The Natural Thyroid Diet

Thyroid Factor

Thyroid Factor is a program that was created by Dawn Sylvester to help women deal with thyroid issues. Dawn Sylvester is a 57 years old lady that has worked with 1,000's of real women. She has over the time tried to investigate the underlying reason why majority of women lose energy and also struggle with belly fat and fatigue as they age. It is a comprehensive program thatcomprises of Thyro pause, 11 kinds of thyroid saving foods that will work to help you boost fat burning Free T3. The program also teaches you all the hidden causes of thyroid which are making you fat and later a highly reliable Thyroid reboot plan which is an excellent plan you need to tackle your weight. Additionally, there are tips to reduce bulging fat fast and eventually obtain a healthy body. You also get several bonuses all aimed at helping you solve all the problems that comes with being overweight. The three bonuses you get are 21 Day Thyroid weight loss system, 101 Thyroid boosting foods and Thyroid Jumpstart Guide. Read more...

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Thyroid function and iodine supply during pregnancy

During pregnancy, there are hormonal and metabolic changes that require an adaptation of thyroid function. A healthy pregnant woman can easily compensate for this change. The adaptation is an important prerequisite for normal embryonic and fetal development, and also for an uncomplicated pregnancy. The fetal thyroid begins to function at the end of the third month of pregnancy (Burrow 1994). Before that, the embryo is exclusively dependent on the thyroid supply via the mother. During pregnancy, the mother's need for iodine increases because the thyroid function of the fetus, as well as the mother, is dependent on a sufficient iodine supply.

Hypothyroidism triiodothyronine T3 and thyroxine T4

According to a recent study on 60 hypothyroid women (whose disease was only diagnosed after 12 weeks of pregnancy), hypothyroidism impaired the mental and motor capacities of their children, who were tested at the age of 2 years compared to children of euthyroid or only discrete hypothyroid women during pregnancy (Pop 2003). Haddow (1999) draws similar conclusions from his study on 60 children aged 7-9 years. Their mothers only suffered from discrete hypothyroidism during pregnancy. Based on these results, hypofunction of the thyroid should be diagnosed and treated for the benefit of Lhe developing unborn child. Regarding the risk of neonatal hypothyroidism after maternal thyrostatic therapy during pregnancy, sec section 2.15.7. Hormonally effective thyroid hormones are the L-forms of triiodothyronine (T3) and thyroxine (T4), which are only metaboli-cally active in a free, non-protein-bound form. T3 is the biologically effective hormone with a short period of effectiveness, while T4...

Thyroid Functions and Drugs Affecting Them

The thyroid gland, a 20 g tissue structure on the upper segment of the trachea, controls essential physiological function by its ability to make, store, and secrete two thyroid hormones. These functions include regulation of growth and general development, primarily by controlling DNA transcription and therefore protein synthesis. This in turn results in various enzymatic activities. Deficiencies in thyroid hormones have catastrophic effects in early life, the extremes of which can be manifested in cretinism by dwarfism and severe mental retardation. Another action is referred to as the calorigenic effect. This is evidenced by the increase in basal metabolic rates in organs such as the kidneys, heart, and liver, as well as in skeletal muscles. Valid mechanisms by which these effects can be satisfactorily explained have been elusive. Thermal regulation should be included in this area, as shown by the fact that thyroid secretions can be stimulated by a decrease in temperature....

Thyroid stimulating hormone TSH thyrotropin SED141489

Recombinant human TSH stimulates iodine uptake, and this facilitates the diagnosis and treatment of recurrent disease or metastases in the follow-up of differentiated thyroid cancer. It is used as an alternative to thyroid hormone withdrawal, to avoid symptomatic hypothyroidism (58r). Headache and nausea occur in 6-40 of

Thyroid hormones and thyroid receptor antibodies

L-thyroxine is used as a substitute in cases of hypothyroidism (at least 1 ng kg daily for adults), and, for this reason, is not problematic. The normal thyroid content of mother's milk is approximately 1 ng 1. An infant takes in about 0.15 ig kg in 24 hours this represents about 1 of a substitution dosage at this age (lOpg kg daily). This amount does not influence the thyroid function of a healthy infant. The same applies for treatment (substitution) of a maternal hypoparathyroidism. Thyroid receptor antibodies (TRAb) can result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis, Serum TRAb concentration in neonates decrease continuously with time after birth. The calculated half-life for offspring-serum and breast-milk TRAb was calculated as approximately 3 weeks and 2 months, respectively. Transient neonatal thyroid disease may be worse and more prolonged during breastfeeding as a consequence of TRAb in breast milk (Tbrnhage...

Drugs For Treating Hyperthyroidism

Hyperthyroidism results from excess production of thyroid hormones due to various reasons. Treatment of the resulting thyrotoxicosis (Basedow's disease) consists of using drugs that inhibit excess synthesis of hormones, as well as using radioactive iodide in order to disrupt or remove thyroid gland follicles with excess activity. Drugs used for hyperthyroidism can be classified as drugs that suppress thyroid hormone synthesis in the anterior lobe of the hypophysis, and they consist of diiodotyrosine and iodine, as well as drugs that suppress thyroid hormone synthesis in thyroid glands (propylthiouracil, methylthiouracil, methimazole, and carbimazole). Thioamides are reducing agents. They inhibit thyroid hormone synthesis by inhibiting the peroxidase enzymatic system, which catalyzes oxidation of iodide ions and iodine that are consumed in food, which is necessary for iodination of tyrosine derivatives. Thus they reduce the concentration of free iodine necessary to react with tyrosine...

Hyperthyroidism and thyrostatics

An uncontrolled hyperthyroidism of a pregnant woman is a risk for the outcome of pregnancy and the fetus fetal growth retardation, pre-eclampsia, prematurity, and intrauterine death or stillbirths occur more often (Glinoer 1997). In cases of Graves' disease or Hashimoto thyroiditis - the latter usually results in hypothyroidism - the maternal auto-antibodies should be tested at the beginning of pregnancy and early in the third trimester. A high concentration, especially of TSH-receptor antibodies (TRAb), is often correlated with a diaplacental transfer of these antibodies. It is estimated that 1-2 of pregnancies with Graves' disease result in a transient hyperthyroidism of the fetus or newborn, respectively (Carrol 2005). A recently published prospective study on 115 pregnant women reports a much higher rate of 12.6 of fetal neonatal hyperthyroidism (Rosenfeld 2005). Propylthiouracil has a higher protein-binding than the other thyrostatic substances, and presumably a lower placental...

Thyroid Hormone and Antithyroid Drugs

Endogenous iodine-containing thyroid hormones L-thyroxine and L-triiodothyronine are produced by the thyroid gland, which exhibits pronounced metabolic control over practically every cell in the body using the two mentioned iodine-containing hormones. By controlling the rate of oxidative cellular processes, these hormones take part in regulation of growth and development of the organism, formation of bone marrow and bone tissue they affect activity of the CNS, cardiovascular system, gastrointestinal tract, metabolism of carbohydrates, fats, and proteins they have an effect on regulation of body temperature, muscle activity, water-electrolyte balance, and reproduction, playing an extremely important role in normal physical and mental development. Unlike many other hormones, they exhibit a diffusive effect on the whole organism, not on individual organs. Synthesis, storage, and release of thyroid hormones by the thyroid gland are primarily regulated by the thyrotropin hormone, while the...

Thyroid function tests

Artefactual increases of as much as 50 in total thyroxine, estimated by a competitive protein-binding assay, and of as much as 30 in triiodothyronine resin uptake are probably due to rapid and continuing lipolytic hydrolysis of triglycerides after blood has been drawn (126). Thyroid function tests should therefore always be performed on blood samples taken before (or a sufficient time after) heparin treatment (127). An increase in serum-free thyr-oxine concentrations has also been reported after low molecular weight heparin, by up to 171 in specimens taken 2-6 hours after injection. When specimens were obtained 10 hours after injection, the effects were smaller, but with concentrations still up to 40 above normal the results can still cause errors of interpretation (128).

Thyroid Disorder and Drug Metabolism

Patients with thyroid disease may have an altered response to drugs. Thyroxin is a potent activator of the cytochrome P450 enzyme system, and hypothyroidism is associated with inhibition of hepatic oxidative metabolism of many drugs. Croxson et al. (82) measured serum digoxin concentration using a radioimmunoassay in 17 hyperthyroid and 16 hypothyroid patients and observed significantly lower levels of digoxin in patients with hyperthyroidism and significantly higher levels of digoxin in patients with hypothyroidism. Although there is a general conception that serum phenytoin clearance is not affected by thyroid function state, Sarich and Wright (83) reported a case where a 63-year-old female, who developed decreased serum level of free T4, showed phenytoin toxicity that may be related to decreased cytochrome P450-mediated hydroxylation of phenytoin. Another case report also indicated phenytoin intoxication induced by hypothyroidism. A 42-year-old woman with a 29-year history of...

