Home' Australian Pharmacist : July 2011 Contents Vol.30–July#07
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
amiodarone, following her discharge
from hospital. Amiodarone can impair
the metabolism of warfarin which may
potentiate its anticoagulant effect.5
If Irene’s doctor decides to cease or
change the dose of amiodarone she
will need to have more frequent blood
tests to check her INR.
You recommend that Irene take a mild
laxative to relieve her constipation,
e.g . lactulose 5–10 mL at night.
Six weeks later Irene returns to
your pharmacy to update you on her
progress. Following your referral, her
GP had conducted a series of blood
tests and confirmed that she had
developed hypothyroidism. Irene’s GP
also said that the blood test results
from the hospital indicated that her
thyroid levels were already ‘quite low’
before she started on amiodarone.
Irene was commenced on thyroxine
50 mcg once daily and is now due for
her first follow-up ‘thyroid blood test’.
She was still having troubles with
constipation while her new medication
began to work, but is now passing
regular bowel motions. Irene tells you
that her skin is no longer dry, she has
more energy and is not feeling the
cold as much. Her warfarin dose has
now stabilised and she is feeling much
more positive about her health.
1. Which of the following is
NOT a cause of primary
b) Pituitary necrosis.
c) Hashimoto’s disease.
2. The risk of developing
hypothyroidism (AIH) is:
a) increased at doses of amiodarone
above 150 mg daily.
b) increased at doses of amiodarone
above 200 mg daily.
c) increased at doses of amiodarone
above 250 mg daily.
d) independent of the dose of
amiodarone taken daily.
3. Which one of the following
is NOT a symptom of
a) Cold intolerance.
d) Coarse skin.
e) Increased sweating.
4. Which of the following options
a) Primary hypothyroidism can be
confirmed with a raised level of
thyroid-stimulating hormone (TSH)
(>20 mU/L) and low free thyroxine
b) Elderly and female individuals
have an increased risk of
A score of 4 out of 5 attracts 1 CPD credit.
hypothyroidism is a persistent
condition that is difficult to treat.
d) Irradiation of the thyroid can cause
e) Thyroid hormone replacement is
usually commenced with thyroxine
25–50 mcg daily.
5. Amiodarone contains what
percentage of iodine?
Key learning points
Pharmacists are able to play an
active role in helping to identify and
refer individuals with potentially
undiagnosed conditions, such as
hypothyroidism. Constipation, dry
skin, cold intolerance and lethargy
are all symptoms of hypothyroidism
and if an individual is experiencing
a number of these symptoms, it is
important that they be referred to their
GP for thyroid function tests. When an
individual presents to the pharmacy
with a seemingly straightforward
complaint, further questioning can
reveal a far more complex picture. This
understanding can then lead to correct
treatment, alleviating the symptoms
and improving the individual’s quality
1. Royal Pharmaceutical Society of Great Britain.
British National Formulary (BNF). 61st edn. London:
Pharmaceutical Press; Mar 2011. p 94.
2. Hueston WJ. Treatment of hypothyroidism. American
Family Physician. 2001; 64(10):1717–24.
3. Topliss D, Eastman C. Diagnosis and management
of hyperthyroidism and hypothyroidism. MJA. 2004;
4. Kennedy RL, Griffiths H, Gray TA. Amiodarone and the
thyroid. Clinical Chemistry. 1989; 35(9):1882–7 .
5. Campbell T. Amiodarone. Aust Prescriber. 2005;
6. Barbesino G, Chiovato L. The genetics of Hashimoto’s
disease. Endocrinology and Metabolism Clinics of
North America. 2000; 29(2):357–74.
7. Loh K. Amiodarone-induced thyroid disorders: a clinical
review. Postgraduate Medical Journal. 2000; 76:133–
8. Nava-Ocampo A, Soldin O, Koren G. Hypothyroidism
during pregnancy. Canadian Family Physician. 2004;
9. Sutandar M, Garcia-Bourniessen F, Koren G.
Hypothyroidism in pregnancy. Journal of Obstetric
Gynaecology Canada. 2007; 29(4):354–6.
10. Mortimer R. Thyroid function tests. Aust Prescriber.
2011; 34(1):12–5 .
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