๐—”๐—ฅ๐—ข๐—ก ๐—ฆ๐—ง๐—จ๐——๐—ฌ
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ุจุณู… ุงู„ู„ู‡ ุงู„ุฑุญู…ู† ุงู„ุฑุญูŠู…

ุงู„ู„ู‡ู… ุตู„ ุนู„ู‰ ู…ุญู…ุฏ ูˆุขู„ ู…ุญู…ุฏ

ู…ุญุชูˆู‰ ุงู„ู‚ู†ุงุฉ:
ุดุฑูˆุญุงุช ุตูŠุฏู„ุฉ
ุนุถูˆูŠุฉ ู…ุฑุญู„ุฉ ุซุงู†ูŠุฉ ูƒูˆุฑุณ ุซุงู†ูŠ
ูุงุฑู…ุง ู…ุฑุญู„ุฉ ุซุงู„ุซุฉ ูƒูˆุฑุณ ุซุงู†ูŠ
ูุงุฑู…ุง ู…ุฑุญู„ุฉ ุฑุงุจุนุฉ ูƒูˆุฑุณ ุงูˆู„
ูุงุฑู…ุง ู…ุฑุญู„ุฉ ุฑุงุจุนุฉ ูƒูˆุฑุณ ุซุงู†ูŠ
ุนู„ุงุฌูŠุงุช ู…ุฑุญู„ุฉ ุฎุงู…ุณุฉ

ู„ู„ุชูˆุงุตู„:
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Applied Therapeutic ฤฑฤฑ
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ุจุงู„ุงุนุชู…ุงุฏ ุนู„ู‰ ุงู„ู…ู†ู‡ุฌ ุงู„ู…ูˆุญุฏ ูขู ูขูฆ

1. Adrenal Gland Disorders
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2. Thyroid Gland Disorders
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3. Alzheimer Disease
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4. Anxiety Disorders
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5. Depressive Disorders
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6. Schizophrenia
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7. Insomnia
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8. Contraception
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9. Hormone Replacement Therapy
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10. Menstruation Related Disorders
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11. Cancer Chemotherapy & Treatment
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12. Leukemias
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13. Lymphomas
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14. Breast Cancer
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15. Prostate Cancer
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16. Adverse Effects Of Chemotherapy
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๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ๐“„น๐“„ผ
ุญู„ูˆู„ ุงุณุฆู„ุฉ ุงู„ุนู„ุงุฌูŠุงุช ู„ู„ุฏูˆุฑ ุงู„ุงูˆู„ 2026

#ุดุฎุงุจูŠุท

Notes:
#adrenal_disorders
#thyroid_disorders
#alzheimer
#MDD
#anxiety
#schizophrenia
#insomnia
#contraception
#HRT
#MRD
#Leukemia
#Lymphoma
#Breast_Cancer
#Prostate_Cancer
#ad_effect_CT

๐—”๐—ฅ๐—ข๐—ก ๐—ฆ๐—ง๐—จ๐——๐—ฌ
โค141๐Ÿ™5๐Ÿ’”4๐Ÿ’ฏ2๐Ÿ˜ญ2
ูˆู‡ุฐู†ูŠ ูู‚ุท ู…ุญุฐูˆูุงุช ู…ู† thyroid gland (ุงู„ู…ุคุดุฑ ุญุฐู ูู‚ุท)
ู„ุงู† ู‡ู… ู…ู† ุดุฑุญุชู‡ุง ุฌุงู† ุงู„ู…ู†ู‡ุฌ ุงู„ุฌุฏูŠุฏ ุจุนุฏู‡ ู…ุง ู†ุงุฒู„

ุจุงู„ู†ุณุจุฉ ู„ู‡ุงูŠ ุงู„ุฌุฑุนุฉ ุงู‚ุฑูˆู‡ุง ุญุชู‰ ู„ูˆ ู…ุง ู…ูˆุฌูˆุฏุฉ ุจุงู„ู…ู†ู‡ุฌ ุงู„ุฌุฏูŠุฏ

ุนู…ูˆู…ุง ู…ูˆ ุดูŠ ู…ุคุซุฑ ุจุณ ุญุชู‰ ูŠูƒูˆู† ุจุนู„ู…ูƒู…

ุจุงู‚ูŠ ุงู„ู…ูˆุงุถูŠุน ุงุฐุง ู†ุฒู„ุช ุงู„ู‡ุง ู…ู„ุงุฒู… ู…ุฑุชุจุฉ ุฑุญ ุชูƒูˆู† ู…ุนุชู…ุฏุฉ ุน ู…ู†ู‡ุฌ ูขู ูขูฆ ู…ู† ู…ูˆุถูˆุน ุงู„ูƒุงู†ุณุฑ ูˆุตุงุนุฏ

