аЯрЁБс>ўџ ?Aўџџџ>џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС5@ №ПА+bjbjЯ2Я2 !4­X­Xбџџџџџџˆ2222222Fj j j j ~ lF0ўі і і і і і і і $.R€FЅE2Љ і і Љ Љ Ѕ22і і ъoooЉ Ъ2і 2і oЉ o@oЏ22Џі ъ РЗ нїТj s "ЏгЌ00ЏЦ• аЦЏFF2222Ц2Џ$і  o $ …і і і ЅЅFF$ j e FFj DrugClassMOAToxicity/Side EffectsClinical Use, etc.Treatment of hypothyroidism  Levothyroxine sodium (SynthroidЎ) T4  Acts as endogenous T4Cardiovascular complications (“!these w/conservative treatment.); Toxic nodular goiter (hyperthyroidism) Myxedema; Preferred over T3 for adults (longer duration, lower cost) Liothyronine T3 Acts as endogenous T3 Same as aboveCretinism in children – start therapy soon after birth; Quicker onset & better absorption than T4; also for myxedemaTreatment of hyperthyroidism Propylthiouracil (PTU), Methimazole Thioureylenes Inhibit T3/T4 synthesis, prob. via blockade of peroxidase enzymes; PTU also blocks T4’!T3 conversion. Agranulocytosis, bone marrow aplasia; cross placenta, secreted in milkPrimary treatment of Grave s disease; Adjunct to radioiodine treatment; Used B4 thyroidectomy to prevent thyroid stormThiocyanate, PerchlorateIonic inhibitorsCompletely inhibit iodide transport into thyroidFatal aplastic anemiaNO LONGER USED. IodineHigh concentrations quickly prevent T3/T4 release, inhibit T3/T4 synthesis by blocking TSHAngioedema, hypersensitivity reactions, Chronic intoxication (iodism) = burning mouth, throat, eyes, headache, cough, GI irritation, skin lesions.Used pre-op toprЈЌкєјњ( * h – І Њ Ў ж ќ    ( / 9 ? C E V W m n o ~ ‡ о п ъ ђ є  Q R T U     @ D j к ј v   -CQqxƒ„†‡›œžŸКФљѕюљѕюѕщѕщѕририЭиљѕщѕиѕириѕщѕщѕюљѕщѕљѕюѕщѕщѕщрТриљѕљѕљѕљѕљНѕљѕщѕщѕщѕщѕДho5CJ\ ho>*hoH*nHo(tHho5\nHtHhonHtHhonHo(tH hoH* ho6]ho ho5\G Jpяяяяя$$„œ&@#$/„ДIfa$А+ўprЌB2$$„œ&@#$/„ДIfa$Нkd$$If–lж” жr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laіЌЎАкєіў , ќ ў E ~qqqqqqqqqq $„œ&@#$/„ДIf€kdѕ$$If–lж” ж”џќ7h8 ж tП 6@”œ”Дж џрррж0џџџџџџі6ііжџжџжџжџ”Д4ж4ж laіpж џррр E F G T U X Y B55555 $„œ&@#$/„ДIfНkdЃ$$If–lж”Нжr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laіY o p ~ Ж ѓ є ђђђђђ5НkdŠ$$If–lж”]жr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laі $„œ&@#$/„ДIfє    + 7 8 F G H Œ яnaaaaaaaaa $„œ&@#$/„ДIf€kd$$If–lж”Jж”џќ7h8 ж tП 6@”œ”Дж џрррж0џџџџџџі6ііжџжџжџжџ”Д4ж4ж laіpж џррр$$„œ&@#$/„ДIfa$ " А ў D Ђ Є ђђђђђ5Нkd-$$If–lж”Нжr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laі $„œ&@#$/„ДIfЄ О ж ј -CSђђђђђђ $„œ&@#$/„ДIfSTU\]КMB55555 $„œ&@#$/„ДIfНkd$$If–lж”/жr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laіФЦжјўMRX(("(L(`(z((Ќ(Ў(А(И(Œ)ъ)$*&*(*0*N*ј*ќ*+P+R+l+n+p+Œ+А+њёњёњэцэфлглгШгШгэУэцМэцэцэДэлгШгэЉэho5CJ\aJhomHsH