MEDICATIONS FOR

HYPERTHYROIDISM

GENERIC NAME:
Iodide

TRADE NAME:
ThyroSafe, Thyroshield

CLASSIFICATION:
Antithyroid agents

INDICATIONS:
Adjunct with other antithyroid drugs in preparation for thyroidectomy. Treatment
of thyrotoxic crisis. Radiation protectant following radiation emergencies or
administration of radioactive iodine.

MECHANISM OF ACTION:
Rapidly inhibits the release and synthesis of thyroid hormones. Decreases the
vascularity of the thyroid gland. Decreases thyroidal uptake of radioactive iodine
following radiation emergencies or administration of radioactive isotopes of iodine.
Iodine is a necessary component of thyroid hormone. Therapeutic Effects: Control of
hyperthyroidism. Decreased bleeding during thyroid surgery. Decreased incidence of
thyroid cancer following radiation emergencies.

ROUTE/ DOSAGE:
Preparation for Thyroidectomy:
 PO (Adults and Children): Strong iodine solution—3–5 drops (0.1–0.3ml) 3
times daily for 10 days prior to surgery. Potassium iodide saturated solution
(SSKI)—1–5 drops (50–250mg) 3 times daily for 10 days prior to surgery.

Hyperthyroidism:
 PO (Adults and Children): Strong iodine solution—1ml in water 3 times daily.
Potassium iodide saturated solution (SSKI)—6–10 drops (300–500mg) 3 times
daily.
 PO (Infants <1 yr): 3–5 drops (150–250 mg) 3 times daily.

ADVERSE REACTIONS/SIDE EFFECTS:

CNS: confusion, weakness. GI: GI bleeding, diarrhea, nausea, vomiting. Derm:
acneiform eruptions. Endo: hypothyroidism, goiter, hyperthyroidism. F and E:
hyperkalemia. Neuro: tingling. MS: joint pain. Misc: hypersensitivity, iodism.

DRUG TO DRUG/FOOD INTERACTION:

Drug-Drug: Use with lithium may cause increase hypothyroidism. increase
antithyroid effect of methimazole and propylthiouracil. Increase hyperkalemia may result
from combined use with potassium-sparing diuretics, ACE inhibitors, angiotensin II
receptor antagonists or potassium supplements.

PATIENT/FAMILY TEACHING:
 Instruct patient to take medication as directed. Take missed doses as soon as
possible but not just before next dose; do not double doses.
 Instruct patient to report suspected pregnancy to health care professional before
therapy
is initiated.
 Advise patient to consult health care professional about avoiding foods high in
iodine (seafood, iodized salt, cabbage, kale, turnips) or potassium(see Appendix
L).
  Advise patient to consult health care professional before using OTC or herbal
cold remedies. Some cold remedies use iodide as an expectorant.
 Hyperthyroidism: Instruct patient to take medication as ordered. Missing a dose
may precipitate hyperthyroidism.

GENERIC NAME:
Methimazole

TRADE NAME:
Tapazole

CLASSIFICATION:
Antithyroid agents

INDICATIONS:
Palliative treatment of hyperthyroidism. Used as an adjunct to control
hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.

MECHANISM OF ACTION:
Inhibits the synthesis of thyroid hormones. Therapeutic Effects: Decreased
signs and symptoms of hyperthyroidism.

ROUTE/ DOSAGE:
 PO (Adults): Thyrotoxic crisis—15–20 mg q4 hr during the first 24 hr (with other
interventions). Hyperthyroidism—15–60mg/day as a single dose or divided doses
for 6–8 wk. Maintenance—5.30mg/kg as a single dose or 2 divided doses.
 PO (Children): Initial—400mcg (0.4mg)/kg/day in single dose or 2 divided doses.
Maintenance—200 mcg/kg/day in single dose or 2 divided doses.

ADVERSE REACTIONS/SIDE EFFECTS:

CNS: drowsiness, headache, vertigo. GI: diarrhea, drug-induced hepatitis, loss of
taste, nausea, parotitis, vomiting. Derm: rash, skin discoloration, urticaria. Hemat:
agranulocytosis, anemia, leukopenia, thrombocytopenia. MS: arthralgia. Misc: fever,
lymphadenopathy.

DRUG TO DRUG/FOOD INTERACTION:

Drug-Drug: Additive bone marrow depression with antineoplastics or radiation
therapy. Antithyroid effect may be decreased by potassium iodide or amiodarone.
Increased risk of agranulocytosis with phenothiazines. May alter response to warfarin
and digoxins.

