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Thyroid Drugs2[1]

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Information about Thyroid Drugs2[1]

Published on November 15, 2007

Author: girlie

Source: slideshare.net

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Thyroid Drugs

FUNCTIONS OF THE ENDOCRINE SYSTEM Maintenance and regulation of vital functions Response to stress and injury Growth and development Energy metabolism Reproduction Fluid, electrolyte, and acid-base balance

Maintenance and regulation of vital functions

Response to stress and injury

Growth and development

Energy metabolism

Reproduction

Fluid, electrolyte, and acid-base balance

THYROID GLAND Located in the anterior part of the neck Controls the rate of body metabolism and growth Produces thyroxine (T 4 ), triiodothyronine (T 3 ), and thyrocalcitonin

Located in the anterior part of the neck

Controls the rate of body metabolism and growth

Produces thyroxine (T 4 ), triiodothyronine (T 3 ), and thyrocalcitonin

Thyroid & Parathyroid Gland

PARATHYROID GLAND Located near the thyroid Controls calcium and phosphorus metabolism Produces parathyroid hormone (PTH)

Located near the thyroid

Controls calcium and phosphorus metabolism

Produces parathyroid hormone (PTH)

Thyroid Gland Follicular cells produce 2 thryroid hormones Thyroxine = tetraiodothyronine = T 4 Triiodothyronine = T 3 Thyroid hormones regulate: Oxygen use and basal metabolic rate Cellular metabolism Growth & development Parafollicular cells (C-cells) produce hormone Calcitonin Helps regulate calcium homeostatsis

Follicular cells produce 2 thryroid hormones

Thyroxine = tetraiodothyronine = T 4

Triiodothyronine = T 3

Thyroid hormones regulate:

Oxygen use and basal metabolic rate

Cellular metabolism

Growth & development

Parafollicular cells (C-cells) produce hormone

Calcitonin

Helps regulate calcium homeostatsis

Clinical Presentations Bradycardia Habitual abortion / sterility Impotence Anorexia Heat intolerance Diaphoresis Increased appetite Incidental Goiter Unexplained weight gain Constipation Myxedema Memory loss / impairment Tremor Muscle weakness & fatigue Dyspnea Dependant edema Impaired mentation (confusion) Later Depression & loss of concentration Dry skin (Pruritis) Cold intolerance Myalgias Somnolence & fatigue Menorrhagia Goiter Nervousness / Irritability Palpitations (tachycardia) Unexplained weight loss Diarrhea Sleep disturbances (insomnia) Vision changes (exopthalmos) Amenorrhea / oligomenorrhia Initial HYPOTHYROID HYPERTHYROID TYPE of S/S

Thyroid Drugs Generic Thyroid Drug Names Levothyroxine /L- thyroxine | Liothyronine | Liotrix | Methimazole | Propylthiouracil / PTU | Natural Thyroid | Thyrotropin alfa Thyroid Drugs Brand Names Armour Thyroid | Cytomel | Levothroid | Levoxyl | Naturethroid | Synthroid | Tapazole | Thyrogen | Thyrolar | Unithroid | Westhroid

Generic Thyroid Drug Names

Levothyroxine /L- thyroxine | Liothyronine | Liotrix | Methimazole | Propylthiouracil / PTU | Natural Thyroid | Thyrotropin alfa

Thyroid Drugs Brand Names Armour Thyroid | Cytomel | Levothroid | Levoxyl | Naturethroid | Synthroid | Tapazole | Thyrogen | Thyrolar | Unithroid | Westhroid

Levothyroxine Brand names in the U.S : Synthroid , Levothroid , Levoxyl , Unithroid Brand names in Canada : Synthroid , Eltroxin, and PMS-Levothyroxine Brand names outside U.S .: Euthyrox, Thyroxine, Berlthyrox, Droxine, Eferox, Elthyrone, Eltroxin, Eutirox, Letrox, Levaxin, Levotirox, Levothyrox, Levotiroxina, Oroxine, T4KP, Thevier, Throxinique, Thyradin, Thyradin S, Thyrax, Thyrax Duotab, Thyrex, Thyro-4, Thyrosit, Thyroxin, Thyroxin-Natrium, Tiroidine Description Levothyroxine is the generic name for the synthetic form of thyroxine, a thyroid hormone replacement drug.

