HYPERTHYROIDISM - MEDICINES FOR THE TREATMENT OF HYPERTHYROIDISM

Definition

"Hyperthyroidism" is defined as a complex syndrome characterized by a marked overproduction of thyroid hormones: the thyroid gland used for the synthesis of T3 and T4 is overactive, consequently there is a significant acceleration of metabolism, especially in terms of oxygen consumption and production heat.

Causes

The underlying causes of hyperthyroidism are multiple: toxic (or hyperfunctioning) adenoma, excessive intake of thyroid drugs (generally for slimming purposes), toxic multinodular goiter, overproduction of TSH, Graves-Basedow's disease. hyperthyroidism is in women between the ages of 20 and 40, although the disease can affect anyone, and at any age.

Symptoms

The inexplicable increase in heart rhythm and sudden weight loss, associated with excessive sweating and swelling of the lymph nodes in the neck, are the typical onset symptoms of hyperthyroidism; These evident signs can also be accompanied by a series of more or less significant symptoms: alopecia, altered menstrual regularity and mood, decreased sexual desire, weakness, diarrhea, goiter, osteoporosis, intense thirst, tendency to irritability, tremors.

Medicines

The treatment of hyperthyroidism must be established according to the triggering cause, and can be purely pharmacological (makes use of the use of thyrostatic drugs), surgical (removal of a part or of the entire thyroid) or radioactive with iodine 131 (radiometabolic therapy) .
It is important to undergo a specialist check-up where symptoms are evident: postponing the diagnosis, in fact, could lead to unpleasant complications such as fibrillation, osteoporosis, neuro-psychiatric complications and, in the case of hyperthyroidism dependent on Graves-Basedow's disease, ophthalmopathy.
In pharmacological therapy, the assumption of thyrostatic drugs can be supported by the simultaneous administration of active ingredients (beta-blockers) useful for the control of symptoms such as tachycardia and mood alteration.

Before a thyroidectomy operation, the patient is generally treated with an iodine-based solution, called "Lugol's reagent", for a period of time ranging from 10 to 14 days, in combination with antithyroid drugs. This solution seems particularly useful before a thyroid excision operation, both to inhibit the synthesis of thyroid hormones, and to better compact the glandular parenchyma (which decreases the probability of bleeding during surgery).

The following are the classes of drugs most used in the therapy against hyperthyroidism, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Iodine 131: this substance represents the protagonist of metabolic radiotherapy, widely used to treat hyperthyroidism in surgically inoperable patients. The administration of radioactive iodine is also indicated for those patients suffering from cardiac disorders (heart disease), presenting relapsing forms of hyperthyroidism after thyroidectomy. The drug is generally taken by mouth, intramuscular and intravenous routes are rarely considered. The dose should be prescribed by the doctor after accurate diagnosis of the patient; the therapeutic effects of the drug are observed only after 4-5 weeks of treatment . Excessive doses of iodine 131 can cause the opposite effect, hypothyroidism: in the latter case, the hormonal alteration can be easily controlled through the daily (and life-long) intake of a drug, Levothyroxine sodium (eg . Eutirox) Do not take during pregnancy.

Methimazole or Thiamazole (eg Tapazole): in Italy, Metimazole is the drug of choice for the treatment of hyperthyroidism: the initial dose varies from 15 to 60 mg per day (divided into three doses); the maintenance dose is 1-15 mg per day.

Carbimazole (eg Carbothiroid): drug of choice for the treatment of hyperthyroidism in Britain. The drug should be taken for one or two years, given the high risk of relapse of hyperthyroidism post-discontinuation of the drug. This antithyroid active can cause itching and skin rashes of various degrees: the aforementioned side effects should not alarm excessively, as they can be kept under control by administering other targeted drugs (antihistamines).

Propylthiouracil (eg Propycil): to be used if the patient is sensitive or allergic to carbimazole. It is recommended to take the drug at the dose indicated by the doctor: excessive use of the drug can cause hypothyroidism. The drug belongs to the class of thionamides, and carries out its therapeutic action as an immunosuppressant: it is recommended to prolong the therapy for at least 12 months, to allow the drug to perform its therapeutic activity to the maximum and to reduce the likelihood of relapses of hyperthyroidism. Although the drug can also be administered to pregnant women, its use is still not recommended, unless it is serious or extreme cases: this drug, in fact, could cause fetal goiter and hypothyroidism in the unborn child.

Potassium iodide (eg Potas IO FN, available in tablets or oral solution): take orally 250 mg of the drug three times a day. Take the drug 10-14 days before surgery. It is possible to take the drug at a dosage of 2-6 drops at 5-10% (iodine solution) orally, three times a day, on a full stomach.

Potassium perchlorate (eg. Peritroid): potassium perchlorate is also widely used in therapy to treat hyperthyroidism (possibly associated with thyroid nodules). The drug is available in the form of 200 mg tablets: it is recommended to take 3 -4 tablets per day (600-800 mg), divided into three doses. The first benefits of this drug for the treatment of hyperthyroidism are on average appreciable after one month of treatment.