Thyroid Hormones

AKA Cytomel, Dextrothyroxine, Eltroxin, Euthroid, Levoid, Levothroid, Levothyroxine, Levoxyl, Liotrix, Liothyronine, Proloid, Synthroid, Thyroglobulin, Thyroid, Thyrolar, Thyroxine. Effects A class of drugs that mimic the hormone produced in the thyroid gland. Subclinical hypothyroidism, or a slightly underfunctioning thyroid, can be one reason for poor concentration, mental confusion, and memory disturbances . The condition is also characterized by such symptoms as cold hands and feet, menstrual problems, dry skin, thin hair, and low energy levels. It is little-known and often overlooked by doctors. Precautions Any thyroid drugs should be taken only under the guidance of a physician. Common symptoms include tremors, headaches, irritability, insomnia, changes in appetite, diarrhea, leg cramps, menstrual irregularities, fever, heat sensitivity, unusual swelling, weight loss, and nervousness. Less frequent symptoms include hives, rash, vomiting, chest pain, heartbeat irregularities, and...

Antithyroid drugs

THYROID HORMONES (SED-14, 1485 SEDA-23, 451 SEDA-24, 484 SEDA-25, 503) Drug abuse Abuse of thyroid hormones can have adverse effects. A 61-year-old woman who, as well as being hy-pothyroid, had celiac disease and a history of bowel resection for pancreatic cancer, was eu-thyroid taking thyroxine 175-188 g day (4A). However, when she simultaneously took calcium carbonate (1250 mg day) she had a raised serum thyrotropin (TSH) concentration of 41 mU l. Delaying calcium carbonate ingestion by 4 hours returned her serum TSH concentration to high normal (5.7 mU l) within a month. and arthralgia. Fatal hepatitis and hepatic necrosis have been described, but severe liver injury is believed to be rare, with only 20 reported cases up to 1993 (9AC). In contrast, subclinical hepatic dysfunction, characterized by a rise in hepatic enzymes, may be common and does not necessitate propylthiouracil withdrawal in the absence of symptoms (9AC). In a retrospective review of 497 patients treated for...

Thyroid

Propranolol inhibits the conversion of thyroxine (T4) to tri-iodothyronine (T3) by peripheral tissues (173), resulting in increased formation of inactive reverse T3. There have been several reports of hyperthyroxinemia in clinically euthyroid patients taking propranolol for non-thyroid reasons in high dosages (320-480 mg day) (174,175). The incidence was considered to be higher than could be accounted for by the development of spontaneous hyperthyroidism, but the mechanism is unknown. The effect of beta-adrenoceptor antagonists on thyroid hormone metabolism is unlikely to play a significant role in their use in hyperthyroidism. Since D-propranolol has similar effects on thyroxine metabolism to those seen with the racemic mixture, membrane-stabilizing activity may be involved (176). In one case, beta-adrenoceptor blockade masked an unexpected thyroid crisis, resulting in severe cerebral dysfunction before the diagnosis was made (177).

Drug Metabolism and Clearance in Pregnancy

During pregnancy, the thyroid is hyper-stimulated resulting in changes in thyroid hormone concentrations. Gestational age-specific reference intervals are now available for thyroid function tests. Knowledge of expected normal changes in thyroid hormone concentrations during pregnancy allows individual supplementation when needed (98). Hypothyroidism is common in pregnancy, and therapeutic drug monitoring of antithyroid drugs is important. Consistently lower serum concentrations of propy-lthiouracil were observed in pregnant women compared with that in non-pregnant women (99).

Second Generation Effects Teratogenicity

The major adverse effect on the fetus is altered thyroid function (SEDA-13, 141) (SEDA-14, 149) (SEDA-19, 194) (SEDA-20,176). There have been individual reports of neonatal hyperthyroxinemia (219), goiter (216), and hypothyroidism (220). In the patient with goiter there was associated hypotonia, bradycardia, large fontanelles, and macroglossia (216).

Interference with Diagnostic Tests Serum creatinine

Thyroid function tests Amiodarone causes altered thyroid function tests, with rises in serum concentrations of T4 and reverse T3 and a fall in serum T3 concentration (267). This is due to inhibition of the peripheral conversion of T4 to T3, causing preferential conversion to reverse T3. These changes can occur in the absence of symptomatic abnormalities of thyroid function.

Syndromes of Anxiety and Their Treatment

Biological Causes of Anxiety It is important to rule out any medical causes of anxiety. Thyroid disorders, hypoglycemia, Cushing's disease, and pheochromocy-toma, a rare tumor of the adrenal gland, can cause symptoms similar to anxiety. You should consider a medical exam if your anxiety does not have an obvious cause.

Animal and in vitro toxicology

In further studies rats were treated with doses of THC up to 50 mg kg and mice with up to 500 mg kg 5 times a week for 2 years in a standard carcinogenicity test (9). After 2 years, more treated animals had survived than controls, probably because the treated animals ate less and had lower body weights. The treated animals also had a significantly lower incidence of the various cancers normally seen in aged rodents in testes, pancreas, pituitary gland, mammary glands, liver, and uterus. Although there was an increased incidence of precancerous changes in the thyroid gland in both species and in the mouse ovary after one dose (125 mg kg), these changes were not dose-related. The conclusion was that there was no evidence of carcinogenic activity of THC at doses up to 50 mg kg.'' This was also supported by the failure to detect any genetic toxicity in other tests designed to identify drugs capable of causing chromosomal damage. For example, THC was negative in the so-called Ames test,''...

Other features of the patient

Thyroid disease Apart from the pharmacokinetic differences in thyroid disease (mentioned above), there may also be changes in tissue responsiveness, with reduced sensitivity in hyperthyroidism and the reverse in hypothyroidism (145). The reasons for these changes are not known, but

Syndromes of Depression and Their Treatment

Thyroid disorders, anemia, cancer, Alzheimer's disease, and Epstein-Barr virus infections can lead to depression, so you should consider a physical examination and appropriate laboratory work before starting treatment. Ideally, your depression will resolve when you obtain treatment for your medical problem, although you may require treatment with antidepressants indefinitely if you have Alzheimer's or Parkinson's disease. If you have tried several antidepressants without benefit, consider augmentation. Augmentation with lithium or thyroid supplementation has helped some people. Augmentation strategies include using two antidepressants of different classes at the same time. A combination of a TCA and an SSRI has helped many people. Some combinations of antidepressants should not be taken because they can cause severe side effects. For example MAO inhibitors should not be combined with TCAs or SSRIs because of the potential for life-threatening reactions. Two SSRIs should not be taken...

The Endocannabinoid System

CB1 receptor in the thyroid gland. CB1 receptor expression during the late embryological stages of the rat thyroid was found to be very high (55), whereas lower but still detectable levels of CB1 receptor mRNA and protein were present in the adult rat gland distributed in both follicular and parafol-licular cells as demonstrated by IHC (56).

Lithium and other moodstabilizers antimanic agents

Some authors recommend controlling thyroid function in both the pregnant woman and the neonate (Frassetto 2002. Llewellyn 1998). Recommendation. Exposure to lithium is not an indication for termination of pregnancy. Women who need lithium therapy may continue the drug during pregnancy, but they should be closely monitored. Lithium should be given in small, divided doses (i.e. slow-release preparations). Monthly monitoring of maternal serum levels of lithium is recommended, weekly during the last month of pregnancy, and every 2 days perinatally. If necessary, the dose should be adjusted. Salt-restricted diets and diuretics should be avoided. A detailed fetal echocardiography should be offered. Ultrasound monitoring may control for polyhydramnios. Lithium should be decreased or discontinued when delivery is expected, and reinstituted immediately after delivery. The thyroid function in both the pregnant woman and the neonate should be controlled, as well as toxic symptoms in the neonate....

Hypothalamic releasing hormones

Synthetic analogs are protirelir( l) corticorelii lJiH controls thyroid function via the thyroid-stimulating hormone (TSH), and also stimulates prolactin secretion. There is evidence that TRH exerts a significant relaxant effect in human myometrium and in human umbilical vasculature. These effects could have clinical implications in treated pregnant women (Potter 2004). Some authors have suggested that TRH added to prenatal glucocorticoids in women at risk of preterm delivery could reduce pulmonary problems and neonatal lung disease. Nevertheless, some studies and an extensive review of the literature published on this topic, with over 4600 women analyzed, concluded that prenatal TRH in addition to corticosteroids did not reduce the risk of neonatal respiratory diseases, but can produce adverse effects in both women and their infants (Crowther 2004, 1997, Ballard 1998). Some authors described an association between maternal treatment with TRH and delay in mental development in...