Brand names in the U.S : Synthroid , Levothroid , Levoxyl , Unithroid Brand names in Canada : Synthroid , Eltroxin, and PMS-Levothyroxine Brand names outside U.S .: Euthyrox, Thyroxine, Berlthyrox, Droxine, Eferox, Elthyrone, Eltroxin, Eutirox, Letrox, Levaxin, Levotirox, Levothyrox, Levotiroxina, Oroxine, T4KP, Thevier, Throxinique, Thyradin, Thyradin S, Thyrax, Thyrax Duotab, Thyrex, Thyro-4, Thyrosit, Thyroxin, Thyroxin-Natrium, Tiroidine

Description

Levothyroxine is the generic name for the synthetic form of thyroxine, a thyroid hormone replacement drug.

Hypothyroidism: Causes Primary (most common) Hashimoto’s thyroiditis - autoimmune Treatment-related (2 nd most common) Radioactive iodine Tx or surgery for hyperthyoidism Iodine deficiency Endemic goiter Endemic cretinism: most common cause of congenital hypothyroidism in deficient areas Major cause of mental deficiency worldwide Rare inherited enzyme deficiencies Secondary Failure of H-P axis d/t deficient TRH or TSH secretion

Primary (most common)

Hashimoto’s thyroiditis - autoimmune

Treatment-related (2 nd most common)

Radioactive iodine Tx or surgery for hyperthyoidism

Iodine deficiency

Endemic goiter

Endemic cretinism: most common cause of congenital hypothyroidism in deficient areas

Major cause of mental deficiency worldwide

Rare inherited enzyme deficiencies

Secondary

Failure of H-P axis d/t deficient TRH or TSH secretion

Hypothyroidism: Classified by the organ of origin Primary hypothyroidism ( thyroid gland ) The most common forms include Hashimoto's thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism . Secondary hypothyroidism ( pituitary gland ) Occurs if the pituitary gland does not create enough thyroid stimulating hormone (TSH) to induce the thyroid gland to create a sufficient quantity of thyroxine . Although not every case of secondary hypothyroidism has a clear-cut cause, it is usually caused when the pituitary is damaged by a tumor, radiation, or surgery so that it is no longer able to instruct the thyroid to make enough hormone Tertiary hypothyroidism , also called hypothalamic-pituitary-axis hypothyroidism ( hypothalamus ) Results when the hypothalamus fails to instruct the pituitary to produce sufficient TSH.

Primary hypothyroidism ( thyroid gland ) The most common forms include Hashimoto's thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism .

Secondary hypothyroidism ( pituitary gland ) Occurs if the pituitary gland does not create enough thyroid stimulating hormone (TSH) to induce the thyroid gland to create a sufficient quantity of thyroxine .

Although not every case of secondary hypothyroidism has a clear-cut cause, it is usually caused when the pituitary is damaged by a tumor, radiation, or surgery so that it is no longer able to instruct the thyroid to make enough hormone

Tertiary hypothyroidism , also called hypothalamic-pituitary-axis hypothyroidism ( hypothalamus ) Results when the hypothalamus fails to instruct the pituitary to produce sufficient TSH.

Thyroid Supplements Thyrogen Thyrotropin Dx Tool for Thyroid Ca Tapazole Methimazole Various generic Propylthiouracil (PTU) Thyroid Suppressants Thyrolar, Euthroid Liotrix (T 4 : T 3 = 4:1) Cytomel, Triostat Liothyronine (synthetic T 3 ) Synthroid, Levothroid, Levo-T Levothyroxin sodium (synthetic T 4 ) Thyroid Supplements TRADE GENERIC CLASS

Thyroid Hormones: Indications Primary, secondary or tertiary hypothyroidism Replacement therapy Pituitary TSH suppression Euthyroid goiters Nodular thyroid Thyroid cancer NOT recommended as treatment for Transient thyroiditis Obesity (unlabelled use – neither safe nor effective) Fertility

Primary, secondary or tertiary hypothyroidism

Replacement therapy

Pituitary TSH suppression

Euthyroid goiters

Nodular thyroid

Thyroid cancer

NOT recommended as treatment for

Transient thyroiditis

Obesity (unlabelled use – neither safe nor effective)

Fertility

Thyroid Hormones: Action Increased: Basal metabolic rate Oxygen consumption Respiratory rate Body temperature Cardiac output Heart rate Blood volume Rate of fat, protein, and CHO metabolism Enzyme system activity Growth & maturation CNS development in children

