For patients with hypo- or hyperthyroidism, medication therapy management (MTM) providers should review the medication list for medications that may be contributing to thyroid dysfunction.
MTM providers should be aware of and inquire about symptoms that may indicate under- or over-treatment of a thyroid condition. A thyroid function panel must confirm clinical suspicion.
MTM providers should assess for conditions (eg, interacting medications or nonadherence) that may alter dosage requirements of thyroid medications.
INTRODUCTION TO THYROID DISORDERS
The thyroid normally synthesizes two thyroid hormones, thyroxine (T4) and triiodothyronine (T3), after glandular stimulation by thyroid-stimulating hormone (TSH).1 Prior to this, thyrotropin-releasing hormone (TRH) produced by the hypothalamus stimulates the anterior pituitary to release TSH. This hypothalamic-pituitary-thyroid axis maintains thyroid hormone homeostasis through a negative feedback loop. That is, adequate thyroid hormone levels inhibit the release of TRH and TSH from the hypothalamus and pituitary, respectively (Figure 36-1).
Hypothalamic-pituitary-thyroid hormone axis.
In both the hypothalamus and pituitary, 3,5’,3-triiodothyronine (T3) is primarily responsible for inhibition of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) secretion.
Abbreviation: T4 = thyroxine.
Source: Reproduced, with permission, from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw-Hill Publishing; 2010.
Thyroid hormones regulate metabolism and affect essentially every organ system in the human body. T4 is produced in greater amounts than T3, but T4 exhibits less biological activity. Production of T3 occurs primarily through peripheral conversion of T4 by deiodinase enzymes (80%), with approximately 20% of T3 produced directly by the thyroid gland.1
Hyperthyroidism is a condition in which there is inappropriate synthesis and secretion of thyroid hormone (either T3, T4, or both) from the thyroid gland.2,3,4 Thyroid hormone excess results either from overproduction (eg, Graves’ disease, toxic multinodular goiter [TMNG], toxic adenoma) or, infrequently, thyroid inflammation (eg, thyroiditis). Graves’ disease, an autoimmune disorder, accounts for 60% to 80% of cases of hyperthyroidism.
Other Terms Associated with Hyperthyroidism
Thyrotoxicosis – a clinical state marked by inappropriately high thyroid hormone action in the peripheral tissues
Thyroid storm – a sudden and life-threatening condition with an increase in signs and symptoms of decompensated thyrotoxicosis, including fever greater than 102°F (38.8°C), tachycardia, tachypnea, nausea, vomiting, diarrhea, abdominal pain, and delirium
Usually precipitated by trauma, surgery, or infection
Arrhythmias, heart failure, ischemic heart disease, or coma may develop
Requires prompt treatment and hospitalization
Hypothyroidism indicates a failure of the thyroid gland to produce ...