Pharmacists Play a Role in Managing Thyroid Conditions

JANUARY 31, 2018
January is Thyroid Disorder Awareness Month, but the role of the pharmacist in managing this disorder can benefit the patient throughout the year. Many may not realize just how useful pharmacists can be in helping manage thyroid disorders by providing education.

Many forms of thyroid disorders exist, and knowing what signs and symptoms to look for can be critical in determining if one may have a disorder that should be evaluated by his or her physician and confirmed by abnormal blood test results, such as levels of TSH and free T3 and T4.1 Often, the symptoms of thyroid disorders may be similar to those one could experience as a side effect of certain medications. A pharmacist could help identify these in patients.

Helping to distinguish between these side effects and underlying conditions is critical, and referral to a physician may be necessary. While other thyroid disorders do exist, the most common diagnoses consist of either hypothyroidism or hyperthyroidism.

Hypothyroidism is characterized by a low level of thyroid hormone from an underactive thyroid gland. Symptoms of this condition may include feeling cold, tired, and a depressed mood. Hypothyroidism is treated with synthetic thyroxine in medications such as levothyroxine (brand name Synthroid or Tirosint), which is the preferred therapy. Other options are available, and all are synthetic forms with the exception of the naturally-derived product, Armour Thyroid, which is also known as Nature-Throid.2,3 Side effects may result from taking too low or too high of a dose, which can lead to continued symptoms or symptoms of hyperthyroidism, respectively.1

Hyperthyroidism is characterized by an elevated level of thyroid hormone from an overactive thyroid gland. Symptoms of this condition may include feeling anxious, fatigued due to an inability to sleep, weight loss, and a racing heart. One treatment option is the use of anti-thyroid medications, including Methimazole (MMI) or Propylthiouracil (PTU), both of which may be used in children, adolescents, and pregnant patients.2,3 Side effects may include allergic reactions, a decreased number of white blood cells, which may be severe and life-threatening, and potential liver damage.1

Thyroid medications require careful, patient-specific dosing. Once a physician has changed the dosage of medication to achieve the desired levels of thyroid hormone in a patient, it is crucial to maintain that particular dose and medication until otherwise directed. Brand and generic thyroid medications should not be interchanged unless one’s physician is made aware, as these substitutions are not always equivalent, and such change could offset the level of thyroid hormone previously established. This is an important counseling point and one that many patients may not be aware of the degree of importance.

While there are only a few medications currently used to treat thyroid disorders, pharmacists can provide education on new or existing medications. Whether stopping by in person or picking up the phone to call, patients should be encouraged to reach out to their pharmacists—the most accessible healthcare provider—the next time a question arises about any medication, as it is both the duty and the joy of a pharmacist to provide this service.
 
This article was written with Morgan Sellars, PharmD Candidate, Harrison School of Pharmacy at Auburn University in Alabama.

References
 
  1. Hypothyroidism. American Thyroid Association. www.thyroid.org/hyperthyroidism/. Accessed December 20, 2017.
  2. Jonklaas J, Kane MP. Thyroid Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds.Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146066204. Accessed January 31, 2018.
  3. Methimazole. In: Lexi‐Drugs, Lexi‐Comp Online. Hudson, OH: LexiComp/Wolters Kluwer Health. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7267. Updated January 4m, 2018. Accessed January 18, 2018.


Marilyn Bulloch, PharmD, BCPS
Marilyn Bulloch, PharmD, BCPS
Marilyn Novell Bulloch, PharmD BCPS, is an Associate Clinical Professor of Pharmacy Practice at the Auburn University School of Pharmacy and an Adjunct Assistant Professor at the University of Alabama School of Medicine College of Community Health Sciences Department of Internal Medicine. She completed a post-graduate pharmacy practice residency at the University of Alabama-Birmingham Hospital and a post-graduate specialty residency in critical care pharmacy at Charleston Area Medical Center in Charleston, West Virginia. Dr. Bulloch also completed a Faculty Scholars Program in geriatrics through the University of Alabama-Birmingham Geriatric Education Center in 2011. She serves on multiple committees and in leadership positions for many local, state, and national pharmacy and interdisciplinary medical organizations.
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