Clinical pharmacology of thyroid and antithyroid drugs

Radica Stepanović-Petrović; Maja Tomić

doi:10.5937/arhfarm72-40086

Radica Stepanović-Petrović University of Belgrade – Faculty of Pharmacy, Department of Pharmacology
Maja Tomić University of Belgrade – Faculty of Pharmacy, Department of Pharmacology

DOI: https://doi.org/10.5937/arhfarm72-40086

Keywords: Hashimoto's thyroiditis, Graves' disease, levothyroxine, thiamazole, propylthiouracil

Abstract

Autoimmune diseases accompanied by the development of hypothyroidism (Hashimoto's thyroiditis) and hyperthyroidism (Graves' disease) are one of the most common disorders of the thyroid gland. Hypothyroidism is a clinical syndrome that occurs as a result of thyroid hormone deficiency. Hyperthyroidism is excessive activity of the thyroid gland accompanied by hypersecretion of thyroid hormones. In simple terms, to achieve a euthyroid state in both clinical syndromes, two drugs are (most commonly) used - levothyroxine (hypothyroidism) and thioamide (hyperthyroidism). While it may seem simple, during the treatment, which is life-long in the case of hypothyroidism, patients should actually be carefully monitored, with the adjustment of the drug dose and the inclusion of other drugs for the treatment of comorbidities.

References

1. Brent GA, Koenig RJ. Thyroid and antithyroid drugs. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 13th ed. New York: McGraw-Hill Education; 2018; p. 787-801.

2. Brayfield A. Martindale: The complete drug reference. 39th ed. London: Pharmaceutical press; 2017.

3. Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8:457-69.

4. Topliss DJ, Eastman CJ. 5: Diagnosis and management of hyperthyroidism and hypothyroidism. Med J Aust. 2004;180(4):186-93.

5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670-751.

6. Jameson JL, Mandel SJ, Weetman AP. Hypothyroidism. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 2698-703.

7. Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ. 2008;337:a801.

8. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.

9. Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004;351(3):241-9.

10. Preston CL. Stockley’s Drug Interactions, 12th ed. London: Pharmaceutical Press; 2019.

11. Aanderud S, Myking OL, Strandjord RE. The influence of carbamazepine on thyroid hormones and thyroxine binding globulin in hypothyroid patients substituted with thyroxine. Clin Endocrinol (Oxf). 1981;15:247-52.

12. Irving SA, Vadiveloo T, Leese GP. Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS). Clin Endocrinol (Oxf). 2015;82:136-41.

13. Benvenga S, Bartolone L, Pappalardo MA, Russo A, Lapa D, Giorgianni G, et al. Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid. 2008;18:293-301.

14. Liel Y, Sperber AD, Shany S. Nonspecific intestinal adsorption of levothyroxine by aluminum hydroxide. Am J Med. 1994;97:363-5.

15. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26:1343-1421.

16. Jameson JL, Mandel SJ, Weetman AP. Hyperthyroidism. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Companies; 2018; p. 2703-10.

17. Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism. Eur Thyroid J. 2018;7:167-186.

18. Bartalena L, Kahaly GJ, Baldeschi L, Dayan CM, Eckstein A, Marcocci C, et al. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021;185:G43-G67.