Skip to main content
SpringerLink
Log in

Clinical Pharmacokinetics of β-Adrenoceptor Blocking Drugs in Thyroid Disease

  • Published:
Clinical Pharmacokinetics Aims and scope Submit manuscript

Summary

β-Adrenoceptor blocking drugs (β-blockers) have an established place in the management of patients with thyroid disease. Thyroid hormones, however, markedly alter hepatic, renal and cardiovascular function and thus may significantly influence drug disposition. In hyperthyroidism the clearance of propranolol following intravenous administration is increased by approximately 50%, an effect that may be attributed to the marked increase in liver blood flow that occurs in this condition. On the other hand, the increased clearance of propranolol during long term oral therapy is presumably due to increased hepatic drug metabolising enzyme activity. However, following single oral doses the clearance of propranolol has been reported both to be unchanged and increased in hyperthyroid patients. Both during single dose and long term therapy the elimination half-life of propranolol is unaltered, in part due to an increased apparent volume of distribution. The degree of plasma protein binding of propranolol appears to be slightly reduced in the hyperthyroid state.

There is evidence to suggest that the clearance of metoprolol, which like propranolol undergoes extensive hepatic metabolism, is also increased in hyperthyroidism. In contrast, the oral clearance of renally excreted β-blockers such as sotalol and atenolol, and probably practolol also, is not altered in hyperthyroidism.

In general, all β-blockers produce a similar degree of symptomatic response. Those with intrinsic sympathomimetic activity (e.g. oxprenolol) do not reduce heart rate to the same extent as propranolol. Recent studies have shown a significant relationship between plasma propranolol levels and the objective measures (reduction in exercise tachycardia, serum triiodothyronine concentration and weight change) but not the subjective measures of therapeutic response. Concentration-response relationships are also becoming apparent for other β-blockers such as metoprolol and nadolol. The 20-fold interindividual variation in propranolol plasma concentrations, which may be largely attributed to age and smoking habits, emphasises the need for individualisation of dosage. This may also explain the reported cases of thyroid crisis, particularly postoperatively in patients receiving a fixed dosage regimen. In the latter situation surgery may also markedly alter the handling of propranolol.

The effect of hypothyroidism on the disposition of β-blockers has not been definitively studied. In hypothyroidism the elimination half-life of propranolol following a single oral dose may be prolonged although clearance is not affected. During long term therapy, preliminary evidence suggests that steady-state plasma propranolol levels are elevated. The clearance of practolol is reduced and its elimination half-life is prolonged compared with the hyperthyroid state.

It is unlikely that the efficacy of newer β-blockers will exceed that of propranolol. However, in certain clinical situations a long acting or a cardioselective agent may be preferable. The influence of thyroid disorders on the kinetics and the concentration-response relationships of the newer agents will, however, require further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aro. A.; Anttila, M.; Korhonen, T. and Sundquist, H.: Pharmacokinetics of propranolol and sotalol in hyperthyroidism. European Journal of Clinical Pharmacology 21: 373–377 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Bax. N.D.S.; Lennard, M.S. and Tucker, G.T.: Effect of beta-blockers on thyroid hormone. British Medical Journal 281: 1283 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Bell. J.M.; Russell, C.J.; Nelson, J.K.; Kelly, J.G. and McDevitt, D.G.: Studies on the effect of thyroid dysfunction on the elimination of β-adrenoceptor blocking drugs. British Journal of Clinical Pharmacology 4: 79–82 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Bodem. G. and Chidsey, C.A.: Pharmacokinetic studies of practolol, a beta adrenergic antagonist in man. Clinical Pharmacology and Therapeutics 14: 26–29 (1973).

    PubMed  CAS  Google Scholar 

  • Bradley, S.E.; Stephens, F.C.; Coelho, J.B. and Reville, P.: The thyroid and the kidney. Kidney International 6: 346–365 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Carruthers, S.G.; Ghosal, A.; McDevitt, D.G.; Nelson, J.K. and Shanks, R.G.: The assessment of β-adrenoceptor blocking drugs in hyperthyroidism. British Journal of Clinical Pharmacology 1: 93–98 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Crooks, J.; Hedley, S.J.; Macnee, C. and Stevenson, I.H.: Changes in drug metabolising ability in thyroid disease. British Journal of Pharmacology 49: 156P–157P (1973).