AGlucosidase Inhibitors

These drugs are Pregnancy Category B drugs and safety for use during pregnancy has not been established. Digestive enzymes may reduce the effect of miglitol. The effects of acarbose may increase when the agent is administered with the loop or thiazide diuretics, glucocorti-coids, oral contraceptives, calcium channel blockers, phenytoin, thyroid drugs, or the phenothiazines. Miglitol may decrease absorption of ranitidine and propranolol.

Pregnancy Category C

Levorphanol can cause dangerous and even fatal breathing difficulty. For that reason medical personnel are supposed to carefully adjust dosage to a patient's individual needs rather than depend upon customary amounts of the drug being safe. It is supposed to be used with special caution in patients with asthma, low thyroid function, urinary difficulty, or an enlarged prostate. Wariness is also prudent when using the substance to reduce heart pain, because the drug's influence on cardiac function has not been confirmed. The substance can lower blood pressure and may produce nausea, vomiting, and constipation. Levorphanol can make users woozy and harm skills needed for operating a car or other dangerous machinery. Although levorphanol is a depressant in humans, it increases leg activity in ponies an effect that may not have escaped notice by persons seeking ways to improve the animals' performance in races.

HoloRarrxr Complexes Interact with Two Classes of Transcriptional Coactivators

Interaction of the HAT coactivatorcomplex with the ligand-activated receptors is apparently transient as dissociation is believed to occur as a result of acetylation of one or more coactivators on lysine residues adjacent to the signature LXXLL motif (187). Subsequently, the activated receptor presumably recruits a second class of multi-protein, transcriptional coactivator complexes to the template, and this latter complex, referred to as the thyroid hormone receptor-associated protein (TRAP)

Comparative studies

In a randomized comparison of recombinant interferon alfa-2b and interferon alfa n-3 (9 MU week for 1 year) in 168 naive patients with chronic hepatitis C, there was no significant difference in clinical outcomes and the incidence or type of adverse effects between the groups (9). There was a non-significant trend toward more severe leukopenia and a higher incidence of severe thyroid disorders in patients who received recombinant interferon alfa-2b.

General adverse effects

Of interferon alfa are very similar (SEDA-21, 369) (SEDA-22, 399), but they differ with the dose, schedule of administration, and the disease. At least 4-5 of patients with chronic hepatitis C had to discontinue treatment because of adverse effects, and dosage reduction was required in 9-22 of those receiving 9-15 MU week (15). In a large retrospective evaluation of 11 241 patients with chronic viral hepatitis, the incidence of fatal or life-threatening adverse effects related to interferon alfa was one in 1000 events included irreversible liver failure, severe bone marrow depression, and attempted suicide (16). Overall, severe adverse effects were observed in 1 of patients, and comprised mostly thyroid disorders, neuropsychiatric manifestations, and cutaneous adverse effects. In other studies in patients with chronic hepatitis, the incidence of major adverse effects was 25 in 659 patients (17) in Japan, dosage reduction or withdrawal was necessary in 31 of 987 patients receiving...

Contraindications

Thyroid hormones are used as replacement therapy when the patient is hypothyroid. By supplementing the decreased endogenous thyroid production and secretion with exogenous thyroid hormones, an attempt is made to create a euthyroid (normal thyroid) state. Levothyroxine (Synthroid) is the drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosages, and has a more uniform potency than do other thyroid hormone replacement drugs. Thyroid hormones are also used in the treatment or prevention of various types of euthyroid goiters (enlargement of the thyroid gland), including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto's), and multinodular goiter and in the management of thyroid cancer. The hormone may be used with the antithyroid drugs to treat thyrotoxicosis. Thyroid hormones also may be used as a diagnostic measure to differentiate suspected hyperthyroidism from euthyroidism.

Adverse Reactions

These drugs are contraindicated in patients with known hypersensitivity to the drug or to any constituents of the drug, after a recent myocardial infarction (heart attack), or in patients with thyrotoxicosis. When hypothy-roidism is a cause or contributing factor to a myocardial infarction or heart disease, the physician may prescribe small doses of thyroid hormone.

Promoting an Optimal Response to Therapy

Thyroid hormones are administered once a day, early in the morning and preferably before breakfast. An empty stomach increases the absorption of the oral preparation. Levothyroxine (Synthroid) also can be given intravenously and is prepared for administration immediately before use. The dosage is individualized to the needs of the patient. The dose of thyroid hormones must be carefully adjusted according to the patient's hormone requirements. At times, several upward or downward dosage adjustments must be made until the optimal therapeutic dosage is reached and the patient becomes euthyroid.

Ongoing Assessment

The full effects of thyroid hormone replacement therapy may not be apparent for several weeks or more, but early effects may be apparent in as little as 48 hours. During the ongoing assessment, the nurse monitors the vital signs daily or as ordered and observes the patient for signs of hyperthyroidism, which is a sign of excessive drug dosage. Signs of a therapeutic response include weight loss, mild diuresis, a sense of well-being, increased appetite, an increased pulse rate, an increase in mental activity, and decreased puffiness of the face, hands, and feet.

Gerontologic Alert

Older adults are more sensitive to thyroid hormone replacement therapy and are more likely to experience adverse reactions when taking the thyroid hormones. In addition, the elderly are at increased risk for adverse cardiovascular reactions when taking thyroid drugs. The initial dosage is smaller for an older adult, and increases, if necessary, are made in smaller increments during a period of about 8 weeks. Periodic thyroid function tests are necessary to monitor drug therapy. Dosage may need to be reduced with age. If the pulse rate is 100 bpm or more, the nurse notifies the primary health care provider before the drug is administered.

Educating the Patient and Family

Thyroid hormones are usually given on an outpatient basis. The nurse emphasizes the importance of taking the drug exactly as directed and not stopping the drug even though symptoms have improved. The nurse provides the following information to the patient and family when thyroid hormone replacement therapy is prescribed The dosage of this drug may require periodic adjustments this is normal. Dosage changes are based on a response to therapy and thyroid function tests. Therapy needs to be evaluated at periodic intervals, which may vary from every 2 weeks during the beginning of therapy to every 6 to 12 months once symptoms are controlled. Periodic thyroid function tests will be needed.

Drug Drug Interactions General

There is reason to anticipate problems if the resin is given along with acidic drugs and some other drugs that have a narrow safety margin, such as oral anticoagulants (coumarins), cardiac glycosides, and thyroid hormones (thyroxine, triiodothyronine). Interference with the absorption of other acidic drugs, including the barbiturates, naproxen, phenylbutazone and its congeners, and the thiazide diuretics, can almost certainly occur, but is of little or no clinical importance, since the doses of these drugs can easily be adjusted as time goes by, to allow for any reduction in absorption, or alternative drugs can be

Pregnancy Category D

Mephobarbital is to be avoided if a person has porphyria, a disease reflecting a body chemistry disorder and in which a person may be harmed by exposure to light. The drug should also be avoided if a person has a muscle-weakening disease called myasthenia gravis, or a thyroid deficiency causing an affliction called myxedema.

Iodinecontaining contrast media

The amount of free iodine in the contrast medium is less than 0.1 of the total. The amount of the free iodide depends on the compound, and can increase during storage. The Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature and developed guidelines (Webb 2005). Free iodide can reach the fetal thyroid and be stored there. The danger with iodine in excess is transient fetal hypothyroidism, particularly from the twelfth week of pregnancy onward, when the fetal thyroid starts its endocrine function (Webb 2005). Recommendation. In particular during the second and third trimesters, iodine-containing contrast agents should only be used for compelling diagnostic indications. Neonatal thyroid function should be checked carefully during the first week.

Contraindications Precautions And Interactions

When xanthine bronchodilators are administered with sympathomimetic drugs (see Chap. 22), additive CNS and cardiovascular effects may occur. If a patient eats large amounts of charcoal-broiled foods while taking the xanthines, a decrease in the therapeutic effect of the xanthines may occur. Certain foods contain xan-thine (eg, coffee, colas, or chocolate) and may increase the risk of cardiac and CNS adverse reactions. Cigarettes, nicotine gum and patches, barbiturates, phenytoin, loop diuretics, isoniazid, and rifampin may decrease the effectiveness of the xanthines. There is an increased risk of xanthine toxicity when the drugs are administered with influenza vaccination, oral contraceptives, glucocorticoids, p-adrenergic blockers, cimeti-dine, macrolides, thyroid hormones, or allopurinol.

General Information

Pentagastrin is a short peptide that stimulates the production of gastric acid from the stomach by a direct action on gastrin receptors and of calcitonin from thyroid C cells (1). It also acts on cholecystokinin receptors centrally and stimulates the release of adrenocorticotropin (ACTH) and hence the production of glucocorticoids (2). Pentagastrin was originally used to test for suppression of gastric acid in patients who had had a vagotomy, and has been used to study gastric physiology and to test the effects of drugs that inhibit gastric acid secretion. It has also been used in the diagnosis of medullary carcinoma of the thyroid because it stimulates the production of calci-tonin.