Increased:

Basal metabolic rate

Oxygen consumption

Respiratory rate

Body temperature

Cardiac output

Heart rate

Blood volume

Rate of fat, protein, and CHO metabolism

Enzyme system activity

Growth & maturation

CNS development in children

Myxedema

Pharmacokinetics: Supplements Biliary / Renal 99% T3: 3-5 days T4: 1-3 wk T3: 2-3 days T4: 6-7 days T3: 24-72 hr T4: 1-3 wk T3: 12-36 hr T4: ? Variable in GI but T3 > T4 Liotrix Biliary / Renal 99% PO: 3-5 days 2-3 days PO: 24-72 hr PO: 12-36 hr Complete in GI (95% in 4 hr) Liothyro-nine Biliary 99% (T4>T3) PO: 1-3 wk IV: ? 6-7 days PO: 1-3 wk IV: 24 hr PO: ? IV: 6-8 hr Variable in GI (50-80%) Levothy-roxine METABOLISM PROTEIN- BINDING DURA TION ½-LIFE PEAK ONSET ABSOR-PTION DRUG

Thyroid Hormones: Tx Principles Critical decisions with initial dose & dose changes Individualized treatment Careful laboratory monitoring for management Start at low dose and  Q 4-6 wks until nL TSH Initial T4: 25-75 mcg Maintenance T4: 75-150 mcg Single dose before breakfast T4 Treatment of choice Slow onset & cumulative effects T3 Rapid onset & dissipation May be preferable for rapid correction of hypothyroidism

Critical decisions with initial dose & dose changes

Individualized treatment

Careful laboratory monitoring for management

Start at low dose and  Q 4-6 wks until nL TSH

Initial T4: 25-75 mcg

Maintenance T4: 75-150 mcg

Single dose before breakfast

T4

Treatment of choice

Slow onset & cumulative effects

T3

Rapid onset & dissipation

May be preferable for rapid correction of hypothyroidism

Thyroid Hormones & Geriatrics Hypothyroidism common May exacerbate CV disease At risk for angina with initiation of thyroid hormone Start low and gradually increase dosage Absorption may be increased with aging Dosage adjustments may be required

Hypothyroidism common

May exacerbate CV disease

At risk for angina with initiation of thyroid hormone

Start low and gradually increase dosage

Absorption may be increased with aging

Dosage adjustments may be required

Thyroid Hormones & Pediatrics Critical for normal growth & development, esp. CNS Undiagnosed  Cretinism Screening for at-risk neonates (T4 & TSH) Require higher doses to meet metabolic demands for growth & development in first 3 years of life

Critical for normal growth & development, esp. CNS

Undiagnosed  Cretinism

Screening for at-risk neonates (T4 & TSH)

Require higher doses to meet metabolic demands for growth & development in first 3 years of life

Thyroid Hormones: Contraindications Untreated thyrotoxicosis Uncorrected adrenal insufficiency  will precipitate crisis Hypersensitivity

Untreated thyrotoxicosis

Uncorrected adrenal insufficiency  will precipitate crisis

Hypersensitivity

Thyroid Hormones: Cautions Aggravation of known cardiac disease Manifestation of occult cardiac disease Start with low dose & administer cautiously in high-risk patients Aggravation of diabetes mellitus & diabetes insipidus

Aggravation of known cardiac disease

Manifestation of occult cardiac disease

Start with low dose & administer cautiously in high-risk patients

Aggravation of diabetes mellitus & diabetes insipidus

Thyroid Hormones: Adverse Effects Weight loss Heat intolerance Weight loss Heat intolerance Weight loss Heat intolerance Metabolic Diarrhea, Abdominal cramps, N / V Diarrhea, Abdominal cramps, N / V Diarrhea, Abdominal cramps, N / V GI Irregular menses Hyperglycemia Hypocholesterolemia Irregular menses Hyperglycemia Hypocholesterolemia Irregular menses Endocrine Diaphoresis Alopecia (children) Diaphoresis Diaphoresis, Alopecia (children) Derm Irritability, Nervousness, Insomnia Nervousness, Headache, Insomnia Irritability, Nervousness, Insomnia CNS Tachycardia, Arrhythmias, Angina Angina, Arrhythmias, Palpitations Tachycardia, Arrhythmias, Angina CV LIOTRIX LEVOTHYROXINE LIOTHYRONINE SYSTEM