ho6] hoH*ho5\nHtHhonHtHhonHo(tHU ho5\hoho5CJ\ hoCJ$“!vascularity and ‘!firmness of gland; Useful in thyroid storm or severe thyrotoxicosis 131I Quickly trapped in thyroid gland, destroys parenchymal cells preferentially.Chromosomal aberrations: contraindicated in young or pregnant patients; Delayed hypothyroidism in 50% For hyperthyroidism: safer than surgery in non-pregnant patients; Half-life is 8 days. PropranololВ-blocker“!severe cardiac stimulation with thyroid stormThyroid Drugs Dr. Foster 4/4/02 ML(Ў(А(В(М(О(ђђ5ђђђНkdћ$$If–lж”жr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laі $„œ&@#$/„ДIfО(Р(Z)ъ)&*(*А*о*ђђђђђђђ $„œ&@#$/„ДIfо*р*ј* +++n+B55555 $„œ&@#$/„ДIfНkdт$$If–lж””жr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laіn+p+Œ+А+B==$a$НkdЩ$$If–lж”Xжr”џм ФЇ)ќ7H шT  U tП 6@”œ”Дж0џџџџџџі6ііжџџџџџжџџџџџжџџџџџжџџџџџ”Д4ж4ж laі0Ар= Аа/!Аа"АR#а$а%Аѓ$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”  tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жU/ж џЌ$$If–!vh5жh8#vh8:V –l”  ж tП 6@”œ”Дж џрррж0џџџџџџі6і”Д5жh8pж џрррх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”Н tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUѓ$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”] tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жU/ж џЌ$$If–!vh5жh8#vh8:V –l”J ж tП 6@”œ”Дж џрррж0џџџџџџі6і”Д5жh8pж џрррх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”Н tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”/ tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l” tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”” tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUх$$If–!vh5жH 5жш5жT 5ж 5жU#vH #vш#vT #v #vU:V –l”X tП 6@”œ”Дж0џџџџџџі6і”Д5жH 5жш5жT 5ж 5жUœ<@ёџ< NormalCJ_HmH sH tH DAђџЁD Default Paragraph FontVi@ѓџГV  Table Normal :V і4ж4ж laі (kєџС(No List б4џџџџ %89VWXmz{€–ўџEFGTUXYop~Жѓє+78FGHŒЎЏі@op}‰šЫсёђѓњћXыPQRWXYІю  Qhiu€АБПгM90 M90 M90 M90 M90  M90  M90M90M90 M90M90 M90M90 M90 M90M90  M90M90 M90M90 M90M90 M90M90 M90M90  M90   M90 M90 M90  M90 M90 M90 M90  M90 M90  M90 M90  M90 M90 M90   M90M90 M90 M90 M90 M90  M90M90 M90 M90 M90 M90M90  M90M90 M90 M90M90 M90M90 M90M90M90 M90 M90 M90 M90 M90 M90  M90M90ФА+pЌE Y є Є SMО(о*n+А+ А+ џџLе24їGЪгаг8*€urn:schemas-microsoft-com:office:smarttags€date€ €2002€4€Day€Month€YearXenwДЕGS#+68EžŸp{Xb–œљњ  ituw‚гu~Џг89WXz{€–GTUXY~є+8H@ЫђѓћRXю uБаггџџKris Keisa Bennett153839хњ&oаaђ %89VWz–ўEFTXo~ѓє7HЎіop‰šЫсёђњћXыPQWXІ hiu€АБгŽŽŽŽŽŽŽŽŽ†џ@ €Д G@žžљбPP@P P@P(џџUnknownџџџџџџџџџџџџG‡:џTimes New Roman5€Symbol3& ‡:џArialG5€  ‡ŸMS Mincho-џ3џ fg"qˆ№аhЂєsЂєsЭ