Bile Acid Sequestrants

The bile acids sequestrants, particularly cholestyra-mine, can decrease the absorption of numerous drugs. For this reason, the bile acid sequestrants should be administered alone and other drugs given at least 1 hour before or 4 hours after administration of the bile acid sequestrants. There is an increased risk of bleeding when the bile acid sequestrants are administered with oral anticoagulants. The dosage of the anticoagulant is usually decreased. The bile acid sequestrants may bind with digoxin, thiazide diuretics, penicillin, propranolol, tetracyclines, folic acid, and the thyroid hormones, resulting in decreased effects of these drugs.

Second Generation Effects Pregnancy

Routine vaginal douching with povidone-iodine during pregnancy causes maternal iodine overload and markedly increases the iodine content in amniotic fluid and of the fetal thyroid, as soon as the trapping mechanism of iodine by the thyroid has started to develop. Vaginal use of povidone-iodine is therefore not recommended during pregnancy (34,35) and labor (36). The fetal thyroid starts to store iodine between the 10th and 13th weeks of gestation, and to secrete thyroid hormone between the 18th and 24th weeks. Especially after intravaginal administration during pregnancy, povidone-iodine can cause congenital goiter and hypothyroidism in newborn infants. However, hyperthyroidism can also occur. In 99 of 9320 newborns, TSH concentrations were above the reference range (20 mU ml) on the fifth day of life, but between the 10th and 21st day, all these infants had normal TSH concentrations and normal thyroid function (37). In 76 of the newborns with hyperthyrotropine-mia, urinary iodine...

Peripheral Endocrine Tissues

Thyroid CB1 receptor mRNA has been detected in rat thyroid gland (Buckley et al., 1998 Porcella et al., 2002). Moreover, immunohistochemical localization demonstrated positive staining of CB j receptor in both follicular and parafollicular cells of the thyroid. Treatment of rats with WIN55212 significantly increases serum levels of the thyroid hormones 3,5,3-tri-iodothyonine (T3) and thyroxine (T4), in the absence of change in pituitary TSH release (Porcella et al., 2002). Moreover, CP55940 and anandamide were shown to decrease activity of thyroid parafollicular cells and calcitonin release (Winnicka et al., 2003). These studies support a direct effect of cannabinoid on rat thyroid hormonal activity.

Iodine And The Iodides

Thyroid disease and the heart. Heart 2000 84 455-60. 8. Fukata S, Kuma K, Sugawara M. Granulo-cyte colony-stimulating factor (G-CSF) does not improve recovery from antithyroid drug-induced agranulocytosis a prospective study. Thyroid 1999 9 29-31. 13. Meister LH, Guerra IR, Carvalho GD. Images in thyroidology. Vasculitis secondary to treatment with propylthiouracil. Thyroid 2001 11 199-200.

Placebocontrolled studies

In a double-blind, placebo-controlled study in 288 patients with previously treated erosive or ulcerative gastro-esophageal reflux disease rabeprazole 10 or 20 mg day was significantly more effective than placebo in preventing relapse of erosive or ulcerative gastro-esophageal reflux disease and was well tolerated (10). Commonly reported adverse events were abdominal pain, nausea, diarrhea, rhinitis, pharyngitis, a flu-like syndrome, and back pain. Rabeprazole had no clinically significant effects on laboratory values, thyroid function tests, the electrocardiogram, vital signs, or body weight.

Drug Administration Drug dosage regimens

There are two general patterns of use of antithyroid drugs monotherapy with progressive reduction in dosage during recovery from hyperthyroidism and a higher dosage of antithyroid drugs complemented by thyroid replacement therapy to avoid hypothyroidism. There is no convincing evidence for a better short-term or long-term control of Graves' disease with either form of therapy, but combination therapy followed by monotherapy with levothyroxine increased the remission rate

Organs and Systems Cardiovascular

Overdosage of thyroid hormones causes tachycardia or palpitation but can also cause several types of dysrhyth-mia, for example atrial fibrillation. Evidence from the Framingham population that suppression of serum TSH is a susceptibility factor for atrial fibrillation has heightened concern that subclinical hyperthyroidism secondary to levothyroxine can also cause atrial fibrillation (14). Five women who reported frequent bouts of palpitation were investigated while taking levothyroxine and again after levothyroxine withdrawal (15). There was a clear increase in mean 24-hour heart rate during levothyroxine treatment, as well as an increase in atrial extra beats and the number of episodes of re-entrant atrioventricular nodal tachycardia. Four of these patients had evidence of abnormal conduction pathways, even when they were not taking levothyroxine, as evidenced by a short PR interval, but exacerbation of atrial dysrhythmias in these predisposed subjects is consistent with the view...

Drug Administration Drug overdose

Inadvertent excessive use of thyroid hormones (for example, by eating ground beef contaminated with thyroid hormones (40), the incorrect use of these drugs for the treatment of obesity (41), excessive thyroid substitution therapy, and factitious use of thyroid hormones for psychiatric reasons (42)) result in mild hyperthyroidism, but serious short-term adverse effects are rare. Overdosage of levothyroxine causes increased metabolism resulting in increased heat production, with increased sweating and weight loss despite normal or even increased appetite. Accidental or suicidal injection of large amounts of thyroid hormones is exceptional (43). Clinical symptoms do not necessarily correlate well with plasma T4 concentrations and range from anxiety, confusion, or coma to tachycardia, atrial fibrillation, and angina. At least three lethal cases have been reported (SEDA-8, 371). Treatment of thyroid overdosage is not standardized and can include gastric lavage, sedatives, beta-blockers,...

Monitoring Therapy

Some diseases (liver disease, kidney disease, and malnutrition) interfere with the transport or metabolism of thyroid hormones and thereby alter thyroid function tests. Several drugs (for example amiodarone, androgens, glu-cocorticoids, phenytoin, and salicylates) interfere with the transport or metabolism of thyroid hormones and thereby alter thyroid function tests. These have been reviewed (61). In patients taking levothyroxine serum TSH rises after treatment with sertraline (62) and antimalarial prophylaxis with chloroquine and proguanil (SEDA-22, 469).

History and Recent Therapeutic Uses

Naked pDNA was the first instance where the skeletal muscle was transfected (1). Since then, a variety of tissues had been transfected with direct gene transfer. Naked pDNA had been injected into the interstitial space of liver (2-4), thyroid (5), heart muscles (6), brain (7), and urological organs (8). The naked DNA containing one or more anticancer genes were also injected in various tumors with mixed efficacy (9-11). Non-viral gene therapy had become a useful tool in generating various therapeutic effects in diverse animal models. One of these -effects is to induce anticancer response in tumor models by introducing anticancer genes. In an effort to elicit anticancer effect in tu-morogenic cells implanted in medullary thyroid cancer (MTC) rat-xenografts, NO synthase II (NOS II) gene, which catalyzes nitric oxide (NO) production, was incorporated in a plasmid under the control of CMV promoter and injected in the rat. The gene triggered a suicidal effect (apoptc s) on the tumor cells...

Gene Delivery for Myocardial Diseases

Kitsis et al. (41) have demonstrated that the tissue-specific promoter chimeras injected into the heart could respond accurately to shift in thyroid hormone levels in vivo. Injection of pDNA with gene constructs driven by cellular promoters resulted in detectable levels of reporter gene activities. The cellular promoter was derived from the rat a-myosin heavy.chain (a -MHC) gene whose expression in vivo is restricted to cardiac muscle and is positively regulated by thyroid hormone. This method proved valuable to identify the regulatory portion of genes expressing specifically in cardiac muscles. Direct DNA injection had been extended to evaluate and characterize the activation properties of a cardiac-specific promoter enhancer of the slow cardiac troponin C (cTnC) gene that express in cardiac striated muscles (42). Myocardial direct DNA injection was also used to analyze the tran-scriptional regulation of brain creatine kinase (BCK) gene in the heart (43). pDNA constructs containing...

Antiseptics and disinfectants

When povidone iodine is used as a local disinfectant on intact skin, on wounds and on the mucosa as well as in body cavities, iodine transfer to the fetus must be assumed. This can lead to functional disturbances in the fetal thyroid gland. The intake of iodine from a vaginal douche during labor can lead to a temporary TSH-increase in the newborn's blood - a sign of transient hypothyroidism (Weber 1998). This should be considered in the interest of the undisturbed thyroid status necessary for central nervous system differentiation. Retrospective evaluation of children born to mothers who applied iodine vaginal douching did not show indications of teratogenic effects (Czeizel 2004). However, this study did not identify the time of exposure or usage during pregnancy.

