The serum levels of thyroid hormones (Hyperthyroidism) or

The thyroid gland is located anteriorly in
the neck with the main secretions being T3 and T4 hormones which act as metabolic
regulators in the body. Its functions are regulated by the pituitary gland found
within the brain and it is via a negative and positive feedback mechanism.  The hormone that takes part in this
regulation is thyroid stimulating hormone (Brent, 2012). 
This makes it an important organ in the body whose dysfunction can lead
to serious morbidity 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 debilitating
to sub-clinical to asymptomatic and each can result in either an increase in
the serum levels of thyroid hormones (Hyperthyroidism) or decrease in levels of
thyroid hormones (Hypothyroidism).  Both
these disease states manifest with differing signs and symptoms such as weight
loss, too much sweating, intolerance to heat and problems with the eyes among others
for hyperthyroidism, while hypothyroidism manifest as unintended gain of weight,
intolerance to cold and myxedema among others. Examples of pathologies that
affect  the thyroid gland include 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 used in the treatment and management
of Hyperthyroidism include anti-thyroid drugs such as Carbimazole, methimazole,
propylthiouracil which are started 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 giving iodine supplements either in food or in
tablets. The drug levothyroxine is also used to increase  levels of serum thyroid hormone to baseline.

Other causes of thyroid dysfunction are
immune related like hashimoto’s while others are due to infections that cause
inflammation of the thyroid gland such as thyroiditis. These can be treated
with non-steroidal anti-inflammatory drugs (NSAIDs), levothyroxine and
corticosteroid prednisolone to reduce thyroid inflammation.

Effects
of age on thyroid Medications

The pharmacodynamics and pharmacokinetics
of drugs are affected by patients’ ages and as such, in the extreme age-groups,
differences in the elimination rates, drug metabolism, and compositions of body
might affect the bioavailability, duration of action, the route and methods of
administration and even the dosage of drugs which alternatively affects the
workings of drugs in those groups. The drugs that are majorly eliminated via
the kidneys end up remaining in the body for longer if the renal system is
impaired in any way 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, 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 subsides as
soon as the drug is withdrawn.  Propylthiouracil
also has a small risk for hepatotoxicity and as such, liver function tests are
necessary to ensure it is not damaged. Methimazole can cause aplastic anemia
and thrombocytopenia; reducing this effect involves 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.