IntroductionThe thyroid gland is located anteriorly inthe neck with the main secretions being T3 and T4 hormones which act as metabolicregulators in the body. Its functions are regulated by the pituitary gland foundwithin the brain and it is via a negative and positive feedback mechanism. The hormone that takes part in thisregulation is thyroid stimulating hormone (Brent, 2012). This makes it an important organ in the body whose dysfunction can leadto serious morbidity and, therefore, proper management 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 manifest with differing signs and symptoms such as weightloss, too much sweating, intolerance to heat and problems with the eyes amongothers for hyperthyroidism, while hypothyroidism manifest as unintended gain ofweight, intolerance to cold and myxedema among others. Examples of pathologiesthat affect the thyroid gland includegrave’s disease, thyroiditis, tumors, auto-immune conditions like hashimoto’sthyroiditis according to, iodine deficiencies etc. (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 in the treatment and management ofHyperthyroidism include anti-thyroid drugs such as Carbimazole, methimazole,propylthiouracil which are started at high doses. These can help achieveeuthyroid states within 14 days of use.
Beta-blockers like 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 either in food or intablets. The drug levothyroxine is also used to bring down levels of serum thyroidhormone to baseline. Other causes of thyroid dysfunction areimmune related like hashimoto’s while others are due to infections that causeinflammation of the thyroid gland such as thyroiditis. These can be treatedwith non-steroidal anti-inflammatory drugs (NSAIDs), levothyroxine andcorticosteroid prednisolone to reduce thyroid inflammation. Effectsof age on thyroid MedicationsThe pharmacodynamics and pharmacokineticsof drugs are affected by patients’ ages and as such, in the extreme age-groups,differences in the elimination rates, drug metabolism, and compositions of bodymight affect the bioavailability, duration of action, the route and methods ofadministration and even the dosage of drugs which alternatively affects the workingsof drugs in those groups.
The drugs that are majorly eliminated via the kidneysend up remaining in the body for longer if the renal system is impaired in anyway such as in the elderly population. The result is an enhancement in themagnitudes of side effects and prolongation of their durations of action. Inaddition, 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 usedfor management of autoimmune thyroid disease can have many side effects onalmost all systems in the body including but not limited to osteoporosis,hypertension, gastrointestinal symptoms and increased susceptibility toinfections (Pandya,Puttanna, & Balagopal, 2014).
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The commonestside-effects of the anti-thyroid drugs is a rash that subsides as soon as the drugis withdrawn. Propylthiouracil also hasa small risk for hepatotoxicity and as such, liver function tests are necessaryto ensure it is not damaged. Methimazole can cause aplastic anemia andthrombocytopenia; reducing this effect involves doing full blood counts toidentify problems with the marrow as soon as possible. Other side effects ofthyroid drugs like headaches and upset of the gastrointestinal system can bemanaged by educating the patients on the expected effects and advising them tovisit a hospital if the side effects persist or become worse.
.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 cooperation between the health care provider and thepatient if proper and adequate remission is to be expected.