Medical And Behavioral Toxicity Overview

Alcoholic liver disease may also produce femi-nization in men, as a result of impaired metabolism (breakdown) of female sex hormones such as estrogen. Signs of such feminization in men include gynecomastia (enlarged breasts) and female fat distribution. In women who drink alcohol excessively, there is a high prevalence of gynecologic disorders (missed periods and problems in functioning of ovaries) and a possibly earlier onset of menopause than in nondrinkers. In women alcohol is metabolized at different rates according to the particular phase of the menstrual cycle. Other hormonal effects have been described in association with acute alcohol ingestion, including the impaired release of growth hormone and increased release of prolactin, a hormone involved in milk production. Thyroid function, which controls the body's rate of metabolism, can be indirectly affected as a result of alcoholic liver disease. This effect occurs from impaired conversion of T4 (a form of thyroid hormone) to...

Soporific Agents Hypnotics and Sedative Drugs

Insomnia is a symptom, and its proper treatment depends on finding the cause of sleeplessness and treating the underlying etiology. The most common type of insomnia is transient insomnia due to acute situational factors. The typical factor is stress. Chronic insomnia is most commonly caused by psychiatric disorders. Numerous medical disorders can cause insomnia. Many drugs have been implicated as causing insomnia alcohol, antihypertensives, antineoplastics, -blockers, caffeine, corticosteroids, levodopa, nicotine, oral contraceptives, phenytoin, protriptyline, selective serotonin reuptake inhibitors (SSRIs), stimulants, theophylline, and thyroid hormones. The underlying cause or causes of insomnia should be treated whenever possible. The primary indication for use of hypnotic agents in patients with insomnia is transient sleep disruption caused by acute stress.

Use Of Endocannabinoidbased Substances In Animal Models Of Disorders

To investigate the possible use of endocannabinoid-based drugs against cancer cell proliferation, very recently experiments were carried out in our laboratory in an in vivo model of tumor growth. The experiments consisted of injecting rat thyroid cells transformed into malignant cells by the H-ras oncogene into athymic mice and measuring the size of the thyroid carcinoma subsequently formed under the mouse skin during the following three weeks. The test substances or the corresponding vehicles were injected twice a week for three weeks, and changes in tumor size caused by direct or indirect agonists of cannabinoid receptors were quantified (Bifulco et al., 2001). Using this protocol, we found that a metabolically stable AEA analog and a rather selective CBj receptor agonist, met-fluoro-anandamide, when administered intratumor at a relatively low dose (0.5 mg kg), exerts a potent as well as CBj-mediated tumor-growth inhibitory effect (Bifulco et al., 2001). Most importantly, we now...

Long Term Effects Drug abuse

There is a high prevalence of the use of amfetamine-like drugs in Brazil, particularly among women, owing to the culture of slimness as a symbol of beauty'' (74). Of 2370 subjects in Sao Paulo and Brasilia, 72 had already undergone from one to more than 10 previous courses of treatment, usually with amfetamine-like anor-ectic drugs. Over half of them had taken amfetamine-like drugs in compound formulations containing four or more substances, such as benzodiazepines and or laxatives, diuretics, and thyroid hormones. There were adverse reactions to the amfetamine-like drugs in 86 and 37 sought medical advice 3.9 required hospita-lization. The authors argued the need for more rigorous legislation and enforcement strategies to stop such misuse of drugs.

Vitamin Uptake and Metabolism

Like the retinoic acid receptors, the vitamin D receptor is a nuclear receptor belonging to the steroid hormone superfamily of nuclear receptors, which includes receptors for estrogen, glucocorticoids, thyroid hormones, and retinoic acid. There are at least 50 genes that respond to hydroxylated calciferols regulating calcium release and uptake and cell division. 3.2.3.1 Calcium Regulation. There are at least three hormones that regulate calcium metabolism, parathyroid (PTH), calcitonin, and l,25(OH)2. Bone is the principal calcium reservoir and is a dynamic tissue, with calcium being released and deposited. New calcium comes from our diet, and excess serum calcium is excreted through the kidneys. In response to low serum calcium levels, PTH stimulates the hydroxylation of 25(OH)D3, leading to formation of calcium transport protein and activation of osteoclast cells required to release calcium from bone. PTH also inhibits calcium excretion by the kidney....

Compounds Acting On Other Proteins Of The Nuclear Receptor Superfamily Retinoids

Including the vitamin D receptors, thyroid hormone receptors, and peroxisome proliferator activating receptors (PPARg). The RAR-RXR heterodimers bind to specific DNA sequences, known as retinoic acid response elements (RARE). In the absence of ligands, the heterodimer-DNA complex is linked to corepressors and histone deacetylases, inducing chromatin compaction and silencing the promoter region of the target genes (gene repression). The binding of ligands to the hetero-dimers induces a conformational change that destabilizes the interaction with core-pressors and allows the union to coactivators, leading to gene transcription (Fig. 3.30).

Leucaena leucocephala Lamk de

Progression in mammalian cells cultured in vitro in phase G1 and is used as a synchronization agent. The precise mechanism by which mimosine disrupts cellular proliferation remains controversial, and it has also been suggested that it blocks cell cycle progression by chelating iron (Fe2+) from iron-dependent enzymes such as ribonucleotide reductase (Kulp KS et a ., 1996 Fig. 156). A single intragastric dose of mimosine to mice inhibits the intake of iodine 125 by the thyroid at the iodine-binding step (Hegarty MP etal., 1979).

Susceptibility Factors

Pre-existing cardiac disease and long-standing hypo-thyroidism carry serious risks. Adrenal insufficiency can be associated with hypo-thyroidism (either by autoimmune destruction or due to hypophyseal disease) and carries the risk of acute Addisonian crisis if thyroid substitution precedes gluco-corticoid therapy. The diagnostic problem presented by the fact that a few patients with central hypothyroidism have a moderately increased serum TSH should be kept in mind (38). Some goitrous patients have autonomous thyroid hormone secretion, which is still within the reference range, but they become hyperthyroid even with relatively small amounts of exogenous thyroid hormones, since the latter accumulate with the endogenous autonomous thyroid secretion. Since levothyroxine is occasionally used in supraphysio-logical doses to treat euthyroid people with refractory depression, adverse effects in healthy controls (n 13) and patients with refractory depression also taking antidepressants (n 13)...

Treatment Options in Bipolar Disorder

The side effects of the mood stabilizers can be troubling. Lithium often causes increased appetite with weight gain, tremor, increased thirst and frequent urination, and can impair thyroid and kidney function when taken for many years. Valproate can cause fatigue when first started and increased appetite with weight gain. People often notice some mild hair loss after two to three months on valproate, though it generally grows back without difficulty. Rarely, valproate and carbamazepine can cause potentially serious blood disorders. All three require regular blood work to measure levels in your body and ensure that you are not having a toxic reaction. Lamotrigine can cause a rash and liver failure.

Radiation associated with the nuclear industry

Although not apparent for the first 3 years after the accident, by the end of 1994 a clear increase in childhood thyroid cancers was being seen in children from the surrounding areas. As the data available so far cover only approximately 10 years since the incident. it is too early for there to be significant information concerning other cancers. No relevant data were found regarding whether there was any change in the incidence of reproductive toxicity or in the incidence of congenital anomalies in the surrounding areas.

Effects of longterm exposure to cannabis

A stable analogue of anandamide also produced a drastic reduction in the tumor volume of a rat thyroid epithelial cell line transformed by K-ras oncogene, implanted in nude mice (55E). The antiprolif-erative effect of cannabinoids has suggested a potential use for such drugs in cancer treatment (56R).

Vaginal therapeutics

Are used as antiseptics or antimicrobials. Iodine is absorbed via the skin and mucous membranes and moves into milk via a positive pump, so milk levels far exceed maternal plasma levels (see Chapter 4.11). A high intake of iodine suppresses the infant's thyroid activity.

R Comedication and multimedication in users of acetylsalicyclic acid and vitamin E in Germany 38M

In male users of salicylates and vitamin E the frequency of co-medication with lipid lowering drugs was 14 , with cardiovascular drugs 11 , and with analgesics 9 . Of female users of salicylates and vitamin E, 23 also took mineral products, 11 thyroid drugs, 10 estrogens, and 9 beta-blockers.

Syndromes of Psychosis and Their Treatment

Psychotic symptoms can be a secondary phenomenon originating in another disorder. Thyroid conditions, epilepsy, brain tumors, multiple sclerosis, and syphilis can cause psychotic symptoms. It is important to exclude these causes before treatment. Steroids, stimulants, amphetamines, cocaine, hallucinogens, marijuana, and PCP can also cause psychotic symptoms. It is essential to stop taking any drug that may be causing psychotic symptoms. Psychotic symptoms can also occur in bipolar disorder, depression, dementia, and posttraumatic stress disorder. It is important to ensure that you don't have one of the medical problems listed above. You should have a physical exam, blood tests of your thyroid, liver, kidneys, electrolytes, calcium, glucose, and a complete blood count (CBC). At some point you should have an EEG to check for seizures and a CT scan or MRI to look for brain abnormalities.