Thyroid Hormones: Drug Interactions Oral anticoagulants  effect r/t vitamin K metabolism Cholestyramine (Questran) & colestipol (Colestid)  absorption of thyroxine Androgens & estrogens  protein-binding &  effectiveness of medication Insulin & oral hypoglycemics Become less effective & dosage adjustments may be needed to maintain BG levels B-blockers & digitalis Less effective as hypothyroidism improves

Oral anticoagulants

 effect r/t vitamin K metabolism

Cholestyramine (Questran) & colestipol (Colestid)

 absorption of thyroxine

Androgens & estrogens

 protein-binding &  effectiveness of medication

Insulin & oral hypoglycemics

Become less effective & dosage adjustments may be needed to maintain BG levels

B-blockers & digitalis

Less effective as hypothyroidism improves

Thyroid Hormones: Overdosage Toxicity: S/S of hyperthyroidism; may mimic thyrotoxicosis (hyperthyroidism, Graves' disease) Decrease or temporarily D/C Tx for 5-7 days, then resume at lower dose

Toxicity:

S/S of hyperthyroidism; may mimic thyrotoxicosis (hyperthyroidism, Graves' disease)

Decrease or temporarily D/C Tx for 5-7 days, then resume at lower dose

Thyroid Hormones: Monitoring Therapy Measure TSH in 4-6 weeks 4-6 weeks for full therapeutic effectiveness Monitor TSH monthly until normal & stable Annual evaluation once maintenance therapy achieved Evaluate levels if s/s of over/under-dosage Maintain children < 3 on upper level of T4 therapeutic range and normal TSH Laboratory assessment: < 1 Year: Q 1-2 months Age 1-3: Q 2-3 months > 3 Years: Q 3-12 months

Measure TSH in 4-6 weeks

4-6 weeks for full therapeutic effectiveness

Monitor TSH monthly until normal & stable

Annual evaluation once maintenance therapy achieved

Evaluate levels if s/s of over/under-dosage

Maintain children < 3 on upper level of T4 therapeutic range and normal TSH

Laboratory assessment: < 1 Year: Q 1-2 months Age 1-3: Q 2-3 months > 3 Years: Q 3-12 months

Thyroid Hormones: Monitoring Therapy cont’d Response NOT immediate. Sx improvement in 2 wks. Lifelong Tx – importance of compliance Do NOT alter or abruptly stop dose Do NOT alter brand Great variability in bioequivalence b/w manufacturers Take at same time every day Before breakfast on an empty stomach to  absorption Later  difficulty falling asleep Report s/s of over/under-dosage

Response NOT immediate. Sx improvement in 2 wks.

Lifelong Tx – importance of compliance

Do NOT alter or abruptly stop dose

Do NOT alter brand

Great variability in bioequivalence b/w manufacturers

Take at same time every day

Before breakfast on an empty stomach to  absorption

Later  difficulty falling asleep

Report s/s of over/under-dosage

Hyperthyroidism: Causes Graves’ disease (diffuse toxic goiter) Autoimmune Toxic nodular goiter Hyperfunctioning multinodular goiter Thyroiditis Transient hyperthyroidism Iodine-induced hyperthyroidism Iatrogenic

Graves’ disease (diffuse toxic goiter)

Autoimmune

Toxic nodular goiter

Hyperfunctioning multinodular goiter

Thyroiditis

Transient hyperthyroidism

Iodine-induced hyperthyroidism

Iatrogenic

Thyroid Suppressants: Indications Hyperthyroidism Long-term use for disease remission If surgery contraindicated Prior to surgery (subtotal thyroidectomy) or radiation (radioactive iodine) Unlabelled use for PTU Alcoholic liver disease to  hypermetabolic state Control of thyroid overproduction ~ ½  permanent remission; ~ ½  become hypothyroid Sx improvement in 1-2 weeks; euthyroid in 4-8 weeks Should be euthyroid prior to surgery

Hyperthyroidism

Long-term use for disease remission

If surgery contraindicated

Prior to surgery (subtotal thyroidectomy) or radiation (radioactive iodine)