    Google Scholar 

  • Eichelbaum, M.: Drug metabolism in thyroid disease. Clinical Pharmacokinetics 1: 339–350 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Eichelbaum, M.; Bodem, G.; Gugler, R.; Schneider-Deters, C. and Dengler, H.J.: Influence of thyroid status on plasma half-life of antipyrine in man. New England Journal of Medicine 290: 1040–1042 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Elfstrom, J.: Drug pharmacokinetics in the post-operative period. Clinical Pharmacokinetics 4: 16–22 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Eriksson. M.; Rubenfeld, S.; Garber, A.J. and Kohler, P.O.: Propranolol does not prevent thyroid storm. New England Journal of Medicine 296: 263–264 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Feely. J.: Propranolol and the hypercalcaemia of thyrotoxicosis. Acta Endocrinologica 98: 528–532 (1981).

    PubMed  CAS  Google Scholar 

  • Feely. J.: Forrest, A.L.; Gunn, A.: Hamilton. W.F.D.; Stevenson, I.H. and Crooks, J.: Beta-blocking drugs and thyroid function. British Medical Journal 4: 1352 (1977).

    Google Scholar 

  • Feely. J.; Crooks, J. and Stevenson, I.H.: Alterations in plasma propranolol steady-state concentration in thyroid disease. Clinical Pharmacology and Therapeutics 23: 112–113 (1978).

    Google Scholar 

  • Feely, J.; Crooks, J. and Stevenson, I.H.: Altered pharmacokinetics of propranolol in hyperthyroidism. British Journal of Clinical Pharmacology 8: 387P (1979a).

    Article  Google Scholar 

  • Feely. J.; Isles, T.E.; Ratcliffe, W.A. and Crooks, J.: Propranolol triiodothyronine reverse triiodothyronine and thyroid disease. Clinical Endocrinology 10: 531–538 (1979b).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.; Forrest, A.; Gunn, A.; Hamilton, W.; Stevenson, I. and Crooks, J.: Influence of surgery on plasma propranolol levels and protein binding. Clinical Pharmacology and Therapeutics 28: 759–764 (1980a).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.; Stevenson, I.H. and Crooks, J.: Propranolol dynamics in thyrotoxicosis. Clinical Pharmacology and Therapeutics 28: 40–44 (1980b).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.; Forrest, A.; Gunn, A.; Hamilton, W.; Stevenson, I. and Crooks, J.: Propranolol dosage in thyrotoxicosis. Journal of Clinical Endocrinology and Metabolism 51: 658–661 (1980c).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.: Crooks, J. and Stevenson, I.H.: The influence of age, smoking and hyperthyroidism on plasma propranolol steady state concentrations. British Journal of Clinical Pharmacology 12: 73–78 (1981a).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.; Stevenson. I.H. and Crooks, J.: Increased clearance of propranolol in thyrotoxicosis. Annals of Internal Medicine 94: 472–474 (1981b).

    PubMed  CAS  Google Scholar 

  • Feely. J.; Stevenson, I.H. and Crooks, J.: Altered plasma protein binding of drugs in thyroid disease. Clinical Pharmacokinetics 6: 298–305 (1981c).

    Article  PubMed  CAS  Google Scholar 

  • Feely, J.; Crooks, J. and Stevenson, I.H.: Plasma propranolol levels in thyroid disorders. European Journal of Clinical Pharmacology 19: 329–333 (1981d).

    Article  PubMed  CAS  Google Scholar 

  • Georges, L.P. and Sode, J.: Thyrotoxic hypercalcaemia treated with propranolol. New England Journal of Medicine 294: 1123–1124 (1976).

    Google Scholar 

  • Gibberd, M.G. and Staffurth, J.S.: Oxprenolol in thyrotoxicosis. Lancet 1: 205 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Ginsberg, A.M.; Clutter, W.E.; Shah, S.D. and Cryer, P.E.: Triiodothyronine-induced thyrotoxicosis increases mononuclear leukocyte β-adrenergic receptor density in man. Journal of Clinical Investigation 67: 1785–1791 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Hagenfeldt, L.; Wennlund, A.; Felig, P. and Wahren, J.: Turnover and splanchnic metabolism of free fatty acids in hyperthyroid patients. Journal of Clinical Investigation 67: 1672–1677 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Hallengren, B.; Nilsson, O.R.; Karlberg, B.E.; Melander, A.; Tegler. L. and Wahlin-Boll, E.: Influence of hyperthyroidism on the kinetics of methimazole, propranolol, metoprolol and atenolol. European Journal of Clinical Pharmacology 21: 379–384 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Heilman, R.; Kelly, K.L. and Mason, W.D.: Propranolol for thyroid storm. New England Journal of Medicine 297: 671–672 (1977).