Bipolar Disorder Syndromes and Their Treatment

Thyroid disorders, anemia, cancer, Alzheimer's disease, and Epstein-Barr virus infections can lead to depression. Many rare medical conditions can also cause depression, so you should consider a physical examination and appropriate laboratory work if your symptoms do not quickly improve with whatever treatment you choose. Obviously you need treatment for any medical disorder you may have. Ideally, your depression will resolve when you obtain treatment for your medical problem, although you may require treatment with antidepressants indefinitely if you have Alzheimer's or Parkinson's disease. Many prescription and recreational drugs can also contribute to depression. Coordinate the treatment for your medical problems with your primary care doctor and psychiatrist if you take medication that can cause depression. Try to stop recreational drugs that can worsen your mood once the euphoria has worn off.

Historical Perspective

Naturally occurring retinoic acids and synthetic derivatives exert cellular effects by binding to and activating two families of nuclear receptors (NRs), retinoic acid receptors (RARs Fig. 7.16) and retinoid X receptors (RXRs Fig. 7.17). Both classes of retinoid receptors are comprised of three subtypes, a, p, and y, all of which belong to the steroid and thyroid hormone receptor superfamily of li-gand-dependent transcription factors (1). RARa was the first member of either retinoid receptor family to be identified simultaneously and independently by the groups of Chamb n (86) and Evans (87), both of which isolated RARa using a low-stringency, cDNA library screening strategy. Subsequently, the Chamb n (88) and Pfahl (89) groups isolated and made the realization that the locus of this gene was a site of viral integration causing hepatocellular carcinoma. The Chambon group then cloned cDNA encoding RARy and demonstrated that this receptor was highly expressed in skin (90, 91), long...

Breakthrough Episodes

The first step in managing a breakthrough episode of either mania or depression is to check medication adherence, evaluate other potential precipitants of relapse (e.g., seasonal changes, which are common in bipolar disorder, onset of peri-menopause, severe stressors, recurrent substance abuse, etc.) and evaluate medication doses and blood levels. Patients on lithium should have thyroid function tests checked as

Monograph Structure

Endocrine (includes hypothalamus, pituitary, thyroid, parathyroid, adrenal, pancreas, sex hormones) Metabolism Physiological factors Cardiac disease Renal disease Hepatic disease Thyroid disease Other features of the patient DRUG ADMINISTRATION Drug formulations Drug additives

Amitava Dasgupta PhD

Therapeutic drug monitoring is defined as measuring serum concentrations of a drug in a single or multiple time points in a biological matrix after a dosage. The purpose of therapeutic drug monitoring is to individualize the dosage to achieve maximum efficacy of a drug and at the same time minimize adverse drug reactions. Therapeutic drug monitoring has clinical importance for drugs with a narrow therapeutic window, such as various anticonvulsants, cardioactive drugs, theophylline, immunosuppressants, tricyclic antidepressants, antiretroviral drugs, certain antibiotics, and neoplastic drugs. Altered pharmacokinetic parameters are observed for many drugs in disease states including hepatic and renal impairment, cardiovascular disease, thyroid dysfunction, and cystic fibrosis. Altered drug disposition also occurs in pregnant women. Therapeutic drug monitoring helps to identify such altered drug disposition, and dosage adjustment can be made for proper management of the patient to avoid...

Endocrine

Thyroid Since the first reports of hypothyroidism, a number of studies have reported the occurrence of thyroid dysfunction in patients receiving aldesleukin alone or in combination with LAK cells, interferon alfa, interferon gamma, or tumor necrosis factor alfa (SED-13, 1104) (46). Symptoms were usually observed after 2-4 months of treatment (47-49), and mostly consisted of moderate hypothyroidism, which resolved after immunotherapy withdrawal or thyroxine treatment (49,50). Patients treated with aldesleukin plus interferon alfa more commonly developed biphasic thyroiditis with subsequent hypo-thyroidism or hyperthyroidism (50-53). The possibility of a positive correlation between the development of thyroid dysfunction and the probability of a favorable tumor response has been debated (47,49,54). The incidence of thyroid dysfunction did not correlate with the dose or the underlying disease, but increased with treatment duration (46). In a large survey of 281 cancer patients receiving...

Animal toxicology

In further studies rats were treated with doses of THC up to 50 mg kg and mice with up to 500 mg kg 5 times a week for 2 years in a standard carcinogenicity test (11E). After 2 years more treated animals had survived than controls, probably because the treated animals ate less and had lower body weights. The treated animals also had a significantly lower incidence of the various cancers normally seen in aged rodents, in testes, pancreas, pituitary gland, mammary glands, liver, and uterus. Although there was an increased incidence of precancerous changes in the thyroid gland in both species and in the mouse ovary after one dose (125 mg kg), these changes were not dose-related. The conclusion was that there was no evidence of carcinogenic activity of THC at doses up to 50 mg kg . This was also supported by the failure to detect any genetic toxicity in other tests designed to identify drugs capable of causing chromosomal damage. For example, THC was negative in the so-called Ames test ,...

Radiotherapy

Radiotherapy involves the use of X-rays or radiopharmaceuticals (radionuclides) that act as sources of y-rays. Neutron beams are also utilized in some experimental procedures, although this is less common due to the expense and availability of the equipment required. In X-ray therapy, radiation is delivered locally in a highly focused beam to avoid damaging healthy tissue. Although X-ray therapy is a well-established technique, ongoing research is looking into the most effective treatment regimes in terms of the duration and frequency of exposure. The latest technological developments include the use of multiple beams under computer guidance that converge and focus on a tumor with a high degree of accuracy. This technique spares as much surrounding healthy tissue as possible because individual beams can be of the lowest possible energy but they combine to produce the maximum intensity at their focal point at the tumor site. For y-rays, radionuclides in use include cobalt-60, gold-198,...

Antiepileptic drugs

Endocrine Thyroid The effects of antiepi-leptic drugs on thyroid function have been studied in an open prospective study in 90 men with epilepsy (40 taking carbamazepine, 29 taking oxcarbazepine, and 21 taking val-proate monotherapy) and 25 control subjects (2C). Serum thyroxine (T4) and or free T4 concentrations were below the reference ranges in 45 of men taking carbamazepine and 24 of men taking oxcarbazepine. Thyroid peroxidase and or thyroglobulin concentrations were increased in 13 of those taking carbamazepine, 17 of those taking oxcarbazepine, and 6 of controls, but these changes were not associated with altered serum thyroid hormone concentrations. Serum triiodothyronine and thyrotropin concentrations in those taking carbamazepine or oxcarbazepine were normal. In men taking valproate, the concentrations of thyroid hormones, thyrotropin, and antithyroid antibodies were normal. Thus, low serum thyroid hormone concentrations appear to be frequent in men taking carbamazepine or...

Vitamin Bl

Effects A strong antioxidant, vitamin B-l also helps in stabilizes the brain and nervous system's energy production from glucose, stabilizing the appetite, aids in the functioning of the nervous system, helps repair cell damage, helps relieve air and seasickness, and is used in the treatment of herpes zoster (shingles), alcoholism, cirrhosis, overactive thyroid, infection, absorption diseases, prolonged diarrhea, and burns. Precautions There is a wide variation in the amount individuals need some people seem to be able to manufacture it from their intestinal bacteria, though antibiotics may disturb the natural balance of these bacteria. High doses can result in deficiencies of other B vitamins, which can be prevented by increasing the intake of other B vitamins accordingly, such as with a B-complex supplement. Overdosages can also affect thyroid and insulin production, and symptoms though rare, and usually resulting from injections of B-l include allergic reactions, edema, faintness,...

Dipipanone

Persons are supposed to avoid the drug if they suffer from low thyroid activity or enlarged prostate. Dipipanone can make people sleepy, and users are supposed to be cautioned about operating dangerous machinery. Volunteers in one experiment experienced lower alertness after taking dipi-panone, but other experiments found the substance to lack sedative action. Study does show that sedation can occur when dipipanone is given together with the antihistamine triprolidine. Dipipanone can cause headache, tremors, nausea, and vomiting, impair vision, interfere with breathing, make urination difficult, lower blood pressure, and reduce production of saliva. Seizures have been reported. Euphoria may occur. A case study notes delusions and hallucinations caused by the drug. Paranoia has occurred occasionally. A case report tells of serious colon difficulty occurring after someone injected three dissolved oral Diconal tablets, a combination product containing dipipanone and the...

