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Thioamides
  • Drugs 
    • propylthiouracil (PTU)
    • methimazole
  • Mechanism
    • inhibit thyroid hormone synthesis by blocking peroxidase-catalyzed reactions 
      • iodination of tyrosine residues of thyroglobulin
      • coupling of DIT and MIT
    • propylthiouracil ↓ peripheral conversion of T4 to T3
  • Clinical use
    • HYPERthyroidism
  • Toxicity 
    • skin rash
    • agranulocytosis (rare) 
    • aplastic anemia
    • hepatotoxicity (PTU)
      • PTU not used first line in non-pregnant adults and children for this reason
  • Pregnancy
    • use PTU in the first trimester
    • methimazole crosses the placenta and enters breast milk (may be teratogenic)
Thyroid hormones
  • Drugs
    • levothyroxine
      • synthetic T4 (thyroxine)
    • triiodothyronine
      • T3
  • Mechanism
    • replaces endogenous thyroid hormones
  • Clinical use
    • HYPOthyroidism
    • myxedema
  • Toxicity
    • thyrotoxicosis
      • heat intolerance
      • tachycardia
      • dyspnea
      • ↑ appetite
      • tremors
      • arrhythmias
 

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