PATIENT/FAMILY TEACHING:
 Instruct patient to take medication exactly as directed, around the clock. If a dose
is missed, take as soon as remembered; take both doses together if almost time
for next dose; check with health care professional if more than 1 dose is missed.
Consult health care professional prior to discontinuing medication.
 Instruct patient to monitor weight 2–3 times weekly. Notify health care
professional of significant changes.
 May cause drowsiness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.
 Advise patient to consult health care professional regarding dietary sources of
iodine (iodized salt, shellfish).
 Advise patient to report sore throat, fever, chills, headache, malaise, weakness,
yellowing of eyes or skin, unusual bleeding or bruising, rash, or symptoms of
hyperthyroidism or hypothyroidism promptly.
  Instruct patient to consult health care professional before taking any OTC
medications.
 Advise patient to carry identification describing medication regimen at all times.
 Advise patient to notify health care professional of medication regimen prior to
treatment or surgery.
 Emphasize the importance of routine exams to monitor progress and to check for
side effects.

GENERIC NAME:
Propylthiouracil (PTU)

TRADE NAME:
Thyracil

CLASSIFICATION:
Antithyroid agents

INDICATIONS:
Palliative treatment of hyperthyroidism. Adjunct in the control of hyperthyroidism
in preparation
for thyroidectomy or radioactive iodine therapy.

MECHANISM OF ACTION:
Inhibits the synthesis of thyroid hormones. Therapeutic Effects: Decreased
signs and symptoms of hyperthyroidism.

ROUTE/ DOSAGE:
 PO (Adults): Thyrotoxic crisis—200–400mg q 4 hr during the first 24 hr.
Hyperthyroidism—300–900mg once daily or in 2–4 divided doses initially (up to
1.2 g/day);maintenance dose 50–600 mg/day once daily or in 2–4 divided doses.
 PO (Children >10 yr): 50–300mg/day given once daily or in 2–4 divided doses.
 PO (Children 6–10 yr): 50–150 mg/day given once daily or in 2–4 divided doses.
 PO (Neonates): 10 mg/kg/day in divided doses.

ADVERSE REACTIONS/SIDE EFFECTS:

CNS: drowsiness, headache, vertigo. GI: nausea, vomiting, diarrhea, drug-
induced hepatitis, loss of taste. Derm: rash, skin discoloration, urticaria. Endo:
hypothyroidism. Hemat: agranulocytosis, leukopenia, thrombocytopenia. MS: arthralgia.
Misc: fever, lymphadenopathy, parotitis.

DRUG TO DRUG/FOOD INTERACTION:

Drug-Drug: Additive bone marrow depression with antineoplastics or radiation
therapy. Additive antithyroid effects with lithium, potassium iodide, or sodium iodide.
Increased risk of agranulocytosis with phenothiazines.

PATIENT/FAMILY TEACHING:
 Instruct patient to take medication exactly as directed, around the clock. If a dose
is missed, take as soon as remembered; take both doses together if almost time
for next dose; check with health care professional if more than 1 dose is missed.
 Consult health care professional prior to discontinuing medication.
 Instruct patient to monitor weight 2–3 times weekly. Report significant changes.
 May cause drowsiness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.
 Advise patient to consult health care professional regarding dietary sources of
iodine (iodized salt, shellfish).
  Advise patient to report sore throat, fever, chills, headache, malaise, weakness,
yellowing of eyes or skin, unusual bleeding or bruising, symptoms of
hyperthyroidism or hypothyroidism, or rash to health care professional promptly.
 Instruct patient to consult health care professional before taking any OTC
medications containing iodine concurrently with this medication.
 Advise patient to carry identification describing medication regimen at all times
and to notify health care professional of medication regimen prior to treatment or
surgery.
 Emphasize the importance of routine exams to monitor progress and to check for
side
 effects.

GENERIC NAME:
Lithium

TRADE NAME:
Lithobid

CLASSIFICATION:
Mood Stabilizers

INDICATIONS:
Manic episodes of manic depressive illness (treatment, maintenance, prophylaxis).

MECHANISM OF ACTION:
Alters cation transport in nerve and muscle. May also influence reuptake of
neurotransmitters.
Therapeutic Effects: Prevents/decreases incidence of acute manic episodes.

ROUTE/ DOSAGE:
 PO (Adults and Children ≥12 yr): Tablets/capsules—300–600 mg 3
times daily initially; usual maintenance dose is 300mg 3–4 times daily.
Slow-release capsules—200–300 mg 3 times daily initially; increased up
to 1800mg/day in divided doses. Usual maintenance dose is 300–400 mg
3 times daily. Extended-release tablets—450–900mg twice daily or 300–
600 mg 3 times daily initially; usual maintenance dose is 450mg twice
daily or 300mg 3 times daily.
 PO (Children <12 yr): 15–20mg (0.4–0.5mEq)/kg/day in 2–3 divided
doses; dosage may be adjusted weekly.