#thyroid_disorders
โค15
ู…ู„ุฎุต ุงุณุจุงุจ ุงู„ู€ hyperthyroidism

ุจุงู„ู†ุณุจุฉ ู„ุฏูˆุงุก ุงู„ู€ amiodarone ูู‡ูˆ ู…ู…ูƒู† ูŠุณุจุจ ‏hyperthyroidism ุจุณุจุจ ู…ุญุชูˆุงู‡ ุงู„ุนุงู„ูŠ ู…ู† ุงู„ iodine ู…ู…ูƒู† ุชู…ุชุตู‡ ุงู„ TG
ูˆู…ู…ูƒู† ู‡ุฐุง ุงู„ุงูŠูˆุฏูŠู† ูŠุฏู…ุฑ ุงู„ TG ูˆูŠุตูŠุฑ overt hypothyroidism
ุงูˆ ูŠุตูŠุฑ ุชุฃุซูŠุฑ ุงู„ Wolffโ€“Chaikoff effect ูˆูŠุตูŠุฑ ุชุซุจูŠุท ู„ู„ุบุฏุฉ ุจุดูƒู„ ู…ุคู‚ุช ูˆู…ู…ูƒู† ูŠุณุชู…ุฑ ุงู„ุชุซุจูŠุท ูˆูŠุตูŠุฑ subclinical hypothyroidism

#thyroid_disorders
โค17
Cases of Hyperthyroidism


โญ• Thionamide

1. Pt was diagnosed Hyperthyroidism given methimazole or PTU ,
symptoms improved initially, but now she has relapsed hyperthyroidism

ุงู„ุจุฏูŠู„ ุงู„ู…ูุถู„ุŸ

preferred Use of radioactive iodine

2. patient (children or older pt) is diagnosed with Hyperthyroidism
The doctor is deciding between methimazole and PTU as initial therapy

ูŠุฎุชุงุฑ methimazole ู‡ูˆ ุงู„ุฎุท ุงู„ุงูˆู„ ุงุฐุง ุงู„ู…ุฑูŠุถ ุทูู„ ุงูˆ ูƒุจูŠุฑ ุจุงู„ุนู…ุฑ ู„ุงู† ptu ูŠุณุจุจ hepatotoxicity

3. pregnant women has Hyperthyroidism
ุจุนุฏู‡ุง ุจุงู„ุซู„ุซ ุงู„ุงูˆู„ ุงูˆู„ ุซู„ุงุซุฉ ุงุดู‡ุฑ ู…ู† ุงู„ุญู…ู„ ุงูˆ ุงูˆู„ ูกูข ุงุณุจูˆุน ุงู„ุนู„ุงุฌ ุงู„ู…ูุถู„ ู†ุฎุชุงุฑ PTU

ุซู„ุซ ุซุงู†ูŠ ุงูˆ ุซุงู„ุซ ู†ุฎุชุงุฑ methimazole

4.patient on methimazole develops severe rash and arthralgia (hypersensitivity)

ู†ุจุฏู„ ู„ู„ PTU

5. patient presents with: Fever, Tachycardia, Agitation, Severe thyrotoxicosis
ูŠุนู†ูŠ ูŠุนุงู†ูŠ ู…ู† ุงู„ุนุงุตูุฉ Thyroid storm

ู†ุฎุชุงุฑ PTU ุนู„ู‰ ุญุณุงุจ ุงู„ methimazole




๏ปฟโญ• Iodide

6. A patient with Gravesโ€™ disease is scheduled for thyroidectomy in 10 days.

what drug is given before surgery?
ุงู„ู…ูุถู„ ู„ุชุญุถูŠุฑ ุงู„ู…ุฑูŠุถ ู„ู„ุนู…ู„ูŠุฉ ุงู„ุฌุฑุงุญูŠุฉ ู‡ูˆ

iodide (SSKI or Lugol solution)

7. A patient receives radioactive iodine (RAI) therapy for Gravesโ€™ disease

ุดู†ูˆ ุงู„ุนู„ุงุฌ ุงู„ู…ุณุงุนุฏ ุงู„ูŠ ู…ู…ูƒู† ุงุถูŠูู‡ ุจุนุฏ ุงุนุทุงุก ุงู„ RAIุŸ
ุงู„ุฌูˆุงุจ iodide (SSKI or Lugol solution) ุงูˆ ฮฒ-Blockers

8. woman is diagnosed with toxic multinodular goiter presenting with symptoms of hyperthyroidism

