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Anti-Thyroid Agents
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methimazole (Tapazole ® )
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Use Palliative treatment of hyperthyroidism, return the hyperthyroid patient to a normal metabolic state prior to thyroidectomy, and to control thyrotoxic crisis that may accompany thyroidectomy. The use of antithyroid thioamides is as effective in elderly as they are in younger adults; however, the expense, potential adverse effects, and inconvenience (compliance, monitoring) make them undesirable. The use of radioiodine due to ease of administration and less concern for long-term side effects and reproduction problems (some older males) makes it a more appropriate therapy. Mechanism of Action Inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland, blocking iodine's ability to combine with tyrosine to form thyroxine and triiodothyronine (T3), does not inactivate circulating T4 and T3 -------------------------- Dosing: Adults: Initial: 15 mg/day for mild hyperthyroidism; 30-40 mg/day in moderately severe hyperthyroidism; 60 mg/day in severe hyperthyroidism; maintenance: 5-15 mg/day Adjust dosage as required to achieve and maintain serum T3, T4, and TSH levels in the normal range. An elevated T3 may be the sole indicator of inadequate treatment. An elevated TSH indicates excessive antithyroid treatment. -------------------------- Supplied: Tablet: 5 mg, 10 mg, 20 mg |
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propylthiouracil (PTU)
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Use Palliative treatment of hyperthyroidism as an adjunct to ameliorate hyperthyroidism in preparation for surgical treatment or radioactive iodine therapy; management of thyrotoxic crisis Mechanism of Action Inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland; blocks synthesis of thyroxine and triiodothyronine -------------------------- Dosing: Adults: Initial: 300 mg/day in divided doses every 8 hours. In patients with severe hyperthyroidism, very large goiters, or both, the initial dosage is usually 450 mg/day; an occasional patient will require 600-900 mg/day; maintenance: 100-150 mg/day in divided doses every 8-12 hours Elderly: Use lower dose recommendations; Initial: 150-300 mg/day WWithdrawal of therapy: Therapy should be withdrawn gradually with evaluation of the patient every 4-6 weeks for the first 3 months then every 3 months for the first year after discontinuation of therapy to detect any reoccurrence of a hyperthyroid state. -------------------------- Normal laboratory values: Total T4: 5-12 mcg/dL Serum T3: 90-185 ng/dL Free thyroxine index (FT4 I): 6-10.5 TSH: 0.5-4.0 microunits/mL ------------------------- Supplied: Tablet: 50 mg |
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