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Thera XI > 11 Thyroid Disorders Nazemzadeh > Flashcards

11 Thyroid Disorders Nazemzadeh Flashcards

1
Q

What are the thyroid levels like for HYPOthyroidism?

A

High TSH, Low T4, Low T3

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2
Q

What is the TSH normal range?

A

0.5-5

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3
Q

What is the Free T4 normal range?

A

0.8-2.7

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4
Q

What are the thyroid levels like for HYPERthyroidism?

A

Low TSH, High T4, High T3

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5
Q

What are the primary causes of HYPOthyroidism?

A

Thyroid gland failure. Hashimoto’s Thyroiditis

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6
Q

What medications can cause HYPOthyroidism?

A

Interferon, Ribavirin, Amiodarone, Lithium, etc.

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7
Q

What are the tests for autoimmunity and the normal values?

A

Thyroid peroxidase antibodies (TPOAb): < 100. Anti-thyroglobulin antibodies (TgAb) < 8%. Thyrotropin receptor antibodies (TRAb): negative

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8
Q

What are the most common signs and symptoms of HYPOthyroidism?

A

Fatigue. Weight gain. Cold intolerance. Constipation. Dry skin. Heavy menstrual periods. Depression. Infertility. Bradycardia. Enlarged thyroid

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9
Q

What are the common treatment options for HYPOthyroidism?

A

Levothyroxine. Liothyronine. Liotrix. Desiccated thyroid

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10
Q

What are the contents of Levothyroxine?

A

Synthetic T4, DOC. Patients own physiologic mechanisms control the production of active hormone

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11
Q

What are the contents of Liothyronine

A

Synthetic T3. Wide fluctuations (rapid absorption, short t1/2)

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12
Q

What are the contents of Liotrix?

A

Synthetic T4:T3 in 4:1 ratio. No therapeutic advantage

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13
Q

How should Levothyroxine (Synthroid) be dosed?

A

Healthy adult < 50 yo: 1.6-1.7 mcg/kg/day (adjust for patients < 50 or w/ cardiac disease)

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14
Q

How should Levothyroxine be titrated?

A

By 12.5-25mcg increments at 6-8 week intervals as needed. IV:PO = 1:2

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15
Q

What can cause reduced absorption (chelation) of Levothyroxine?

A

Antacids. Ferrous sulfate. Bile acid sequestrants. Sucralfate

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16
Q

What is monitoring like when starting Levothyroxine?

A

TSH measurements 4-8 weeks after initiation of tx or dose change. Once therapeutic dose determined: TSH after 6 months, then 12 month intervals

17
Q

How do you counsel for Levothyroxine?

A

Take on empty stomach 30 minutes to 1 hour before breakfast. Separate administration of iron and levothyroxine by at least 4 hours. Will take several weeks to see effect. Usually lifelong w/ periodic lab testing. Do NOT d/c w/o discussing w/ provider

18
Q

How does pregnancy affect treatment of HYPOthyroidism?

A

Increased thyroid hormone requirement. As early as 4-6 weeks of pregnancy. Increase through 16-20 weeks. Plateau until delivery

19
Q

What are complications of pregnancy in untreated HYPOthyroidism?

A

Preterm delivery. Low birth weight. Miscarriage. Gestational HTN. Fetal neurocognitive deficits

20
Q

What is the TSH reference range during pregnancy?

A

First: 0.1-2.5, Second: 0.2-3, Third: 0.3-3

21
Q

What is the DOC for HYPOthyroidism in pregnancy?

A

Levothyroxine (Category A). Increase dose by 25-30% at onset of pregnancy. Postpartum: reduce dose back to pre-pregnancy range following delivery

22
Q

What are the most common causes of HYPERthyroidism?

A

Graves disease (most common)

23
Q

What are the signs/symptoms of HYPERthyroidism?

A

Nervousness. Tachycardia. Weight loss. Heat intolerance. Irritability. Tremor. Decreased menstrual flow. Insomnia. Diarrhea. Thyroid enlargement. Bulging eyes (exopthalmos)

24
Q

What are the non pharmacologic treatment options for HYPERthyroidism?

A

Radioactive Iodine Therapy (RAI): treatment of choice for Graves disease, can result in chronic hypothyroidism. Thyroidectomy

25
Q

What are the two drug therapy options for HYPERthyroidism?

A

Methimazole (Tapazole). Propylthiouracil (PTU)

26
Q

What is the DOC in thyroid storm?

A

Propylthiouracil (PTU), otherwise Methimazole is preferred d/t its daily dosing

27
Q

How are the drugs for HYPERthyroidism used during pregnancy?

A

PTU preferred in 1st trimester of pregnancy; Methimazole 2nd/3rd

28
Q

Why are BBs used for symptomatic management in HYPERthyroidism?

A

Decrease HR and SBP. Decrease tremors. Decrease muscle weakness. Improve irritability

Thera XI (16 decks)

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