#amiodarone induced thyrotoxicosis

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Hyperthyroidism: Its Important Symptoms, Causes, Treatment And Lifestyle

Hyperthyroidism: Symptoms, Causes, Treatment And LifestyleIntroductionFunction Of Thyroid GlandWhat is Hyperthyroidism?Causes of HyperthyroidismSymptoms Of Hyperthyroidism Physical Manifestations Emotional RollercoasterDiagnosis Of HyperthyroidismTreatment Options: Bringing Harmony Back Medications Radioactive Iodine Therapy Surgical InterventionEmbracing a New Rhythm: Living with…

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Carvedilol

Brand Names: Coreg & Coreg CR

Generic Available

Common Dosage Forms:

Tablets: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg.

Capsules (Coreg CR): 10 mg, 10 mg, 20 mg, 40 mg, and 80 mg.

FDA Indications/Dosages:

For the management of essential hypertension when used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics: Start with 6.25 mg given twice a day. After 7-14 days and using standing systolic pressure one hour after dosing as a guide, increase dosage to 12.5 mg twice a day. Further dosage increases to 25 mg twice a day and may be made after another 7-14 days.

For the treatment of mild to moderate heart failure of ischemic or cardiomyopathic origin, in combination with digitalis, diuretics, and an ACE inhibitor, to reduce the progression of disease: Start with 3.125 mg given twice a day for 14 days. Dose may be doubled every 14 days to the highest level tolerated by the patients. The maximum dose is 25 mg twice a day in patients weighing less than 85 kg and 50 mg twice a day in patients weighing more than 85 kg. Take with food to slow the rate of absorption and decrease orthostatic effects.

For the use in patients with left ventricular dysfunction (LVEF of ≤ 40%) following myocardial infarction: Start treatment after the patient is hemodynamically stable and fluid retention has been minimized. Start with 6.25 mg given twice a day. Increase the dose after 3-10 days to 12.5 mg twice a day and again after 3-10 days to the target dose of 25 mg twice daily. A lower starting dose may be used in patients with low blood pressure or heart rate, or mild fluid retention.

Monitor: BP, LFT, BG.

Pharmacology/Pharmacokinetics: Carvedilol is a nonselective beta-adrenergic blocking agent with alpha-1-adrenergic blocking activity. The mechanism of action of carvedilol in the treatment of hypertension may be due to beta-adrenergic blockage resulting in (1) a reduction in cardiac output, (2) a reduction in exercise- and/or isoproterenol-induced tachycardia and (3) reduces reflex orthostatic tachycardia. In congestive heart failure, carvedilol has been shown to reduce systemic blood pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance, and heart rate while increasing stroke volume index. Mean terminal elimination half-life ranges from 7 to 10 hours. 98% is bound to plasma proteins, mainly albumin. Metabolism occurs primarily by aromatic ring oxidation and glucuronidation.

Drug Interactions: Rifampin significantly decreases plasma levels. Cimetidine increases steady-state AUC but not Cmax. Quinidine, fluoxetine, paroxetine, and propafenone may increase plasma levels. Use with reserpine, clonidine, digoxin, or monoamine oxidase inhibitors may produce significant hypotension or bradycardia. Use with diltiazem or verapamil may cause conduction disturbances. May increase digoxin plasma levels. Use with inhibitors of CYP2C9 (amiodarone or fluconazole) may exacerbate bradycardia.

Contraindication/Precautions: Use is contraindicated in patients with NYHA class IV decompensated cardiac failure requiring intravenous inotropic therapy, bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome, cardiogenic shock, or severe bradycardia. Use with caution in patients with hepatic impairment. Discontinue use at the first sign of hepatic dysfunction (e.g., pruritus, dark urine, anorexia, jaundice, right upper quadrant tenderness, or unexplained flu-like symptoms). Use with caution in patients with peripheral vascular disease (can aggravate symptoms), in diabetics (can mask hypoglycemia), and in thyrotoxicosis (can mask hyperthyroidism). Use with caution during anesthesia (due to bradycardia). Pregnancy Category C.

Adverse Effects: Dizziness (32%), diarrhea (12%), bradycardia and hypotension (9%), hyperglycemia (12%), and visual abnormalities (5%) occur in treatment of congestive heart failure. The same effects occur in the treatment of hypertension but at approximately the same rate as seen in placebo.

Patient Consultation:

Store in a cool, dry place away from sunlight and children.

If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule. Do not double doses.

