Introduction to serious morbidity and, therefore, proper management

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Last updated: April 18, 2019

IntroductionThe thyroid gland is anatomically locatedin the anterior aspect of the neck with the main secretions being T3 and T4hormones. These hormones act as metabolic regulators in the body.

The functionsof this gland are regulated by the pituitary in the brain and it is via anegative and positive feedback mechanism that involves the hormone thyroidstimulating hormone (Brent,2012).  This makes the thyroid an important organ inthe body whose dysfunction can lead to serious morbidity and, therefore, propermanagement is paramount.BackgroundAccording to Ross et al., (2016), diseasesthat affect the thyroid are classified as either primary (the pathology isintrinsic to the gland) or secondary (pathology is extrinsic to the gland;commonly in the pituitary gland). Diseases symptoms can range from debilitatingto sub-clinical to asymptomatic and each can result in either an increase inthe serum levels of thyroid hormones (Hyperthyroidism) or decrease in levels ofthyroid hormones (Hypothyroidism).  Boththese disease states have differing symptoms like unintended weight loss, heavysweating, intolerance to heat and problems with the eyes among others in thecase of hyperthyroidism, while hypothyroidism manifest as unintended gain ofweight, intolerance to cold and myxedema etc. Examples of pathologies thataffect  the thyroid gland include grave’sdisease, thyroiditis, tumors, auto-immune conditions like hashimoto’sthyroiditis according to, iodine deficiencies etc.

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(Stathatos & Daniels, 2012).Drugsused in Treatment of SymptomsAs stipulated by Jonklaas et al. (2014),the treatment of thyroid diseases is dependent on the specific etiology and theclinical signs apparent on the patient and range from surgical, medical andconservative in sub-clinical cases. Drugs used when managing Hyperthyroidisminclude anti-thyroid drugs such as Carbimazole, propylthiouracil andmethimazole which are started at high doses. These can help achieve euthyroidstates within 14 days of use. Beta-blockers for example propranolol are alsoused to control the hyper-metabolic symptoms. Other drug options include oralradioactive iodide that is absorbed by the thyroid gland and results indown-regulation of thyroid hormone synthesis.

Hypothyroidism that due is toiodine deficiency is managed by giving iodine supplements in food products ortablets. The T4 analogue, levothyroxine is used to raise levels of serum thyroidhormone to within normal ranges in hypothyroid states. Other causes of thyroid dysfunction areimmune mediated pathologies like hashimoto’s while others are due to infectionsthat cause inflammation of the thyroid gland like in thyroiditis.

These can betreated with non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroidslike prednisolone to reduce thyroid inflammation. Effectsof age on thyroid MedicationsThe pharmacodynamics and pharmacokineticsof drugs are affected by patients’ ages and therefore, in the extreme ends ofthe age-groups, differences in the elimination rates, drug metabolism, and compositionsof body might affect the bioavailability, duration of action, the route andmethods of administration and even drug dosing which also affects the actionsof drugs in those groups. The drugs that are majorly eliminated via the kidneysthus remain in the body for longer in case the renal system’s clearing functionis impaired such as in the elderly.

This results is an enhancement in themagnitudes of side effects and prolongation of their durations of action. Additionaly,the elderly have reduced body water and as such, some drugs might beadministered differently, which will directly or indirectly impact onbioavailability.ReducingSide Effects of DrugsAs with any other drug, drugs used inthe treatment of thyroid disease also do have side-effects. Corticosteroids usedin the management of autoimmune thyroid disease can have multiple side effectson almost all systems in the body including but not limited to osteoporosis,hypertension, gastrointestinal symptoms and increased susceptibility toinfections (Pandya,Puttanna, & Balagopal, 2014). The commonestside-effects of the anti-thyroid drugs is a rash that resolves as soon as the drugis withdrawn. Propylthiouracil drug has a small risk for hepatotoxicity and assuch, liver function tests are indicated to ensure it is not damaged.

Methimazole can cause aplastic anemia and thrombocytopenia; reducing thiseffect involves doing full blood counts to identify problems with the marrow assoon as possible. Other side effects of thyroid drugs like headaches and gastrointestinalsystem upsets can be managed by educating the patients on the expected effectsand advising them to visit a hospital if the side effects persist or becomeworse..Conclusively, it is important to educatethe patient on the possible side effects of the drugs given and advise them toseek immediate medical help in case of any unusual symptoms.

Thyroid diseases arechronic and require mutual cooperation involving the health care provider andpatient if proper and adequate remission is to be achieved..

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