 Lugol‘s solution can increase the risk of hypothyroidism if taken concurrently with

lithium

 Potassium-sparing diuretics, potassium supplements, and ACE inhibitors increase

the risk of hyperkalemia

o Precaution

 Caution in Panhypopituitarism or predisposition to adrenal insufficiency

(corticosteroid therapy should be initiated before starting levothyroxine)

 Care in elderly, cardiovascular disorders (including hypertension, myocardial

insufficiency or myocardial infarction), Long-standing hypothyroidism and

diabetes insipidus

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 In patients with diabetes mellitus the dose of antidiabetic drugs including insulin

may need to be increased

 In pregnancy maternal serum-thyrotropin concentration should be monitored

because levothyroxine may cross the placenta and excessive maternal

concentration can be detrimental to fetus

o Interaction

 Absorption of levothyroxine is reduced by antacids, calcium salts, oral iron,

lanthanum, polystyrene sulfonate resins, colestipol, cholestyramine, cimetidine

and sucralfate

 Metabolism of levothyroxine is increases by rifampicin, carbamazepine,

phenobarbital, phenytoin, propranolol

 Amiodarone may increase thyroxine level

 Anticoagulant effect of coumarins is enhanced by thyroid hormones

 Thyroid hormones enhance effects of tricyclics (enhance effects of amitriptyline

and imipramine)

 Requirements for thyroid hormones in hypothyroidism may be increased by

oestrogens

o Precaution

 Higher doses should be prescribed under specialist supervision only

 Treatment in children should be undertaken by a specialist

 All patients should be advised to report any sore throat immediately because of

the rare complication of agranulocytosis

 Use with caution in mild to moderate hepatic impairment; avoid in severe

impairment

 Danger of neonatal goitre and hypothyroidism in pregnancy

 May affect neonatal thyroid function during breastfeeding therefore lowest

effective dose should be used

STEP 7: Key Points (10 minutes)

o Indicated for hyperthyroidism.

o Contraindicated in Severe blood disorders

o Caution for its use during pregnancy as may cause neonatal goitre and

hypothyroidism and during breastfeeding as may affect neonatal thyroid function.

o Indicated for hyperthyroidism (thyrotoxicosis)

o Contraindicated in patients with hypersensitivity to iodine and should be avoided in

patients with hyperthyroidism, hyperkalemia, acute bronchitis, pregnancy and

lactation

o Caution in pregnancy as it may cause neonatal goitre and hypothyroidism in

pregnancy and in breastfeeding as it appears to be concentrated in milk due to danger

of neonatal hypothyroidism or goiter

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o Interacts with lithium and can increase the risk of hypothyroidism if taken

concurrently

o Risk of hyperkalaemia when given with potassium-sparing diuretics, potassium

supplements, and ACE inhibitors

o Indicated for hypothyroidism

o Contraindicated in thyrotoxicosis

STEP 8: Evaluation (10 minutes)

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References

Ministry of Health and Social Welfare. ( 2013). Standard Treatment Guidelines & National

Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania

government printers.

Pharmacotherapy: A pathophysiologic approach (9th ed.). New York, McGraw-Hill

Education.

Sally S.R., Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,

Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The Extra

Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

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