ADVERSE REACTIONS/SIDE EFFECTS:

CNS: seizures, fatigue, headache, impaired memory, ataxia, sedation, confusion,
dizziness, drowsiness, psychomotor retardation, restlessness, stupor. EENT: aphasia,
blurred vision, dysarthria, tinnitus. CV: arrhythmias, ECG changes, edema,
hypotension. GI: abdominal pain, anorexia, bloating, diarrhea, nausea, dry mouth,
metallic taste. GU: polyuria, glycosuria, nephrogenic diabetes insipidus, renal toxicity.
Derm: acneiform eruption, folliculitis, alopecia, diminished sensation, pruritus. Endo:
hypothyroidism, goiter, hyperglycemia, hyperthyroidism. F and E: hyponatremia.
Hemat: leukocytosis. Metab: weight gain. MS: muscle weakness, hyperirritability,
rigidity. Neuro: tremors.

DRUG TO DRUG/FOOD INTERACTION:

Drug-Drug: May prolong the action of neuromuscular blocking agents. Increase risk of
neurologic toxicity with haloperidol or molindone. Diuretics, methyldopa, probenecid,
fluoxetine, and NSAIDs may increase risk of toxicity. Blood levels may be increase by
ACE inhibitors. Lithium may decrease effects of chlorpromazine. Chlorpromazine may
mask early signs of lithium toxicity. Hypothyroid effects may be additive with potassium
iodide or antithyroid agents. Aminophylline, phenothiazines,
and drugs containing large amounts of sodium increase renal elimination and decrease
effectiveness. Psyllium can increase lithium levels.
Drug-Natural Products: Caffeine-containing herbs (cola nut, guarana,mate, tea,
coffee) may decrease lithium serum levels and efficacy.
Drug-Food: Large changes in sodium intake may alter the renal elimination of
lithium. Increase sodium intake will increase renal excretion.

PATIENT/FAMILY TEACHING:
 Instruct patient to take medication as directed, even if feeling well. Take missed
doses as soon as remembered unless within 2 hr of next dose (6 hr if extended
release).
 Lithium may cause dizziness or drowsiness.
 Caution patient to avoid driving or other activities requiring alertness until
response to medication is known.
 Advise patient that psychotherapy is beneficial in improving coping skills.
 Low sodium levels may predispose patient to toxicity. Advise patient to drink
2000–3000
 ml fluid each day and eat a diet with consistent and moderate sodium intake.
Excessive amounts of coffee, tea, and cola should be avoided because of
diuretic effect. Avoid activities that cause excess sodium loss (heavy exertion,
exercise in hot weather, saunas).
 Notify health care professional of fever, vomiting, and diarrhea, which also cause
sodium loss.
 Advise patient that weight gain may occur. Review principles of a low-calorie diet.
 Instruct patient to consult health care professional before taking OTC
medications or herbal products concurrently with this therapy.
 Advise patient to use contraception and to consult health care professional if
pregnancy is suspected.
 Review side effects and symptoms of toxicity with patient. Instruct patient to stop
medication and report signs of toxicity to health care professional promptly.
 Explain to patients with cardiovascular disease or over 40 yr of age the need for
ECG evaluation before and periodically during therapy. Patient should inform
health care professional if fainting, irregular pulse, or difficulty breathing occurs.
 Emphasize the importance of periodic lab tests to monitor for lithium toxicity.

GENERIC NAME:
Propranolol
:
TRADE NAME:
Inderal

CLASSIFICATION:
Beta blockers

INDICATIONS:
Management of hypertension, angina, arrhythmias, hypertrophic cardiomyopathy,
thyrotoxicosis, essential tremors, pheochromocytoma. Also used in the prevention and
management of MI, and the prevention of vascular headaches.

