Thyroid drugs
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Thyroid Drugs: Effects and Clinical Implications
Introduction to Thyroid Drug Interactions
Thyroid function can be significantly influenced by various drugs, both those used to treat thyroid conditions and those prescribed for other medical issues. Understanding these interactions is crucial for effective patient management and treatment outcomes.
Tyrosine Kinase Inhibitors and Thyroid Dysfunction
Tyrosine kinase inhibitors (TKIs), used primarily in cancer treatment, have been increasingly associated with thyroid dysfunction. These drugs can affect thyroid hormone metabolism, leading to conditions such as primary hypothyroidism, especially in patients on thyroid replacement therapy1 9. The clinical impact of these side effects necessitates regular monitoring of thyroid function in patients undergoing TKI therapy.
Immune Modulators and Thyroid Disorders
Immune modulators, used in treating infectious, inflammatory, and neoplastic conditions, can cause both hyperthyroidism and hypothyroidism. The mechanisms behind these effects are not fully understood but may involve immune or non-immune pathways1 9. Clinicians should be vigilant for thyroid dysfunction in patients receiving these treatments.
Anti-Thyroid Drugs: Propylthiouracil vs. Methimazole
Anti-thyroid drugs are essential in managing conditions like Graves' disease. In the United States, propylthiouracil and methimazole are commonly used. Methimazole is often preferred due to its lower toxicity at low doses, cost-effectiveness, and convenience of a single daily dose. However, propylthiouracil is recommended in specific situations such as thyroid storm and during pregnancy or lactation due to its pharmacological properties2.
Adverse Effects of Thyroid Hormone Preparations
Thyroid hormone preparations, particularly thyroxine, are used to treat hypothyroidism and to suppress thyrotropin in certain thyroid cancers. While effective, these treatments can lead to cardiovascular issues and reduced bone density if not carefully monitored. Adjusting dosages based on serum free thyroxine and triiodothyronine levels can minimize these risks3.
Drugs Suppressing TSH and Central Hypothyroidism
Certain medications, including glucocorticoids, dopamine agonists, and somatostatin analogues, can suppress TSH production, potentially leading to central hypothyroidism. While most do not cause clinically significant hypothyroidism, newer drugs like rexinoids can have a more pronounced effect, necessitating careful monitoring4.
Lithium and Iodine-Containing Drugs
Lithium is known to cause hypothyroidism in 5-15% of patients and goiter in up to 37%. Regular thyroid function tests are recommended for patients on lithium therapy. Iodine-containing drugs, such as radiographic contrast media and amiodarone, can also significantly impact thyroid function, sometimes leading to overt thyroid disease5 10.
Conclusion
The interaction between various drugs and thyroid function is complex and clinically significant. From cancer therapies like TKIs to common medications like lithium and iodine-containing drugs, the potential for thyroid dysfunction necessitates careful monitoring and management. Clinicians must stay informed about these interactions to ensure optimal patient care and treatment outcomes.
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Drugs affecting thyroid function.
Thyroidal side effects are increasingly detected with novel drugs used for nonthyroidal conditions, highlighting the need for clinicians to be familiar with thyroid-drug interactions.
Literature Review
Highly CitedWhich anti-thyroid drug?
Methimazole is recommended for routine management of Graves' disease due to its single daily dose, cheaper cost, and less major toxicity compared to propylthiouracil.
Adverse Effects of Thyroid Hormone Preparations and Antithyroid Drugs
Thyroid hormone preparations and antithyroid drugs can cause minor to major adverse effects, but most are minor and transient.
Highly CitedDrugs that suppress TSH or cause central hypothyroidism.
Drugs like glucocorticoids, dopamine agonists, and somatostatin analogues can suppress thyroid hormone levels, but most do not cause central hypothyroidism.
Highly CitedDrug-Induced Thyroid Disorders
Lithium therapy can cause overt hypothyroidism in 5 to 15% of patients, and goitre in up to 37%, while iodine-containing drugs can have profound and variable effects on thyroid function.
Drugs and thyroid function.
Drug interactions can affect thyroid function and treatment effectiveness, requiring careful consideration in patient care decisions.
Highly CitedTargeted Therapy for Advanced Thyroid Cancer: Kinase Inhibitors and Beyond.
Advanced thyroid cancer treatment has advanced rapidly in recent years, with kinase inhibitors and mutation-specific drugs being approved, and other drugs, immunotherapies, and novel strategies under investigation.
Highly CitedInfluence of drugs on thyroid function in dogs.
Drugs like glucocorticoids, propranolol, sulfonamides, phenobarbital, potassium bromide, and NSAIDs can affect canine thyroid function, potentially leading to overdiagnosis of hypothyroidism in dogs.
Highly CitedTyrosine kinase inhibitors and immune checkpoint inhibitors-induced thyroid disorders.
TKI and ICPIs can cause thyroid dysfunction, which can be detected and managed through monitoring TSH and free T4, depending on the clinical impact and biological abnormalities.
Literature Review