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The thyroid is a gland found anteriorly in
the neck and has its main secretions being T3 and T4 hormones that are metabolic
regulators in the body. Its functions are regulated by the pituitary gland found
in the brain via a feedback mechanism.  The
hormone that takes part in this regulation is thyroid stimulating hormone (TSH)
(Brent, 2012).  This makes it an important organ in the body
whose dysfunction can lead to serious medical issues and, therefore, proper
management is paramount.

Background

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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 sever to
sub-clinical to no symptoms and can result in either an increase in the serum
levels of thyroid hormones (Hyperthyroidism) or decrease in levels of thyroid
hormones (Hypothyroidism).  Patients present
clinically with symptoms like weight loss which is unintended, sweating that is
excessive, intolerance to heat and problems with the eyes among others for hyperthyroidism,
while hypothyroidism symptoms include unintended gain of weight, cold intolerance
and swelling of the limbs (myxedema) etc. Examples of pathologies that affect the
thyroid are 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 commonly prescribed for Hyperthyroidism
include anti-thyroid drugs such as Carbimazole, methimazole, propylthiouracil which
are initiated at high doses. These can help achieve euthyroid states within 14
days of use. Beta-blockers like 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 providing
supplemental iodine in foods, food supplements or in tablets. Levothyroxine
which is a thyroxine (T4) analogue is used in hypothyroidism to normalize serum
levels of T4..

There are other causes of thyroid dysfunction
including immune-mediated hashimoto’s and infections that cause inflammation of
the thyroid gland. Non-steroidal anti-inflammatory drugs (NSAIDs), levothyroxine
and corticosteroids like prednisolone can be prescribed in such cases to reduce
thyroid inflammation.

Effects
of age on thyroid Medications

The pharmacodynamics and pharmacokinetics
of drugs are affected by patients’ ages and thus, in the very young ages and
the extremely old population, there exist differences in the drug elimination
rates, drug metabolism, and compositions of body might affect the
bioavailability, duration of action, the route of drug administration and even dosing
of drugs which consequently affect impact drug actions in those groups. The
drugs that are majorly eliminated via the kidneys end up remaining in the body
for longer due to renal system impairment such as in the elderly population. The
result is an enhancement in the magnitudes of side effects and prolongation of
their durations of action. In addition, 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
for management of autoimmune thyroid disease can have many side effects on
almost all systems in the body including but not limited to osteoporosis of
bones, 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 easily resolves upon drug
withdrawal.  Propylthiouracil has a small
risk for causing liver damage and as such it is important to keep conducting
tests to maintain appropriate liver health and functions. Methimazole can cause
aplastic anemia and thrombocytopenia; in order to reduce these effects, it is
prudent to keep doing full blood counts to identify problems with the marrow as
soon as possible. Other side effects of thyroid drugs like headaches and upset
of the gastrointestinal system 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 cooperation between the health care provider and the
patient if adequate remission it to be achieved.

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