Review

Thyroid cancer Treatment of thyroid cancer with 3.7-5.5 GBq of 131I resulted in an increase of FSH levels in 31 of 52 patients. At a higher dose of 9.8 0.89 GBq mean FSH levels increased to 21 IU ml and inhibin levels decreased to 29 pg ml. The LH and testosterone were within the normal range during the whole study. Dose-dependent elevation of serum FSH, 350 mCi and 131I induced impairment of spermatogenesis resulting in azoospermia Pituitary adenoma Radiation resulted in deficiencies of adrenal, thyroidal and gonadal function in 67, 55 and 67 of the patients, respectively. The rate was significantly higher in patients who were only surgically treated with 13, 13 and 0 .

Sulfonylureas

Many drugs may affect the action of the sulfonyl-ureas the nurse must monitor blood glucose carefully when beginning therapy, discontinuing therapy, and any time any change is made in the drug regimen with these drugs. The sulfonylureas may have an increased hypoglycemic effect when administered with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. The hypo-glycemic effect of the sulfonylureas may be decreased when the agents are administered with beta blockers, calcium channel blockers, cholestyramine, corticos-teroids, estrogens, hydantoins, isoniazid, oral contraceptives, phenothiazines, thiazide diuretics, and thyroid agents.

Meglitinides

Theses drugs are contraindicated in patients with hypersensitivity to the drug, type I diabetes, and diabetic ketoacidosis. Both repaglinide and nateglinide are Pregnancy Category C drugs and are not recommended for use during pregnancy and lactation. These drugs are used cautiously in patients with renal or hepatic impairment. Certain drugs, such as NSAIDs, salicylates, MAOIs, and beta adrenergic blocking drugs, may potentiate the hypoglycemic action of the meglitinides. Drugs such as the thiazides, cortico-steroids, thyroid drugs, and sympathomimetics may decrease the hypoglycemic action of these drugs. The nurse must closely observe the patient receiving one or more of these drugs along with an oral antidiabetic drug.

Others

The combretastatins obtained from Combretum caffrum are from a class of polyphenolics known as stilbenes, which act as anti-angiogenic agents, causing vascular shutdown in tumours and resulting in tumour necrosis 106 . Its water-soluble derivative combretastatin A4 phosphate, a disodium phosphate prodrug of combre-tastatin A4, is in phase II clinical trial 62 . The drug is effective against anaplastic thyroid cancer and myopic muscular degeneration and is currently in phase II clinical trials 107 . Combretastatin is a vascular targeting agent it destroys tumour vasculature by inducing morphological changes within the endothelial cells 95, 108 .

Meperidine

Cally toward driving skills, however, led researchers to conclude that people should not operate a motor vehicle for 24 hours after an intramuscular injection of meperidine. Anyone with enlarged prostate, urinary difficulty, Addison's disease, or underactive thyroid should be wary about using the drug. An unusual case report tells of a patient developing Parkinson's disease symptoms from meperidine more commonly such reports arise from contaminated illicit substances related to meperidine. Another illicit peril occurs when persons grind up and inject oral meperidine tablets the talc in those tablets can block tiny blood vessels throughout the body and also cause those vessels to bleed serious business in the eyes or brain. Illicit intramuscular injection of the drug over a period of years can cause muscle damage. Injecting into an artery can lead to gangrene.

Gastrointestinal

In the MN301, US301, and MN302 trials, gastrointestinal symptoms consisted of diarrhea (22-27 ), nausea (13 ), dyspepsia (6-10 ), abdominal pain (6-8 ), mouth ulceration (3-5 ), vomiting (3-5 ), anorexia (3 ), and gastroenteritis (1-3 ) (9,10,12). Diarrhea and nausea are more common in patients who receive a loading dose, but the onset of action can be delayed without the loading dose (36). Gastrointestinal symptoms occur mainly during the first 6 months after initiation of leflu-nomide. The severity of symptoms was mild. If there is severe diarrhea and or weight loss, withdrawal of lefluno-mide and endoscopic examination is advised, since ulcera-tive and microscopic colitis have been detected under such circumstances (70). The pathophysiology of lefluno-mide-associated diarrhea and weight loss is unclear. Weight loss of 9-24 kg was observed in five of 70 patients who took leflunomide, despite normal concentrations of thyroid-stimulating hormone and no other gastrointestinal...

Xray examinations

These effects are a function of the dose administered and of the stage of development of the embryo. Embryo fetai death may also occur during the first 5 days after conception (i.e. in the all-or-none period ) the lowest lethal dose is 10 rads (0.1 Gy). During embryogenesis, the lowest lethal dose for the embryo increases to 25-50 rads and later to more than 100 rads (lGy) (Brent 1999). Severe CNS malformations are to be expected with exposures above 20 rads during early gestation (18-36 days after conception). Microcephaly and mental retardation were observed only after exposures above 20 rads between weeks 8 and 15 after conception. The conclusion from most studies is that for doses lower than 0.05 Gy (i.e. 5 rads) there is no significant increase of the malformation rate in humans, and the risk clearly is increased above 20-50 rads (Brent 1999. Sternberg 1973). A common and important finding is the absence of visceral, limb or other malformations unless there is...

Calcium Ca

Calcium is necessary for the functioning of nerves and muscles, the clotting of blood (see Chap. 44), the building of bones and teeth, and other physiologic processes. Examples of calcium salts are calcium glu-conate and calcium carbonate. Calcium may be given for the treatment of hypocalcemia (low blood calcium), which may be seen in those with parathyroid disease or after accidental removal of the parathyroid glands during surgery of the thyroid gland. Calcium may also be given during cardiopulmonary resuscitation, particularly after open heart surgery, when epi-nephrine fails to improve weak or ineffective myocar-dial contractions. Calcium may be used as adjunct therapy of insect bites or stings to reduce muscle cramping, such as occurs with black widow spider bites. Calcium may also be recommended for those eating a diet low in calcium or as a dietary supplement when there is an increased need for calcium, such as during pregnancy.

Lithium

PRECAUTIONS Warnings Lithium toxicity can occur if the level of lithium is too high. Symptoms include tremor, nausea, vomiting, mental confusion, slurred speech, lack of coordination, and muscular weakness. Consult your physician and obtain a blood lithium level immediately if you suspect your lithium level is too high. Avoid dehydration, as lithium may rise to toxic levels. Use extra caution if you have Kidney or thyroid disease, as lithium can worsen disorders of either organ. Tests needed before starting Kidney and thyroid function tests. Some doctors recommend an EKG because lithium can cause changes in the EKG. Although this is insignificant to your health, it may impair the interpretation of the EKG if heart problems arise at a later date. Alcohol Should be avoided because it can worsen depression. Use in pregnancy When taken during the first trimester, lithium can cause a heart defect. MONITORING YOUR USE Time to effectiveness One to two weeks for acute mania. A full trial is...

Sell sell sell

The market and the potential profit are large enough to drive generic development including the burden of providing evidence pf biologic equivalence. Generic producers would still have a lot lower development cost than the original manufacturer even if these studies are required. Diseases where a change in drug efficacy (i.e. absorption) could have very serious acute side-effects will absolutely need therapeutic equivalency studies. That need could be determined by the FDA through a regulated approval process. Therapeutic equivalence studies would be prudent for generic biologics designed to treat thyroid diseases, anemias and epilepsy because they have a very small window of efficacy and could be quite toxic at too high a blood plasma concentration. The FDA and Congress should definitely lean towards caution in laying out the regulations for the production of generic biologic drugs, but have been slow to put out definitive guidelines because of the wide range of issues including the...

Steroids

There are many types of steroid hormones in the body, such as the sex gonadal hormones testosterone and estrogen, thyroid hormones, growth hormones, and stress hormones, which serve various normal functions. One type of steroid corticosteroids or glucocorticoids is secreted by the adrenal glands (located just above the kidneys). These steroids, particularly synthetic versions of them, have powerful anti-inflammatory actions that help to relieve pain. They are often given as an epidural injection to relieve neck or back pain that results from a compressed or pinched nerve. They can also be injected directly into a joint to relieve pain caused by inflammation in conditions such as tendonitis (inflammation of the tendons), carpal tunnel syndrome, tennis elbow, bursitis (inflammation of sac-like cavities in tendons or muscles that allow them to slide easily over bone), or other joint pain. Professional athletes, who routinely experience one or more of these conditions, are often given...

Colorectal Cancer

Endocannabinoids are known to inhibit the proliferation of breast cancer cells, prostate cancer cells, and rat thyroid cancer cells (Bifulco and Di Marzo 2002). Ligresti and colleagues (2003) showed that the levels of anandamide and 2-AG were increased relative to controls in adenomatous polyps and carcinomas, but there appeared to be no differences in the expression of CB1 and CB2 receptors or FAAH levels among the tissues. To determine if cannabinoids affect colorectal cancer cell growth, the authors used CaCo-2 (which express CB1 receptor) and DLD-1 cells (which express both CB1 and CB2 receptors, with CB1 receptor less expressed than in CaCo-2 cells). Anandamide, 2-AG and HU-210, as well as an inhibitor of anandamide inactivation, potently inhibited CaCo2 cell proliferation (relative potencies HU-210 anandamide 2-AG), while DLD-1 cells were less responsive to cannabimimetics than CaCo-2 cells (Ligresti et al. 2003). Such data suggest that CB1 receptors are more important than CB2...