MECHANISM OF ACTION:
Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and
uterine)-adrenergic receptor sites. Therapeutic Effects: Decreased heart rate and
blood pressure. Suppression of arrhythmias. Prevention of MI.
ROUTE/ DOSAGE:
 PO (Adults): Antianginal—80–320 mg/day in 2–4 divided doses or once daily as
extended/sustained-release capsules. Antihypertensive—40 mg twice daily
initially; may be increased as needed (usual range 120–240mg/day; doses up to
1 g/day have been used); or 80mg once daily as extended/sustained-release
capsules, increased as needed up to 120mg. InnoPran XL dosing form is
designed to be given once daily at bedtime. Antiarrhythmic—10–30mg 3–4 times
daily. Prevention of MI—180–240 mg/day in divided doses. Hypertrophic
cardiomyopathy—20–40mg 3–4 times daily. Adjunct therapy of
pheochromocytoma—20mg 3 times daily to 40 mg 3–4 times daily concurrently
with alpha-blocking therapy, started 3 days before surgery is planned. Vascular
headache prevention—20 mg 4 times daily or 80 mg/day as extended/sustained-
release capsules; may be increased as needed up to 240mg/day. Management
of tremor—40mg twice daily; may be increased up to 120 mg/day (up to
 320mg have been used).
 PO (Children): Antihypertensive/antiarrhythmic—0.5–1mg/kg/day in 2–4 divided
doses; may be increased as needed (usual range for maintenance dose is 2–
4mg/kg/day in 2 divided doses).
 IV (Adults): Antiarrhythmic—1–3mg; may be repeated after 2min and again in 4
hr if needed.
 IV (Children): Antiarrhythmic—10–100mcg (0.01–0.1mg)/kg (up to
1mg/dose);may be repeated q 6–8 hr if needed.

ADVERSE REACTIONS/SIDE EFFECTS:

CNS: fatigue, weakness, anxiety, dizziness, drowsiness, insomnia, memory loss,
mental depression, mental status changes, nervousness, nightmares. EENT: blurred
vision, dry eyes, nasal stuffiness. Resp: bronchospasm, wheezing. CV: arrhythmias,
bradycardia, CHF, pulmonary edema, orthostatic hypotension, peripheral
vasoconstriction. GI: constipation, diarrhea, nausea. GU: erectile dysfunction,
decreased libido. Derm: itching, rashes. Endo: hyperglycemia, hypoglycemia (increased
in children).MS: arthralgia, back pain, muscle cramps. Neuro: paresthesia. Misc: drug-
induced lupus syndrome.

DRUG TO DRUG/FOOD INTERACTION:

Drug-Drug: General anesthesia, IV phenytoin, and verapamil may cause
additive myocardial depression. Additive bradycardia may occur with digoxin. Additive
hypotension may occur with other antihypertensives, acute ingestion of alcohol,or
nitrates. Concurrent use with amphetamines, cocaine, ephedrine, epinephrine,
norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-
adrenergic stimulation (excessive hypertension, bradycardia). Concurrent thyroid
administration may decrease effectiveness. May alter the effectiveness of insulin or oral
hypoglycemics (dose adjustments may be necessary). May decrease effectiveness of
beta-adrenergic bronchodilators and theophylline. May decrease beneficial beta
cardiovascular effects of dopamine or dobutamine. Use cautiously within 14 days of
MAO inhibitor therapy (may result in hypertension). Cimetidine may increase blood
levels and toxicity. Concurrent NSAIDs may decrease antihypertensive action. Smoking
increase metabolism and decrease effects; smoking cessation may increase effects.

PATIENT/FAMILY TEACHING:
 Instruct patient to take medication as directed, at the same time each day, even if
feeling well; do not skip or double up on missed doses. Take missed doses as
soon as possible up to 4 hr before next dose (8 hr with extended-release
propranolol). Inform patient that abrupt withdrawal can cause life-threatening
arrhythmias, hypertension, or myocardial ischemia.
  Advise patient to make sure enough medication is available for weekends,
holidays, and vacations. A written prescription may be kept in wallet in case of
emergency.
 Teach patient and family how to check pulse daily and blood pressure biweekly.
Advise patient to hold dose and contact health care professional if pulse is <50
bpm or blood pressure changes significantly.
 May cause drowsiness or dizziness. Caution patients to avoid driving or other
activities that require alertness until response to the drug is known.
 Advise patients to change positions slowly to minimize orthostatic hypotension,
especially during initiation of therapy or when dose is increased.
 Caution patient that this medication may increase sensitivity to cold.
 Instruct patient to ask a health care professional before taking any OTC
medications or herbal products, especially cold preparations, when taking this
medication.
 Diabetic patients should closely monitor blood glucose, especially if weakness,
malaise, irritability, or fatigue occurs. May mask tachycardia and increased blood
pressure as signs of hypoglycemia, but dizziness and sweating may still occur.
 Advise patient to notify health care professional if slow pulse, difficulty breathing,
wheezing, cold hands and feet, dizziness, light-headedness, confusion,
depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
 Instruct patient to inform health care professional of medication regimen prior to
treatment or surgery.
 Advise patient to carry identification describing disease process and medication
regimen at all times.

REFERENCES:
 Medical-Surgical Nursing by Ignatavicius and Workman 5th edition Vol.2
 Drug Guide for Nurses by Davis 11th edition