Can NSAIDs alter thyroid hormone function? Taking a multidisciplinary approach to address the off target effects of NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs) are taken to treat pain and inflammation, and are the most frequently taken over the counter drug type taken worldwide. They work by inhibiting cyclooxygenase (COX) enzymes, whose products are used by other enzymes to biosynthesise a range of prostanoids. However, the NSAIDs also inhibit COX1, a key enzyme that is present in all cells in the body. Inhibition of COX1 leads to one of the major side effects of NSAIDs, gastric bleeding, and for this reason new COX-1 sparing drugs were created such as celecoxib. For people having to take NSAIDs on a daily basis this was an important development, but unfortunately these drugs were later found to have cardiovascular complications, furthermore, the chances of having a myocardial infarction following other NSAIDs such as diclofenac were also found to be increased. Much research followed to find out whether the cardiovascular side effects were due to the inhibition of COX1 or COX2. While on-target effects of NSAIDs are the likely to be the major cause of side effects, we investigated whether NSAIDs could also have off-target effects.