Cell Growth Arrest

Cannabinoids have been shown to induce cell cycle arrest in breast carcinoma (De Petrocellis et al. 1998), prostate carcinoma (Melck et al. 2000) and thyroid epithelioma cells (Bifulco et al. 2001). In breast carcinoma cells this has been ascribed to the inhibition of adenylyl cyclase and the cAMP protein kinase A (PKA) pathway (Table 1). PKA phosphorylates and inhibits Raf-1, so cannabinoids prevent the inhibition of Raf-1 and induce prolonged activation of the Raf-1 MEK ERK signalling cascade (Melck et al 1999). Cannabinoid-induced inhibition of thyroid epithelioma cell proliferation has been attributed to the induction of the cyclin-dependent kinase inhibitor p27kip1 (Portella et al. 2003). It has been suggested that cannabinoids produce their growth-inhibiting effects on skin and prostate cancer cells at least in part by attenuating epidermal growth factor receptor tyrosine kinase activity (Casanova et al. 2003) and or by lowering epidermal growth factor receptor expression...

Pregnancy

In situ hybridization studies show that mRNAs for CBj and CB2 are expressed in the placental cone and smooth muscle of the uterus in rats, rodent embryo and fetus, and term human placenta, as well as in human BeWo choriocarcinoma cells (Buckley et al., 1998 Kenney et al., 1999). CB1 receptor and FAAH immuno-reactivity are present in human placenta and fetal membranes (Park et al., 2003). Human amniotic fluid contains AEA, OEA, and PEA (Schuel et al., 2002b). The biological functions of these NAEs in amniotic fluids remain to be determined. However, (-)A9-THC crosses the placenta and accumulates in chorionic and amniotic fluids and in all fetal organs (Harbison et al., 1972 Martin et al., 1977 Asch and Smith, 1986 Bailey et al., 1987). Maternal plasma contains significant amounts of 11-nor-9-carboxy THC, a major metabolite of (-)A9-THC, but this metabolite is not detected in amniotic fluid or the fetus (Bailey et al., 1987). These data indicate that 11-nor-9-carboxy THC does not cross...

Interferon Beta

Common side effects include some form of pain at the site of injection, sinusitis, migraine headaches, fever, weakness, chills, muscle aches, abdominal pain, flu-like symptoms, menstruation that is painful or irregular, constipation, vomiting, liver inflammation, sweating, and a reduction in white blood cells. Less common side effects include swelling, pelvic pain, cysts, suicidal tendencies, thyroid goiter, heart palpitations, high blood pressure, rapid heartbeat, bleeding, laryngitis, breathing difficulties, stiffness, tiredness, speech problems, convulsions, uncontrolled movements, hair loss, visual disturbances, pink eye, feelings of a need to urinate, cystitis, breast pain, and cystic breast disease. Rare side effects encompass symptoms occurring almost everywhere on the body.

Physiology

The normal adult thyroid gland secretes about 90 micrograms of thyroxine (T4) and less than 10 micrograms of liothyronine (triiodothyronine, T3) per day. Somewhat less than half of the T4 is converted to T3 by several tissues (especially the liver). Most of the daily production of T3 thus comes from peripheral 5'-deiodination of T4 and not by direct glandular secretion. The thyroid hormones are tightly bound (T4 even more than T3) to plasma transport proteins this explains their prolonged half-lives (about 8 days for T4 and about 1 day for T3). Nuclear receptors for thyroid hormones bind T3 much more efficiently than T4, explaining the more rapid onset of action and greater biological potency of T3. The intestinal absorption and hepatic clearance of orally ingested thyroid hormones also differ. T3 has higher systematic availability than T4, only about 60 of which appears in the peripheral circulation after oral administration (1). However, some formulations provide higher intestinal...

Ethoxyquin

Precautions Albino rats given 1000 to 4000 mg of ethoxyquin per kg of food showed signs of kidney fibrosis, kidney disease, changes in the structure of liver cells, and possible damage to the thyroid. It has also been linked to liver tumors in mice. It is still in the experimental stage.

Thyrostatics

With 5 mg thiamazol per day, up to 65 ig 1 milk could be measured. Accordingly, an infant would receive up to 9.8 Kg kg daily. This represents about 12 of the maternal dosage per kg bodyweight. In the plasma of breastfed twins, 45 and 53 ig l - subtherapeutic levels - of thiamazol were found. The children had no symptoms, and their thyroid status was unremarkable (Rylance 1987). With treatment using 400 mg propylthiouracil, a maximum of 0.7 mg l was found in the mother's milk. For the infant this is at most 0.1 mg kg, i.e. 1.5 of the maternal weight-related dosage in 24 hours. The M P ratio is 0.1 (Kampmann 1980), In older studies in which the methodology was insufficient, M P values of 12 were calculated. In a newer study of 11 children whose mothers took 300-750 mg daily, elevated TSH values were seen in 2 children 7 days after birth. However, these normalized over the course of time, although the maternal dosage remained stable or was even increased. No correlation was found...

Ephedrine

Food and Drug Administration (FDA) became particularly alarmed at the prevalence of medical problems developed by young healthy users, and regulatory efforts were increasing when this book was written. Some scientists say the FDA's concerns are unfounded and that many physical problems after ephedrine ingestion derive from a person's prior medical history or massive overdose. Nonetheless, the FDA believes that ephedrine may harm people who already have the following conditions prostate trouble, psychological afflictions (including depression and nervousness), high blood pressure, diabetes, glaucoma, and ailments of thyroid, kidney, or heart.

Phentermine

Developing primary pulmonary hypertension, a major and often fatal affliction involving blood circulation through the lungs. The drug is not recommended for persons with heart ailment, serious hardening of the arteries, high blood pressure, glaucoma, or an overactive thyroid gland. The drug may impair ability to operate tools and machinery, such as automobiles.

Radionuclides

Iodine131 (,5II) accumulates in mother's milk at the same levels as normal iodine (see Chapter 4.11). Among 31 radionuclides studied for their appearance in mother's milk, 13II had the highest transfer (with 30 of the maternal dose), followed by 45Ca and lJ Cs (both 20 ) and *JSr (10 ) (Harrison 2003). In their review on 131I, Simon and co-workers (2002) found a median half-life in milk of 12 hours. When the mother received stable iodine to block her thyroid before administration of1311, the median half-life was 8.5 hours. Peak values were measured after 9 hours. Stable iodine blocks also the 1311 uptake of the breast and the infant's thyroid. In 1996, Bennett summarized the kinetics of many radiopharmaceuticals during breastfeeding, among them iodine and technetium isotopes. It is difficult to decide what dosage of radioactivity is tolerable for the breastfed infant most authors accept 1 mSv, In the context of the radioiodine contamination after Chernobyl, the German Radiation...

Cleome gynandra L

Pharmaceutical interest The counter-irritant property of Cleome gynan-dra L. is attributed to glucosinolates. When the leaves of any glucosinolate-containing plant are bruised, glu-cosinolates are hydrolyzed by a p-thioglucosidase enzyme (myrosin) into a number of extremely reactive, volatile and pungent isothiocyanates, which cause skin tingling and rubefaction, and upon prolonged contact with the skin vesication (Fig. 119). In addition, isothiocyanates capture iodide and prevent its uptake by the thyroid resulting in hypothyroidism and goiter. Isothiocyanates occur in Brassica nigra (L.) Koch. (family Brassicaceae), which has been used since ancient times to make cataplasms. The therapeutic potential of Cleome gynandra L. is open for pharmacological exploration.

Ljp 394

Carella C, Mazziotti G, Morisco F, Manganella G, Rotondi M, Tuccillo C, Sorvillo F, Caporaso N, Amato G. Long-term outcome of interferon-alpha-induced thyroid autoimmunity and prognostic influence of thyroid autoantibody pattern at the end of treatment. J Clin Endocrinol Metab 2001 86 1925-9.

Anorectic Class

The first diet drug to receive scientific endorsement was thyroid hormone. Its use for this purpose began in the 1890s on the theory that it would boost a person's metabolism and thereby promote faster use of calories. The same theory made dinitrophenol a standard diet drug before World War II. Although it boosted metabolic rate, it also boosted rates of cataracts and of harm to the peripheral nervous system (which involves the functioning of various organs and muscles). For those reasons the drug was abandoned. In the 1930s amphetamines became available and quickly became a popular diet aid despite their potential for abuse.

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