    Google Scholar 

  • Heyma, P.; Larkins, R.G.; Higginbotham, L. and Wah, Ng.K.: D-propranolol and DL-propranolol both decrease conversion of l-thyroxine to 1-triiodothyronine. British Medical Journal 281: 24–25 (1980).

    Article  PubMed  CAS  Google Scholar 

  • How, J.; Khir, A.S.M. and Bewsher, P.D.: The effect of atenolol on serum thyroid hormones in hyperthyroid patients. Clinical Endocrinology 13: 299–302 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Ishizaki, T.; Masuno, M. and Tawara, K.: No enhanced elimination of propranolol in patients with hyperthyroidism. Research Communications in Chemical Pathology and Pharmacology 29: 473–485 (1980).

    PubMed  CAS  Google Scholar 

  • Jones, M.K.; John, R. and Jones, G.R.: The effect of oxprenolol, acebutolol and propranolol on thyroid hormones in hyperthyroid subjects. Clinical Endocrinology 13: 343–347 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Katz, A.I.; Emmanouel, D.S. and Lindheimer, M.D.: Thyroid hormone and the kidney. Nephron 15: 223–249 (1975).

    Article  PubMed  CAS  Google Scholar 

  • Kelly, J.G. and McDevitt. D.G.: Plasma protein binding of propranolol and isoprenaline in hyperthyroidism and hypothyroidism. British Journal of Clinical Pharmacology 6: 123–127 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Kornhauser, D.M.; Wood, A.J.J.; Vestal, R.E.; Wilkinson, G.R.; Branch, R.A. and Shand, D.G.: Biological determinants of propranolol disposition in man. Clinical Pharmacology and Therapeutics 23: 165–174 (1978).

    PubMed  CAS  Google Scholar 

  • Landsberg, L.: Catecholamines and hyperthyroidism. Clinics in Endocrinology and Metabolism 6: 697–718 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Lee. T.C.; Coffey, R.J.; Mackin, J.; Cobb, M.; Routon, J. and Canary, J.J.: The use of propranolol in the surgical treatment of thyrotoxic patients. Annals of Surgery 177: 643–647 (1973).

    PubMed  CAS  Google Scholar 

  • Lotti, G.; Delitala, G.; Devilla, L.; Alagna, S. and Masala, A.: Reduction of plasma triiodothyronine (T3) induced by propranolol. Clinical Endocrinology 6: 405–410 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Ljunggren, J.G. and Persson, B.: Pre-operative treatment of thyrotoxicosis with a beta-adrenergic blocking agent. Acta Chirugica Scandinavica 141: 715–718 (1975).

    CAS  Google Scholar 

  • MacNee, C.; Hedley, A.J.; Adamson, D.G. and Crooks, J.: Drug metabolising capacity in thyroid disease. Israel Journal of Medical Science 8: 1889–1890 (1972).

    Google Scholar 

  • Melander, A.; Danielson, K.; Schersten, B. and Wahlin. E.: Enhancement of the bioavailability of propranolol and metoprolol by food. Clinical Pharmacology and Therapeutics 22: 108–112 (1977).

    PubMed  CAS  Google Scholar 

  • Michie, W.; Hamer-Hodges, D.W.; Pegg, C.A.S.; Orr, F.G.G. and Bewsher, P.D.: Beta-blockade and partial thyroidectomy for thyrotoxicosis. Lancet 1: 1009–1011 (1974).

    Article  PubMed  CAS  Google Scholar 

  • McDevitt, D.G.: β-Adrenoceptor blockade in hyperthyroidism; in Shanks (Ed.) Advanced Medicine: Topics in Therapeutics, 3rd edition, pp. 100–115 (Pitman Medical, London 1977).

    Google Scholar 

  • McDevitt, D.G. and Nelson, J.K.: Comparative trial of atenolol and propranolol in hyperthyroidism. British Journal of Clinical Pharmacology 6: 233–237 (1978).

    Article  PubMed  CAS  Google Scholar 

  • McDevitt, D.G.; Riddell, J.G.; Hadden, D.R. and Montgomery, D.A.D.: Catecholamine sensitivity in hyperthyroidism and hypothyroidism. British Journal of Clinical Pharmacology 6: 297–301 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Murchison, L.E.; Bewsher, P.D.; Chesters, M.I. and Ferrier, W.R.: Comparison of propranolol and practolol in the management of hyperthyroidism. British Journal of Clinical Pharmacology 3: 273–277 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Murchison, L.E.; How, J. and Bewsher, P.D.: Comparison of propranolol and metoprolol in the management of hyperthyroidism. British Journal of Clinical Pharmacology 8: 581–587 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Myers, J.D.; Brannon, E.S. and Holland, B.C.: A correlative study of the cardiac output and the hepatic circulation in hyperthyroidism. Journal of Clinical Investigation 29: 1069–1077 (1950).

