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Thyroid Therapeutics
PHAR 451
Instructor: Dr. Peter Loewen
Office: PHRM 6624
Office Hours:
Class Schedule:
Important Course Pages
Lecture Notes
Course Discussion

Pre-session Objectives

  1. Be able to describe the physiology of thyroid function.
  2. Be able to explain the biochemical parameters used to evaluate thyroid function.
  3. Be able to describe the pathophysiology of the most common causes of hyper- and hypothyroidism.
  4. Be able to name the signs and symptoms of hyper- and hypo-thyroidism.

Session Objectives

By the end of the the session and upon further study and reflection, students should be able to

  1. rationalize a diagnosis of hypothyroidism on the basis of signs and symptoms combined with biochemical tests.
  2. design, implement and monitor (efficacy/toxicity) an effective pharmacotherapeutic plan for managing primary hypothyroidism.
  3. dentify and manage common drug related-causes of hypothyroidism.

Pre-Session Assignment

  1. Obtain Peter Loewen's Thyroid Physiology, Pharmacology, & Pharmacotherapy PLOP.
  2. Read McDermott MT. Hypothyroidism. Ann Intern Med. 2009; ITC6 (1DEC09)
  3. Complete the self-assessment questions below
  4. Obtain and review the session slides, posted in Connect

Preparatory self-assessment questions

1. The predominant hormone secreted by the thyroid gland is

a. Triiodothyronine
b. Tetraiodothyronine
c. Liothyronine
d. Parathyroid hormone

2. The metabolically active thyroid hormone, (________), is produced mainly (_________)

a. T3, in peripheral tissues
b. T4, in peripheral tissues
c. T3, in the thyroid
d. T4, in the thyroid

3. The most common cause of hypothyroidism in North America is

a. Iodine deficiency
b. Graves’ disease
c. Amiodarone
d. Autoimmune thyroiditis

4. The most common cause of hyperthyroidism in North America is

a. Iodine excess
b. Graves’ disease
c. Autoimmune thyroiditis
d. Toxic multinodular goitre

5. Which constellation of symptoms is most consistent with hyperthyroidism

a. Depression, constipation, ascites, bradycardia
b. Normocytic anemia, pleural effusion, menorrhagia, myalgia
c. Bradyphasia, eczema, proptosis, paresthesia
d. Thinning of hair, amenorrhea, osteoporosis, muscle weakness

References & Additional Reading

  1. ASCE / ATA Clinical Practice Guidelines for Hypothyroidism in Adults Endocrine Practice 2012;18(6):989-1027
  2. Levy M. How to interpret thyroid function tests. Clin Med 2013;13:282–6.
  3. Nygaard B. Hypothyroidism (Primary). ClinicalEvidence 2010;01:605.
  4. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010 Dec 13;170(22):1996-2003.
  5. Chaker L, van den Berg ME, Niemeijer MN, et al. Thyroid Function and Sudden Cardiac Death Circulation. 2016;134(10):713-722
  6. Hennessey, J. V., & Espaillat, R. Diagnosis and Management of Subclinical Hypothyroidism in Elderly Adults: A Review of the Literature. Journal of the American Geriatrics Society, 2015:63(8), 1663–1673.
  7. Garg A, Vanderpump MPJ. Subclinical thyroid disease. British Medical Bulletin 2013;107:101–16.
  8. Pham & Shaugnessy. Should we treat subclinical hypothyroidism? BMJ 2008;337:a834 doi:10.1136/bmj.a834

Pregnancy & Hypothyroidism