ุงุฐุง ุณุฃู„ ุนู† ุนู„ุงุฌ ู…ู…ู†ูˆุน ุงู†ุทูŠู‡ ุจู‡ุงูŠ ุงู„ุญุงู„ุฉุŸ

ุงู„ุฌูˆุงุจ iodide (SSKI or Lugol solution) ู…ู…ู†ูˆูˆูˆูˆูˆูˆุน
๏ปฟ



โญ• ฮฒ-Blockers

9. patient with Gravesโ€™ disease or toxic nodules, in preparation for surgery, or in thyroid storm

ู…ุฑูŠุถ ุนู†ุฏู‡ ูˆุญุฏุฉ ู…ู† ู‡ุงูŠ ุงู„ุญุงู„ุงุช ูˆู…ุงุฎุฐ ูˆุงุญุฏ ู…ู† ู‡ุงูŠ ุงู„ุนู„ุงุฌุงุช
antithyroid drugs, RAI, or iodides
ู„ูƒู† ุจุงู‚ูŠุฉ ุนู†ุฏู‡ ู‡ุงูŠ ุงู„ุงุนุฑุงุถ
palpitations, anxiety, tremor, and heat
intolerance

ุดู†ูˆ ุงู„ุนู„ุงุฌ ุงู„ู…ุณุงุนุฏ adjunctive therapy ุงู„ูŠ ู…ู…ูƒู† ุงุถูŠูู‡ ู…ุน ุงู„ุงุฏูˆูŠุฉ ุงู„ุณุงุจู‚ุฉ ุŸ
ฮฒ-Blockers (Propranolol and nadolol)

ูˆูู‚ุท ุจุญุงู„ุฉ ูˆุญุฏุฉ ุงุณุชุฎุฏู…ู‡ ูƒุนู„ุงุฌ ุงุณุงุณูŠ ู…ูˆ ู…ุณุงุนุฏ primary therapy
ุงุฐุง ุฌุงู† ุณุจุจ thyrotoxicosis ู‡ูˆ thyroiditis

ูู…ู…ูƒู† ูŠุฎูŠุฑูƒู… ุจุงู„ุญุงู„ุฉ ุงู„ูŠ ุงุณุชุฎุฏู… ุจูŠู‡ุง ุงู„ ฮฒ-Blockers ูƒุนู„ุงุฌ ุงุณุงุณูŠ




โญ• RAI

10. RAI is the agent of choice for:
Gravesโ€™ disease
toxic autonomous nodules
toxic multinodular goiters

ู…ู…ู†ูˆุน ููŠ Pregnancy

11. A 72-year-old man with Gravesโ€™ disease and ischemic heart disease is planned for radioactive iodine (RAI) therapy.

The physician considers whether to give any medication before RAI.

ู„ูˆ ุงุฌู‡ ูƒูŠุณ
ู…ุฑูŠุถ ูŠุนุงู†ูŠ ู…ู† hyperthyroidism ุงูˆ Gravesโ€™ disease
ูˆุนู†ุฏู‡ ู…ุดุงูƒู„ ุจุงู„ู‚ู„ุจ ูˆุงู„ุทุจูŠุจ ูŠุฑูŠุฏ ูŠู†ุทูŠู‡ ุนู„ุงุฌ ู‡ูˆ RAI

ู…ุง ูŠุตูŠุฑ ูŠู†ุทูŠู‡ ู…ุจุงุดุฑ
ู„ุงู† ุจุงู„ุจุฏุงูŠุฉ ุชุฑุชูุน ู‡ุฑู…ูˆู†ุงุช ุงู„ุบุฏุฉ ุงู„ุฏุฑู‚ูŠุฉ ุงูƒุซุฑ ูˆูŠุฒุฏุงุฏ ุงู„ุถุบุท ุนุงู„ู‚ู„ุจ

ู ุดู†ูˆ ู„ุงุฒู… ู†ุณูˆูŠ ู‚ุจู„ ู„ุง ู†ู†ุทูŠ RAIุŸ

ู†ู†ุทูŠ antithyroid ุงู„ูŠ ู‡ูŠ thionamide ู…ุซู„ุง methimazole
๏ปฟ


โญ•Thyroid storm

12. A 55-year-old patient is admitted to the ICU with thyroid storm
HR 170 bpm, Fever 40ยฐC, Agitation and confusion

ูˆุงู„ู…ุฑูŠุถ ุนู†ุฏู‡ Possible heart failure signs
ุงูˆ ุนู†ุฏู‡ asthma

ูˆุงุฑูŠุฏ ุงู†ุทูŠู‡ ุฏูˆุงุก ู…ู† ุงุฏูˆูŠุฉ ฮฒ-blockerุŸ

ู…ุง ุงุฑูˆุญ ู„ู„ propranolole ู‡ุฐุง non selective ู…ุง ูŠููŠุฏู†ู‡

ุงู„ุฌูˆุงุจ
esmolol
ู„ุงู†ู‡ selective ูˆุขู…ู† ุจุญุงู„ุงุช
cardiac instability
pulmonary disease (e.g., asthma)
risk of decompensation

๏ปฟ

#thyroid_disorders

๐—”๐—ฅ๐—ข๐—ก ๐—ฆ๐—ง๐—จ๐——๐—ฌ
โค9๐Ÿ’ฏ3
Cases of Hypothyroidism


โญ• Levothyroxine

1. A 68-year-old patient is diagnosed with hypothyroidism, He has no history of cardiac disease

What is the appropriate initial dose of levothyroxine?