Unlabelled use for PTU

Alcoholic liver disease to  hypermetabolic state

Control of thyroid overproduction

~ ½  permanent remission; ~ ½  become hypothyroid

Sx improvement in 1-2 weeks; euthyroid in 4-8 weeks

Should be euthyroid prior to surgery

Thyroid Suppressants: Action Reduce absorption of iodine  decreased hormone synthesis Do NOT inhibit stored or circulating levels of T 3 or T 4 Do NOT affect oral or parenteral thyroid supplements Normal synthesis resumes rapidly with cessation of Tx PTU: Inhibits conversion of T 4 to T 3 Methimazole: Longer acting  less frequent dosing

Reduce absorption of iodine  decreased hormone synthesis

Do NOT inhibit stored or circulating levels of T 3 or T 4

Do NOT affect oral or parenteral thyroid supplements

Normal synthesis resumes rapidly with cessation of Tx

PTU:

Inhibits conversion of T 4 to T 3

Methimazole:

Longer acting  less frequent dosing

Pharmacokinetics: Suppressants Hepatic Hepatic METABOLISM Renal 80% Weeks 1-2 hr 6-10 wk 10-21 days Rapid Good in GI Propyl- thiouracil Renal Min Weeks 5-6 hr 4-10 wk 1 wk Rapid Good in GI Methima-zole (Tapazol) EXCRETION PROTEIN - BINDING DURA- TION ½-LIFE PEAK ONSET ABSORPTION DRUG

Thyroid Suppressants: Tx Principles Dose titrated to achieve max response with min dose Tx maintained 12-24 months Once euthyroid x 6-12 months, dosage reduced to determine remission If remission  D/C Tx Consultation at initiation of Tx & remission determination B-blockers (propranolol) for s/s of hyperthyroidism r/t sensitization of SNS)

Dose titrated to achieve max response with min dose

Tx maintained 12-24 months

Once euthyroid x 6-12 months, dosage reduced to determine remission

If remission  D/C Tx

Consultation at initiation of Tx & remission determination

B-blockers (propranolol) for s/s of hyperthyroidism r/t sensitization of SNS)

Thyroid Suppressants: Geriatric & Pediatric Considerations Geriatric Hypothyroidism more common than hyper May have atypical presentation - often atrial fibrillation is presenting symptom Pediatric PTU hepatotoxicity  D/C if s/s of liver dysfunction Pregnancy & Lactation Category D ( There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks ). Can cross placenta & induce goiter or cretinism Should NOT be given while breastfeeding PTU drug of choice if needed - followed by endocrinologist

Geriatric

Hypothyroidism more common than hyper

May have atypical presentation - often atrial fibrillation is presenting symptom

Pediatric

PTU hepatotoxicity  D/C if s/s of liver dysfunction

Pregnancy & Lactation

Category D ( There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks ).

Can cross placenta & induce goiter or cretinism

Should NOT be given while breastfeeding

PTU drug of choice if needed - followed by endocrinologist

Thyroid Suppressants: Contraindications & Cautions Contraindications Hypersensitivity Cautions AGRANULOCYTOSIS !!! Also:leukopenia, thrombocytopenia, & aplastic anemia Monitor bone marrow function D/C if: agranulocytosis, aplastic anemia, hepatitis, fever, exfoliative dermatitis Use with caution in: age > 40, other agranulocytosis-precipitating medications Carcinogenesis in laboratory animals Tx > 1 year

Contraindications

Hypersensitivity

Cautions

AGRANULOCYTOSIS !!!

Also:leukopenia, thrombocytopenia, & aplastic anemia

Monitor bone marrow function

D/C if: agranulocytosis, aplastic anemia, hepatitis, fever, exfoliative dermatitis

Use with caution in: age > 40, other agranulocytosis-precipitating medications

Carcinogenesis in laboratory animals Tx > 1 year

Thyroid Suppressants: Adverse Effects Arthralgia Arthralgia Musculoskeletal Agranulocytosis Aplastic anemia Leukopenia Thrombocytopenia Hypoprothrombinemia Agranulocytosis Aplastic anemia Leukopenia Thrombocytopenia Hypoprothrombinemia Hematologic N/V, Hepatitis (maybe FATAL!) Diarrhea, Diminished taste N/V, Hepatitis (maybe FATAL!) GI Rash, Urticaria, Skin Discoloration Rash, Urticaria, Pruritis Derm Headache, Drowsiness, Vertigo Paresthesia, Headache, Vertigo CNS PTU METHIMAZOLE (Tapazole) SYSTEM

