What are the possible treatments for myxedema?
Myxedema = Hypothyroidism
- Thyroid USP: dried, defatted thyroids from pig & sheep
- Sodium levothyroxine: T4 = drug of choice
- Sodium liothyronine: T3; used for myxedema coma
What are drug treatment options for hyperthyroidism? MOA?
Carbimazole (in UK)
--> MOA: inhibiting Thyroid Peroxidase ==> prevents iodizatiion of thyroglobulin and production of T3 and T4
What are the toxicities of thioamides?
Caution in pregnancy:
- Both PTU and methimazole cross placenta; use lowest possible dose
- Thioamides cross into mother's milk
Rare cases of agranulocytosis
How is a "thyroid storm" treated?
Thyroid storm is due, in large part, to supersensitization of b-adrenergic receptors
--> Treat immediately with b-blockers:
--> Long term treatment with thioamides (PTU, methimazole)
What is the premise of readioactive iodide treatment?
In theory, in the case of toxic nodular adenoma, the adenoma takes up the radioactive iodine while the quiescent normal tissue takes up less
--> In practice, it usually desetroys most of the thyroid
--> Must replace loss of thyroid hormone with levothyroxine
**NEVER use 131I during pregnancy!*
What is the drug of choice to treat hyperthyroidism?
What is the treatment for hypoparathyroidism?
Problem: Low PTH (low serum Ca, high serum phosphate)
- can lead to tetany, convulsions, and death
1,25(OH)2D3 and dietary Ca2+ supplement
What is the treatment for pseudohypoparathyroidism?
Problem: PTH is elevated, but Ca2+ is lwo
--> often the G-protein Gs is low or abnormal
--> PTH fails to stimulate 1a hydroxylase activty in the kidney
What is the treatmet for Rickets?
Problem: lack of sufficient sunlight --> insufficient D3 to make 1,25(OH)2D3
- Increased PTH --> Ca removal from bones --> bones become soft
food supplemented with vit. D2 or D3
What is the treatment for Vitamin D-Dependent Rickets?
Problem: abnormal 1a-hydroxylase in kidney
- autosomal recessive
- sun exposure is not effective
What is the treatment for drug-induced osteopenia?
Problem - Certain drugs interfere with Ca absorption from gut
Treatment: Vitamine 25(OH)D3, D2, or D3
What is the treatment for Paget's Disease?
Problem: overactivity of osteoclasts leads to abnormal restructuring of bone - patients prone to compression fractures
Treatment: Calcitonin or bisphosphonates
What are examples of bisphosphonates?
What are the treatment options for post-menopausal osteoporosis?
Teriparatide (active portion of PTH) - daily subcut. injection
Denosumab - anti-RANKL monocloonal Ab (mimics OPG)