Introduction to serious morbidity and, therefore, proper management

Introduction

The thyroid gland is anatomically located
in the anterior aspect of the neck with the main secretions being T3 and T4
hormones. These hormones act as metabolic regulators in the body. The functions
of this gland are regulated by the pituitary in the brain and it is via a
negative and positive feedback mechanism that involves the hormone thyroid
stimulating hormone (Brent,
2012).  This makes the thyroid an important organ in
the body whose dysfunction can lead to serious morbidity and, therefore, proper
management is paramount.

Background

According to Ross et al., (2016), diseases
that affect the thyroid are classified as either primary (the pathology is
intrinsic to the gland) or secondary (pathology is extrinsic to the gland;
commonly in the pituitary gland). Diseases symptoms can range from debilitating
to sub-clinical to asymptomatic and each can result in either an increase in
the serum levels of thyroid hormones (Hyperthyroidism) or decrease in levels of
thyroid hormones (Hypothyroidism).  Both
these disease states have differing symptoms like unintended weight loss, heavy
sweating, intolerance to heat and problems with the eyes among others in the
case of hyperthyroidism, while hypothyroidism manifest as unintended gain of
weight, intolerance to cold and myxedema etc. Examples of pathologies that
affect  the thyroid gland include grave’s
disease, thyroiditis, tumors, auto-immune conditions like hashimoto’s
thyroiditis according to, iodine deficiencies etc. (Stathatos & Daniels, 2012).

Drugs
used in Treatment of Symptoms

As stipulated by Jonklaas et al. (2014),
the treatment of thyroid diseases is dependent on the specific etiology and the
clinical signs apparent on the patient and range from surgical, medical and
conservative in sub-clinical cases. Drugs used when managing Hyperthyroidism
include anti-thyroid drugs such as Carbimazole, propylthiouracil and
methimazole which are started at high doses. These can help achieve euthyroid
states within 14 days of use. Beta-blockers for example propranolol are also
used to control the hyper-metabolic symptoms. Other drug options include oral
radioactive iodide that is absorbed by the thyroid gland and results in
down-regulation of thyroid hormone synthesis. Hypothyroidism that due is to
iodine deficiency is managed by giving iodine supplements in food products or
tablets. The T4 analogue, levothyroxine is used to raise levels of serum thyroid
hormone to within normal ranges in hypothyroid states.

Other causes of thyroid dysfunction are
immune mediated pathologies like hashimoto’s while others are due to infections
that cause inflammation of the thyroid gland like in thyroiditis. These can be
treated with non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids
like prednisolone to reduce thyroid inflammation.

Effects
of age on thyroid Medications

The pharmacodynamics and pharmacokinetics
of drugs are affected by patients’ ages and therefore, in the extreme ends of
the age-groups, differences in the elimination rates, drug metabolism, and compositions
of body might affect the bioavailability, duration of action, the route and
methods of administration and even drug dosing which also affects the actions
of drugs in those groups. The drugs that are majorly eliminated via the kidneys
thus remain in the body for longer in case the renal system’s clearing function
is impaired such as in the elderly. This results is an enhancement in the
magnitudes of side effects and prolongation of their durations of action. Additionaly,
the elderly have reduced body water and as such, some drugs might be
administered differently, which will directly or indirectly impact on
bioavailability.

Reducing
Side Effects of Drugs

As with any other drug, drugs used in
the treatment of thyroid disease also do have side-effects. Corticosteroids used
in the management of autoimmune thyroid disease can have multiple side effects
on almost all systems in the body including but not limited to osteoporosis,
hypertension, gastrointestinal symptoms and increased susceptibility to
infections (Pandya,
Puttanna, & Balagopal, 2014). The commonest
side-effects of the anti-thyroid drugs is a rash that resolves as soon as the drug
is withdrawn. Propylthiouracil drug has a small risk for hepatotoxicity and as
such, liver function tests are indicated to ensure it is not damaged.
Methimazole can cause aplastic anemia and thrombocytopenia; reducing this
effect involves doing full blood counts to identify problems with the marrow as
soon as possible. Other side effects of thyroid drugs like headaches and gastrointestinal
system upsets can be managed by educating the patients on the expected effects
and advising them to visit a hospital if the side effects persist or become
worse..

Conclusively, it is important to educate
the patient on the possible side effects of the drugs given and advise them to
seek immediate medical help in case of any unusual symptoms. Thyroid diseases are
chronic and require mutual cooperation involving the health care provider and
patient if proper and adequate remission is to be achieved..

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