    Article  PubMed  CAS  Google Scholar 

  • Nelson, J.K. and McDevitt, D.G.: Comparative trial of propranolol and practolol in hyperthyroidism. British Journal of Clinical Pharmacology 2: 411–416 (1975).

    Article  PubMed  CAS  Google Scholar 

  • Nilsson, O.R.; Karlberg, B.E.; Kagedal, B.; Tegler, L. and Almqvist, S.: Non-selective and selective β1,-adrenoceptor blocking agents in the treatment of hyperthyroidism. Acta Medica Scandinavica 206: 21–25 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Nilsson, O.R.; Melander, A. and Tegler, L.: Effects and plasma levels of propranolol and metoprolol in hyperthyroid patients. European Journal of Clinical Pharmacology 18: 315–320 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Peden, N.R.; Gunn, A.; Isles, T.E.; McPherson, J.N.; Stevenson, I.H. and Crooks, J.: The effect of nadolol on thyroid function; in Gross (Ed.) International Experience with Nadolol, a Long-acting β-Blocking Agent. International Congress and Symposium Series/Royal Society of Medicine No. 37, pp.57–63 (Academic Press and Royal Society of Medicine, London 1981).

    Google Scholar 

  • Pimstone, B. and Joffe, B.: The use and abuse of beta-adrenergic blockade in the surgery of hyperthyroidism. South African Medical Journal 44: 1059–1061 (1970).

    PubMed  CAS  Google Scholar 

  • Riddell, J.G.; Neill, J.D.; Kelly, J.G. and McDevitt, D.G.: Effects of thyroid dysfunction on propranolol kinetics. Clinical Pharmacology and Therapeutics 28: 565–574 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Routledge, P.A. and Shand, D.G.: Clinical pharmacokinetics of propranolol. Clinical Pharmacokinetics 4: 73–90 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Rubenfeld, S.; Silverman, V.E.; Welch, K.M.A.; Mallette, L.E. and Kohler, P.O.: Propranolol pharmacokinetics in thyrotoxicosis. Clinical Research 26: 295A (1978).

    Google Scholar 

  • Rubenfeld, S.; Silverman, V.E.; Welch, K.M.A.; Mallette, L.E. and Kohler, P.O.: Variable plasma propranolol levels in thyrotoxicosis. New England Journal of Medicine 300: 353–354 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Rude, R.K.; Oldham, S.B.; Singer, F.R. and Nicoloff, J.T.: Treatment of thyrotoxic hypercalcaemia with propranolol. New England Journal of Medicine 294: 431–433 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Sawin, C.T.; Chopra, D.; Azizi, F.; Mannix, J.E. and Bacharach, P.: The aging thyroid. Journal of the American Medical Association 242: 247–250 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Shand, D.G.: Individualization of propranolol therapy. Medical Clinics of North America 58: 1063–1069 (1974).

    PubMed  CAS  Google Scholar 

  • Shand, D.G.; Branch, R.A.; Evans, G.H.; Nies, A.S, and Wilkinson, G.R.: The disposition of propranolol. VII. The effects of saturable hepatic tissue uptake on drug clearance by the perfused rat liver. Drug Metabolism and Disposition 1: 679–686 (1973).

    PubMed  CAS  Google Scholar 

  • Shanks, R.G.; Hadden, D.R.; Lowe, D.C.; McDevitt, D.G. and Montgomery, D.A.D.: Controlled trial of propranolol in thyrotoxicosis. Lancet 1: 993–994 (1969).

    Article  PubMed  CAS  Google Scholar 

  • Shenfield, G.M.: Influence of thyroid dysfunction on drug pharmacokinetics. Clinical Pharmacokinetics 6: 275–297 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Solomon, D.H. and Kleeman, K.E.: Concepts of pathogenesis of Gravess’ Disease. Advances in Internal Medicine 22: 273–299 (1977).

    PubMed  CAS  Google Scholar 

  • Tawara, K.; Kawashima, K.; Ishikawa, H.; Yamamoto, K.; Saito, K.; Ebihara, A. and Yoshida, S.: Pharmacokinetics and pharmacodynamics of propranolol stereoisomers and hyperthyroid patients. European Journal of Clinical Pharmacology 19: 197–203 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Theilade, P.; Steiness, E.; Jorgensen, P.H. and Hansen, J.M.: Decreased first-pass metabolism of propranolol in hyperthyroidism. Presented to First World Conference on Clinical Pharmacology and Therapeutics, 608A, London (1980).