Thyroid Suppressants: Overdosage S/S: nausea, vomiting, epigastric distress, headache, fever, arthralgia, pruritis, edema, pancytopenia, & agranulocytosis Rare: exfoliative dermatitis, hepatitis, neuropathies, CNS stimulation or depression Monitor: Airway & VS (may require resuscitation) CBC, ABGs, lytes, bone marrow, PT, LFTs

S/S: nausea, vomiting, epigastric distress, headache, fever, arthralgia, pruritis, edema, pancytopenia, & agranulocytosis

Rare: exfoliative dermatitis, hepatitis, neuropathies, CNS stimulation or depression

Monitor:

Airway & VS (may require resuscitation)

CBC, ABGs, lytes, bone marrow, PT, LFTs

Thyroid Suppressants: Drug Interactions Oral anticoagulants  effect r/t vitamin K metabolism Digoxin Levels may  with euthyroid I-131  thyroid uptake Amiodarone, iodine, potassium iodide, iodinated glycerol Decrease medication effectiveness

Oral anticoagulants

 effect r/t vitamin K metabolism

Digoxin

Levels may  with euthyroid

I-131

 thyroid uptake

Amiodarone, iodine, potassium iodide, iodinated glycerol

Decrease medication effectiveness

Thyroid Suppressants: Monitoring Therapy Laboratory testing prior to initiating therapy & periodically until euthyroid (usu. 3-5 months) Serum T4 & T3 initially & after 2 weeks Once euthryroid: elevated TSH  need lower dose Monitor WBC with differential Before initiating Tx & any s/s of infection Monitor PT Esp. before surgical procedures Monitor for hepatotoxicity LFTs: AST, ALT, alkaline phosphatase, LDH, bilirubin, PT Resolution of hypermetabolic state  Pulse, BP, weight, nervousness/tremor Evaluate for: hepatitis, agranulocytosis, GI irritation

Laboratory testing prior to initiating therapy & periodically until euthyroid (usu. 3-5 months)

Serum T4 & T3 initially & after 2 weeks

Once euthryroid: elevated TSH  need lower dose

Monitor WBC with differential

Before initiating Tx & any s/s of infection

Monitor PT

Esp. before surgical procedures

Monitor for hepatotoxicity

LFTs: AST, ALT, alkaline phosphatase, LDH, bilirubin, PT

Resolution of hypermetabolic state

 Pulse, BP, weight, nervousness/tremor

Evaluate for: hepatitis, agranulocytosis, GI irritation

Thyroid Suppressants: Patient Education Require routine monitoring Medication exactly as prescribed Regular schedule & evenly spaced Discuss other medications with provider before using Avoid foods/substances containing iodine Promptly notify provider of any s/s of illness Fever, sore throat, malaise, bleeding/bruising, headache, skin rash, lymph node enlargement Adequate rest & diet; avoid stress

Require routine monitoring

Medication exactly as prescribed

Regular schedule & evenly spaced

Discuss other medications with provider before using

Avoid foods/substances containing iodine

Promptly notify provider of any s/s of illness

Fever, sore throat, malaise, bleeding/bruising, headache, skin rash, lymph node enlargement

Adequate rest & diet; avoid stress

Thyrotropin (Thyrogen) Indications Post-surgical evaluation for remnant thyroid tissue Thyroid cancer recurrence or metastases Used in conjunction w/ or w/o radioiodine imaging Mechanism of Action Enhances sensitivity of thyroglobulin testing Avoids hypothyroid effects during radioimaging scans Adverse Effects Nausea, headache, mild hypersensitivity (rash/urticaria)

Indications

Post-surgical evaluation for remnant thyroid tissue

Thyroid cancer recurrence or metastases

Used in conjunction w/ or w/o radioiodine imaging

Mechanism of Action

Enhances sensitivity of thyroglobulin testing

Avoids hypothyroid effects during radioimaging scans

Adverse Effects

Nausea, headache, mild hypersensitivity (rash/urticaria)

Resources Avicenna www.avicenna.com Clinical Pharmacology www.cponline.gsm.com Drug database www.pharminfo.com/drugdb/db_mnu.html DoctorNet www.doctornet.com Health Finder www.healthfinder.org HealthGate www.healthgate.com

Avicenna

www.avicenna.com

Clinical Pharmacology

www.cponline.gsm.com

Drug database

www.pharminfo.com/drugdb/db_mnu.html

DoctorNet

www.doctornet.com

Health Finder

www.healthfinder.org

HealthGate

www.healthgate.com

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