Take with food to decrease orthostatic hypotension.

Contact a physician if the above side effects are severe or persistent.

Contact lens wearers may experience decreased lacrimation.

Do not discontinue therapy without first consulting physician. Treatment must be tapered over 1 to 2 weeks.

May cause drowsiness. Use caution while operating machinery or when mental alertness is required.

Patients with diabetes need to be aware that this agent can cause masking of hypoglycemic symptoms.

Avoid nonprescription cough, cold, and allergy medications unless otherwise directed.

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Iodine and Hyperthyroidism

Your thyroid gland produces the hormones that control and regulate your metabolism. Iodine is the fuel it runs on. Too little iodine and you may experience hypothyroidism, a condition in which the thyroid does not produce enough hormones. Conversely, hyperthyroidism occurs when the thyroid produces too much of the thyroid hormone thyroxine. As a metabolism regulator, over production impacts the body at the cellular level. This can ultimately lead to symptoms such as weight loss, anxiety, fatigue, hyperactivity, and a general intolerance to heat. Cardiac shock and death can also occur in extreme cases. [1]

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The most common causes for this hormone overproduction are Grave’s Disease (an autoimmune disorder), inflammation of the thyroid (thyroiditis), or thyroid nodules that create and release excess thyroxine. More rare causes include medications such as Amiodarone (an anti-arrhythmia drug) overconsumption of thyroid hormone tablets, or consumption of processed or ground beef contaminated with thyroid tissue.

And, while somewhat rare, over ingestion of iodine, a precursor element of thyroxine, has also been reported as a cause.

Iodine as a Cause of Hyperthyroidism

Balance is important in all aspects of life, especially nutrition. While iodine deficiency plagues much of the world, consuming too much iodine can also be a problem. Dietary sources high in iodine, such as kelp, if taken in extreme abundance, can introduce too much iodine into the body and create an iodine-induced hyperthyroidism. Iodine used for medical reasons, such as an antiseptic on a hospital dressing, as a contrast agent, or from the administration of solutions containing iodine can also lead to its development. [2]

While too much iodine can induce hyperthyroidism, iodine can, oddly enough, also be the solution.

Iodine as the Solution to Hyperthyroidism

Iodine can be used to slow thyroid hormone release. Potassium iodide, Lugol’s solution, or, my personal preference, nascent iodine, can be used to initiate this effect. Applied in this way, iodine can halt complications like those of a Thyroid Storm, where the thyroid overproduces and over releases thyroid hormones leading to serious and potentially fatal effects.

In some cases, small amounts of Iodine-131 (a radioactive iodine) will be applied to slow thyroid hormone production. Studies of individuals exposed to iodine-131 radiation have shown consistent development of hypothyroidism, a condition of reduced thyroid hormone output. [3] In medical applications, only the smallest amount is used to achieve the necessary result.

Manage Iodine Levels for Best Health

Conditions like hyperthyroidism can lead to serious complications – heart problems, osteoporosis, problems with the eyes from vision to physically bulging eyes, and thyroid storm can create life-threatening situations. Maintaining healthy iodine levels is the best method to promote thyroid health and function.

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Watch an In-Depth Video on

Everything You Need to Know About Iodine

by Dr. Edward Group DC, NP, DACBN, DCBCN, DABFM

Source: Iodine and Hyperthyroidism

  References (3)

Hjørringgaard J, Birkelund T, Ravn HB. [Cardiac arrest and cardial insuffiency as result of thyrotoxicosis].Ugeskr Laeger. 2013 Apr 1;175(14):962-3.

Brotfain E, Koyfman L, Frenkel A, Smolikov A, Zlotnik A, Klein M. Iodine-induced hyperthyroidism-an old clinical entity that is still relevant to daily ICU practice: a case report. Case Rep Endocrinol. 2013;2013:792745. doi: 10.1155/2013/792745. Epub 2013 Apr 9.

Ostroumova E, Rozhko A, Hatch M, Furukawa K, Polyanskaya O, McConnell RJ, Nadyrov E, Petrenko S, Romanov G, Yauseyenka V, Drozdovitch V, Minenko V, Prokopovich A, Savasteeva I, Zablotska LB, Mabuchi K, Brenner AV. Measures of Thyroid Function among Belarusian Children and Adolescents Exposed to Iodine-131 from the Accident at the Chernobyl Nuclear Plant. Environ Health Perspect. 2013 Jul;121(7):865-71. doi: 10.1289/ehp.1205783. Epub 2013 May 1.

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