  • Toft, A.D.; Irvine, W.J.; Sinclair, I.; McIntosh, D.; Seth, J. and Cameron, E.H.D.: Thyroid function after surgical treatment of thyrotoxicosis: a report of 100 cases treated with propranolol before operation. New England Journal of Medicine 298: 643–647 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Turner, P.: β-Adrenergic receptor blocking drugs in hyperthyroidism. Drugs 7: 48–54 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Vesell, E.S.; Shapiro, J.R.; Passananti, G.T.; Jorgensen, H. and Shively, C.A.: Altered plasma half-lives of antipyrine, propylthiouracil and methimazole in thyroid dysfunction. Clinical Pharmacology and Therapeutics 17: 48–56 (1975).

    PubMed  CAS  Google Scholar 

  • Vestal, R.E.; Wood, A.J.J.; Branch, R.A.; Shand, D.G. and Wilkinson, G.R.: Effects of age and cigarette smoking on propranolol disposition. Clinical Pharmacology and Therapeutics 26: 8–15 (1979).

    PubMed  CAS  Google Scholar 

  • Wahlberg, P.; Wennstrom, J. and Ekelund, P.: Control of thyrotoxicosis with sotalol. Annals of Clinical Research 8: 415–417 (1976).

    PubMed  CAS  Google Scholar 

  • Walle, T.; Conradi, E.C.; Walle, U.K.; Fagan, T.C. and Gaffney, T.E.: The predictable relationship between plasma levels and dose during chronic propranolol therapy. Clinical Pharmacology and Therapeutics 24: 668–677 (1978).

    PubMed  CAS  Google Scholar 

  • Walle, T.; Conradi, E.C.; Walle, U.K.; Fagan, T.C. and Gaffney, T.E.: Propranolol glucuronide cumulation during long term propranolol therapy: a proposed storage mechanism for pro-panolol. Clinical Pharmacology and Therapeutics 26: 686–695 (1979).

    PubMed  CAS  Google Scholar 

  • Walle, T.; Conradi, E.C.; Walle, U.K.; Fagan, T.C. and Gaffney, T.E.: 4-Hydroxy-propranolol and its glucuronide after single and long-term doses of propranolol. Clinical Pharmacology and Therapeutics 27: 22–31 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Wells, P.G.; Feely, J.; Nadeau, J.; Wilkinson, G.R. and Wood, A.J.J.: Propranolol disposition in thyrotoxicosis. Clinical Research 29: 279A (1981).

    Google Scholar 

  • Wilkinson, R. and Burr, W.A.: The effect of nadolol on thyroid function; in Gross (Ed.) International experience with Nadolol, a Long-acting β-Blocking Agent. International Congress and Symposium series/Royal Society of Medicine No. 37, pp.51–56 (Academic Press and Royal Society of Medicine, London 1981).

    Google Scholar 

  • Wilkinson, G.R. and Shand, D.G.: A physiological approach to hepatic drug clearance. Clinical Pharmacology and Therapeutics 18: 377–390 (1975).

    PubMed  CAS  Google Scholar 

  • Williams, L.T.; Lefkowitz, R.J.; Watanabe, A.M.; Hathaway, D.R. and Besch, Jr, H.R.: Thyroid hormone regulation of beta-adrenergic receptor number. Journal of Biological Chemistry 252: 2787–2789 (1977).

    PubMed  CAS  Google Scholar 

  • Williams, R.S.; Guthrow, C.E. and Lelkowitz, R.J.: β-Adrenergic receptors of human lymphocytes are unaltered by hyperthyroidism. Journal of Clinical Endocrinology and Metabolism 48: 503–505 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Wood, A.J.J.; Carr, K.; Vestal, R.E.; Belcher, S.; Wilkinson, G.R. and Shand, D.G.: Direct measurement of propranolol bioavailability during accumulation steady-state. British Journal of Clinical Pharmacology 6: 345–350 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Yamaji, T.; Motohashi, S.; Murakawa, S. and Ibayashi, H.: Urinary excretion of 6β-hydroxycortisol in states of altered thyroid function. Journal of Clinical Endocrinology 29: 801–806 (1969).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology and Therapeutics, University of Dundee, Dundee, DDI 9SY, Scotland

    John Feely

Authors
  1. John Feely
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Feely, J. Clinical Pharmacokinetics of β-Adrenoceptor Blocking Drugs in Thyroid Disease. Clin Pharmacokinet 8, 1–16 (1983). https://doi.org/10.2165/00003088-198308010-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003088-198308010-00001

Keywords

Search

Navigation