Full Answer
What is the mechanism of action of PTU?
PTU inhibits iodine and peroxidase from their normal interactions with thyroglobulin to form T4 and T3. This action decreases production of thyroid hormone. PTU also interferes with the conversion of T4 to T3, and, since T3 is more potent than T4, this also reduces the activity of thyroid hormones.
What are the possible side effects of PTU therapy?
Less common but serious side effects have occurred with PTU therapy. A decrease of white blood cells in the blood (agranulocytosis) may occur. Symptoms and signs of agranulocytosis include infectious lesions of the throat, the gastrointestinal tract, and skin with an overall feeling of illness and fever.
What are the nursing considerations for PTU B?
Cytosis a few nursing considerations for PTU B. Sure. To monitor your patient for any symptoms of hyperthyroidism and hypothyroidism for dosage adjustments, and also monitor your patients. Weight frequently, PTU may cause leukopenia thrombocytopenia and jaundice lab work that should be cleed completed.
What is the initial dose of PTU?
The initial adult dose of PTU is 300 mg/day divided into 3 divided doses. PTU is usually administered every eight hours. Patients with large goiters may require initial doses up to 900 mg daily.
What are the goals of therapy in treating hyperthyroidism?
The goals of medical therapy are blockade of peripheral effects, inhibition of hormone synthesis, blockade of hormone release, and prevention of peripheral conversion of T4 to T3. Restoration of a clinical euthyroid state may take up to 8 weeks.
What is the function of PTU?
Propylthiouracil (PTU) is an oral medication that is used to manage hyperthyroidism which is due to an overactive thyroid gland. It is an anti-thyroid drug that has a mechanism of action that is similar to methimazole (Tapazole). Graves' disease is the most common cause of hyperthyroidism.
What is the primary goal of therapy for hyperthyroidism and hypothyroidism?
The goal of therapy is to correct the hypermetabolic state with the fewest side effects and the lowest incidence of hypothyroidism. Beta blockers and iodides are used as treatment adjuncts. Antithyroid drugs, radioactive iodine, and surgery are the main treatment options for persistent hyperthyroidism (Table 3).
What does PTU do for hyperthyroidism?
Propylthiouracil is used to treat overactive thyroid (hyperthyroidism). It works by stopping the thyroid gland from making too much thyroid hormone. This medication is not recommended for use in children.
When do we use PTU?
Propylthiouracil is used to treat hyperthyroidism (a condition that occurs when the thyroid gland produces too much thyroid hormone, speeding the body's metabolism, and causing certain symptoms) in adults and children 6 years of age or older. Propylthiouracil is in a class of medications called antithyroid agents.
What is treatment for thyroid storm?
Treatment / Management Typically, propranolol 40 mg to 80 mg is given every 4 to 6 hours. Then, either a loading dose of propylthiouracil (PTU) 500 mg to 1000 mg followed by 250 mg every 4 hours or Methimazole (MMI) 20 mg every 4 to 6 hours should be given.
What is the goal of hypothyroidism?
The goal of treatment for hypothyroidism is to return blood levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) to the normal range and to alleviate symptoms. Medication — The treatment for hypothyroidism is thyroid hormone replacement therapy.
What is the first line treatment for hyperthyroidism?
Pharmacologic Treatment of HyperthyroidismFirst-line agentsDosagePropranololImmediate release: 10 to 40 mg orally every eight hours Extended release: 80 to 160 mg orally once per dayAntithyroid medicationsMethimazole (Tapazole)5 to 120 mg orally per day (can be given in divided doses)9 more rows•Mar 1, 2016
How do you treat low TSH and high T4?
Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism. You'll likely start to feel better soon after you start treatment.
What does PTU do to metabolic rate?
There was found to be a significant reduction in liver weight to body weight ratio in the PTU-treated animals, which probably resulted from the lowered metabolic rate since the liver functions in connection with carbohydrate, fat, and protein metabolism.
When is PTU preferred over methimazole?
Antithyroid drugs during pregnancy — Propylthiouracil is the drug of choice during the first trimester of pregnancy because it causes less severe birth defects than methimazole.
How do you know PTU is working?
You will need to have blood tests from time to time to check that you are on the correct dose and that your liver is working well. This is because propylthiouracil can occasionally cause serious liver problems. Propylthiouracil should have some effect on your symptoms around three to four weeks after treatment starts.
The Case
You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath..
Physical Exam
Her vital signs are blood pressure of 184/106 mmHg, heart rate of 130 beats per minute, respiratory rate of 22 breaths per minute, and temperature of 102.7°F. She seems relatively anxious on physical exam, and you note that she is diaphoretic.
You Avoid Premature Closure
Yet to you, something does not seem right. Her overall presentation does not seem to add up in being secondary to urosepsis. Is there some other underlying issue that is taking place? In addition to the labs you have already ordered for our patient, you quickly decide to add a thyroid function panel, just in case.
Thyroid Storm and Endocrine Emergencies: Sepsis Mimics
Endocrinologic emergencies often fall at the wayside and are not generally considered as a possible diagnosis up front in patients in the emergency department who meet the criteria for systemic inflammatory response syndrome (SIRS).
1. Thionamides
Mechanism of action: Inhibit thyroid peroxidase, an enzyme involved in the production of T3 and T4 through the iodination of tyrosine residues on thyroglobulin
2. Inorganic iodine
Used to prevent the release of pre-formed thyroid hormone from the thyroid gland
3. Beta blockade
Enhanced α- and β-adrenergic stimulation in the setting of thyroid storm leads to clinical manifestations
Warnings
Severe liver injury and acute liver failure, some of which have been fatal, have been reported in adult and pediatric patients taking propylthiouracil
Pregnancy & Lactation
Lactation: distributed in breast milk, contraindicated by some sources (AAP Committee states compatible w/ nursing ; AAFP states safe for nursing)
Pharmacology
Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland; blocks synthesis of T4 and T3
Patient Handout
WARNING: Propylthiouracil has rarely caused very serious (possibly fatal) liver disease, especially during the first 6 months of treatment.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
