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Hi, thyroid hormone regulates the metabolism, and this means that the alteration in the thyroid gland will result in increased or slowed metabolism depending on the direction of the dysfunctionality. People with hypothyroidism are likely to gain weight because of the slowed rate of calories burned. On the contrary, hyperthyroidism increases metabolism, weight loss, and anxiety. Methimazole is a medication used to manage a grave’s disease or hyperthyroidism (Abdi et al., 2019). The drug inhibits the synthesis of the peroxidase enzyme that catalyzes the synthesis of tyrosine from the iodine. Patients with hyperthyroidism are also likely to develop other conditions, including increased heart rate; therefore, a comprehensive patient assessment should be conducted before prescribing the medication.

Patient monitoring is part of the therapeutic administration guideline. The vitals to consider depend on the patient’s underlying conditions and the possible side effects of the drug administered. The side effects of methimazole include agranulocytosis, which could be dangerous to the patient. The baseline tests indicated in the post include the liver function test and the thyroid function test. Furthermore, the post highlights the contraindications of the methimazole drug in pregnancy but fails to identify the ethnic and genetic factors likely to affect the therapeutic efficacy. The drug interaction and therapeutic outcomes depend on many factors, including the patients’ current medical condition, polypharmacy, lifestyle, and level of adherence to the prescription. Offering the right patient education helps in reducing the risk for adverse events and improving positive therapeutic outcomes. Close monitoring should involve comparing the baseline test results with the presents laboratory results to determine whether the patients’ condition is improving or not. The dose administered must also be adjusted depending on the patient’s progress.

References

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Abdi, H., Amouzegar, A., & Azizi, F. (2019). Antithyroid Drugs. Iranian Journal of pharmaceutical research: IJPR, 18(Suppl1), 1–12. https://doi.org/10.22037/ijpr.2020.112892.14005

Reference

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Methimazole

According to the American Thyroid Association treatment and guidelines for Grave’s disease-hyperthyroidism, methimazole is a first line medication (American Thyroid Association, 2022). Its mechanism of action is to antagonize thyroid hormone synthesis by inhibiting peroxidase enzyme which tends to catalyze the making of tyrosine from iodine and tyrosine coupling, all while not destroying existing stores of thyroid hormone (Rosenthal & Burchum, 2021). For baseline data, it would be important to get the patient’s TSH, T3, T4 thyroid levels and a baseline CBC and LFTs prior to starting (Rosenthal & Burchum, 2021). It would be important to monitor periodically, this patient’s CBC with differential for signs of infection and LFT for signs of liver dysfunction. A few evaluating therapeutic effects would be letting the patient know that there can be weight gain and a decrease in heart rate; a decrease in T3 and T4 can evaluate therapy (Rosenthal & Burchum, 2021). It is important to explain to the patient that methimazole can cause agranulocytosis and can be dangerous. Although it is rare, it develops within the first two months of therapy and it would be important to instruct the patient to report a developing sore throat and fever which are the earliest indications, and the provider should discontinue (Rosenthal & Burchum, 2021). The reversal of this adverse event is to stop the medication and treat with filgrastim (Neupogen) which is a granulocyte colony-stimulating factor (Rosenthal & Burchum, 2021). Another adverse even is hypothyroidism when given in high doses this can be treated by reducing the dose. CAM can include biologically-based practices such as vitamins (D and calcium), herbs, and iodine avoidance (American Thyroid Association, 2022).

When it comes women who have Grave’s disease-hyperthyroidism, methimazole should be avoided in the first trimester of pregnancy as methimazole can cross into the placenta (Rosenthal & Burchum, 2021) In this case, the American Thyroid Association treatment and guidelines suggest putting the patient on PTU (propylthiouracil, another hyperthyroid medication) for the first trimester; methimazole use in the remaining trimesters are then considered safe (American Thyroid Association, 2022). When it comes to lactation, methimazole levels can be found, however, with dosages up to 20mg daily is considered safe to use and dose not affect thyroid function or intellectual development in the child (Rosenthal & Burchum, 2021).

References

American Thyroid Association. (2022). Grave’s disease. Retrieve on February 17, 2022 from https://www.thyroid.org/graves-disease/

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier. ISBN: 9780323554954