ู…ุฑูŠุถ hypothyroidism ูˆ ู…ุง ุนู†ุฏู‡ ู…ุดุงูƒู„ ุจุงู„ู‚ู„ุจ

ุดู†ูˆ ุงู„ุฌุฑุนุฉ ุงู„ู…ู†ุงุณุจุฉ ุงู„ู‡ ู…ู† levothyroxine ุŸ

ุงู„ุฌูˆุงุจ : ู†ุจุฏูŠ ุจ
levothyroxine 50 mcg daily

ูˆุจุนุฏ ุดู‡ุฑ ู…ู…ูƒู† ู†ุฒูŠุฏ ุงู„ุฌุฑุนุฉ

2. A 72-year-old woman with hypothyroidism and a history of ischemic heart disease.

What is the safest initial dose of levothyroxine?

ุงู…ุง ุงุฐุง ุงู„ู…ุฑูŠุถ ุนู†ุฏู‡ ู…ุดุงูƒู„ ุจุงู„ู‚ู„ุจ ูุดู†ูˆ ุงู„ุฌุฑุนุฉ ุงู„ู…ู†ุงุณุจุฉ ุงู„ู‡ุŸ

ุงู„ุฌูˆุงุจ : ู†ุจุฏูŠ ุจ
levothyroxine 25 mcg daily
ูˆุดู‡ุฑูŠุง ู…ู…ูƒู† ู†ุฒูŠุฏ ุงู„ุฌุฑุนุฉ ุจู†ุณุจุฉ
25 mcg

3. A 30-year-old pregnant woman is diagnosed with hypothyroidism.

What is the drug of choice?
levothyroxine




โญ• ุงู„ุงุฏูˆูŠุฉ ุงู„ูŠ ุชุชุฏุงุฎู„ ู…ุน ุงูˆ ุชุฃุซุฑ ุนู„ู‰ ุงู…ุชุตุงุต ุงู„ู€ Levothyroxine
ู…ู‡ู…ุฉ ูˆู…ู…ูƒู† ุชุฌูŠ ุจูŠู‡ุง ูƒูŠุณุงุช ู…ุซู„ุง

4. A 60-year-old man with hypothyroidism has been taking levothyroxine for several months.

He is compliant and takes his medication correctly on an empty stomach.

He recently started a new medication for a cardiac arrhythmia.

Recent labs show:
TSH: slightly elevated
Free T4: normal
Free T3: low

What is the most likely cause of his abnormal thyroid function tests?

ู…ุฑูŠุถ ุนู†ุฏู‡ hypothyroidism ูˆุฌุงูŠ ูŠุงุฎุฐ levothyroxine ูˆู…ู„ุชุฒู… ุจุงู„ุฌุฑุนุฉ ูˆูŠุงุฎุฐู‡ ุนู„ู‰ ู…ุนุฏุฉ ูุงุฑุบุฉ

ู…ู† ุณูˆู‡ ุชุญู„ูŠู„ ุงู„ูˆุถุน ู†ูˆุนุง ู…ุง ุทุจูŠุนูŠ ุจุณ T3 ู‚ู„ูŠู„

ู ู…ู† ุณุฃู„ู†ุงู‡ ุดู†ูˆ ุฌุงูŠ ุชุงุฎุฐ ูˆูŠุงู‡ ุนู„ุงุฌุงุช ูƒุงู„ ุงุฎุฐ ุนู„ุงุฌ ูŠู†ุธู… ุถุฑุจุงุช ุงู„ู‚ู„ุจ !!!

ู ุดู†ูˆ ุงู„ุฏูˆุงุก ุงู„ูŠ ู…ู…ูƒู† ูŠุฃุซุฑ ุนู„ู‰ ุชุญูˆูŠู„ T4 ุงู„ู‰ T3 ูˆู‡ูˆ ู…ู† ุงู„ุงุฏูˆูŠุฉ ุงู„ู…ุณุชุฎุฏู…ุฉ ู„ุนู„ุงุฌ ุงู„ู€ arrhythmia

ุงู„ุฌูˆุงุจ
Amiodarone inhibiting T4 to T3 conversion



#thyroid_disorders

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