March 22, 2023

St. John’s 2021 Pharm D candidate, Dianna Rosencrantz joins Christian Stella (Pharm D ABAAHP) on this episode of Precision Opinions Live.

Precision opinions live and i am christian stella pharmd here today with diana rosenkrantz and um diana rosenkrantz was here for for a month we had the privilege of getting to know her and having her work besides us um she currently works at walgreens correct and um pharmd candidate yes so pharmacist is coming right around the corner um but during our rotation

What we were looking into very heavily was thyroid and those something we’re both very passionate about so i just want to what we’re going to do is we’re going to do a breeze through on thyroid so first we’ll start it up what explain what thyroid is for most people it just it doesn’t make sense for the most part they they know of hot thyroid they’ve heard of

Thyroid but what does thyroid do to you and what are the what is the condition if you can explain that right so the thyroid is basically a butterfly shaped organ located at the front of your neck and it’s very important in metabolic stability so it actually has a number of different functions it can help with metabolism proper organ function uh even maintaining

Muscle and bone strength and in children it’s important for development and growth now there are two conditions uh called hypothyroidism and hyperthyroidism so hyperthyroidism is when you have an overactive thyroid and there’s actually a number of signs and symptoms so i do have a little list um because there are just so you can read off the list because there’s

Way too many yeah there’s a lot so um just some include bulging eyes sweating having an enlarged thyroid and that’s known as a goiter um rapid heartbeat weight loss muscle weakness anxiety and irritability irritability or even an irregular menstrual cycle and then when it comes to hypothyroidism or an underactive thyroid you can have drier coarse hair a puffy

Face also a goiter slowed heart rate weight gain brittle nails fatigue frequent and heavy menstrual periods or even cold intolerance okay yeah yeah so i mean it’s pretty much ying and yang um it’s up and down trying to find a balance some people produce too much thyroid some people produce too little and it’s based on how um how your body regulates it and um

Pretty much it it could be autoimmune in some situations so how do doctors figure this out like they’re gonna look at some labs obviously and what are they looking for yeah so they measure uh three different hormones uh the tsh t3 and t4 the tsh is uh called the thyroid stimulating hormone and what that does is it’s released by the pituitary gland to trigger

And stimulate the thyroid to release those thyroid hormones known as t4 and t3 when there’s too much tsh that means that the pituitary gland senses that there’s not enough hormones being made so it’s trying to trigger and stimulate that thyroid to release more of the hormones so it’s showing that the thyroid is under active it’s not releasing enough um and

On the other end of the spectrum there’s low levels of tsh which means that the thyroid is uh too much t4 yeah there’s too much t4 and t3 so it’s just uh overactive it’s working too much it’s not listening to the pituitary gland it’s just working on its own now t4 and t3 are those hormones that are released by the thyroid and actually t4 gets converted into

T3 making t3 basically the active component of the thyroid exactly yeah so there’s there’s free forms there’s um there’s total form so you’ll see on a lab it might say free or total free just means that it’s floating through the bloodstream that’s not attached to anything like a protein um but yeah it’s it’s kind of like the pituitary and the tsh is when it

Gets high it’s calling out to the body it’s like let’s produce more thyroid let’s produce it and it not nothing’s happening because the thyroid the t4 and the t3 are low which is interesting now when we find out when we find this patient and we do all the labs and there are some labs there are some antibodies that we can draw too to see if it is autoimmune now

When when we see this and we have a patient that does have hyper hypo what are the medications we’re seeing for hypo like um one of them is armor thyroid or porcine thyroid thyroid usp explain that one uh so yeah that’s actually an all-natural um medication because it’s actually extracted from the thyroid glands of pigs and it contains both t4 and t3 actually

80 t4 and 20 t3 and we do compound that here in the pharmacy we make it in capsule form so basically we have a pile of the powder and we actually take the capsule shells and we use this punching method so we punch the capsules into the powder and pack it in tight close up the capsule and it’s ready for the patient to use something they teach you in pharmacy

School punch um yeah so i mean the advantage of getting a compounding is compounded is we can use completely no fillers sometimes or just one filler so if a patient is allergic we can use beet powder ginger root powder even vitamin c so whatever they want and whatever they feel comfortable with and their body responds properly to we can use as a filler which

Is nice what about t4 so synthroid yeah so t4 is um actually made synthetically in a lab it’s a synthetic bioidentical so um it’s pretty much made synthetically in a lab to be the exact same hormone that everyone produces yes and actually if you under treat with this medication that can cause coronary heart disease but if you over treat with this medication

That can actually cause atrial fibrillation or even decrease bone quality that could possibly result in fractures but if all is well um and the levels go within range you should see symptoms improve within two to three weeks but that’s not really going to be reflected in the labs until about a month later yeah perfect um now the last one is t3 t3 same thing

Right synthetic yeah it’s synthetic there actually isn’t a lot of information out there about t3 simply because when it is taken orally it gets broken up in the gut and it’s no longer active and it can’t do its job that’s why we t4 is a little bit more common because it won’t become inactive just like that because it gets converted to its active component

Yeah exactly so some patients um what we do in the compounding lab to get to to get them that t3 because t30 is the active form t4 converts into t3 and some patients don’t convert properly so we need to give them that t3 and what we’ll do is we’ll make a capsule use our punch method and we’ll use um something called methycel and make it sustain release so it

Can kind of get through the gut properly and they can have active t3 on board but that’s pretty much it when it comes down to compounding we we can um help these patients because thyroid the therapeutic index is very small um and there’s a lot we can do to help patients that have allergies as well um so i want to thank you diana for coming on i want to thank

You for all your help um throughout this rotation and uh good luck in the future all right thank you thank you for having me be sure to search precision opinions live on stitcher spotify youtube and google pods and make sure to follow precision pharmacy on instagram facebook and all other social media platforms you

Transcribed from video
What is the difference between levothyroxine , liothyronine and porcine thyroid USP? By Precision Opinions Live