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PEBC > 34 - Thyroid Disorders > Flashcards

34 - Thyroid Disorders Flashcards

1
Q

more common in what gender

A

women

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2
Q

Hypothyroidism is an ______ TSH level

A

elevated

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3
Q

What is subclinical hypothyroidism?

A

defined by an elevated TSH with normal thyroid hormone levels

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4
Q

Symptoms of hypothyroidism

A

fatigue, impaired memory, bradycardia, dry skin and hair, constipation, cold intolerance

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5
Q

What does dessicated thyroid contain?

A

both t4 and t3

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6
Q

Hypothyroidism:

What is the treatment of choice?

A

Levothyroxine (L-T4) to normalize TSH level

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7
Q

Hypothyroidism:

Dose adjust for levothyroxine every ____ weeks as needed

A

4-6

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8
Q

Hypothyroidism:

Dose of levothyroxine in adults

A

1.6 mcg/kg/day

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9
Q

Hypothyroidism:

Dose of levothyroxine in newborns

A

10-16 mcg/kg/day

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10
Q

Hypothyroidism:

When do you give liothyronine (T3) ?

A

short term management of patients with thyroid cancer undergoing withdrawal of L-T4 when recombinant TSH is not an option or in order to prepare for radioactive iodine therapy

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11
Q

Hypothyroidism in Pregnancy:

How do you manage women who are already taking thyroid hormone replacement therapy?

A
  • increase the dose by 2 extra tabs/week immediately after a positive pregnancy test
  • further dose adjustments based on TSH levels
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12
Q

Hypothyroidism in Pregnancy:

When do you get TSH levels drawn?

A

-have TSH levels q 6 weeks or 4 weeks after dose adjustment

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13
Q

Hypothyroidism in Pregnancy:

For those not on therapy, what is the target TSH?

A

TSH should be maintained at < 4 mU/L

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14
Q

Hypothyroidism in Pregnancy:

When would you initiate therapy if they’re not on it already?

A

if the TSH > 10 mU/L or if the patient has TSH > 4 mU/L and is positive for anti-TPO antibodies then you want to initiate thyroid replacement therapy

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15
Q

Hypothyroidism:

How do you explain the safety of thyroid replacement in pregnancy and breastfeeding?

A

thyroid replacement is completely safe in pregnancy and breastfeeding and is important to ensure a healthy pregnancy and normal fetal development

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16
Q

Hypothyroidism in Breastfeeding:

How do you treat it?

A

same as non-breastfeeding women

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17
Q

Thyrotoxicosis is also caused ______

A

hyperthyroidism

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18
Q

Hyperthyroidism is when TSH is ____

A

low

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19
Q

Define subclinical hyperthyroidism

A

TSH is low but thyroid hormone levels are normal

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20
Q

Symptoms of hyperthyroidism

A

weight loss, palpitations, diarrhea, heat intolerance, anxiety

21
Q

What drugs can suppress TSH

A

corticosteroids, domperidone, metoclopramide, dopamine

22
Q

Hyperthyroidism:

What can radioactive iodine cause as a side effect?

A

hypothyroidism

23
Q

Hyperthyroidism:

Radioactive iodine is CI in ____

A

pregnancy

24
Q

Hyperthyroidism:

What are the 2 antithyroid drugs?

A
  • methimazole

- PTU

25
Q

Hyperthyroidism:

How do antithyroid drugs work?

A

decrease production of thyroid hormone

26
Q

Hyperthyroidism:

What can PTU also do?

A

block conversion of L-T4 to T3

27
Q

Hyperthyroidism:

When do antithyroid drugs need to be stopped?

A

Need to be stopped 5 days prior to a thyroid scan or treatment with iodine

28
Q

Hyperthyroidism:

Which antithyroid drugs is preferred? Why?

A

MTZ is preferred due to lower incidence of hepatotoxicity

29
Q

Hyperthyroidism:

In what situation is PTU preferred over MTZ?

A

1st trimester of pregnancy

30
Q

Hyperthyroidism:

How do beta blockers work?

A

ameliorate the symptoms of adrenergic excess and are usually used adjunctively in the management of Graves disease or toxic nodules

31
Q

Hyperthyroidism:

Which beta blockers can decrease conversion of L-T4 to T3

A

propranolol and nadolol

32
Q

Hyperthyroidism:

How does iodine (Lugol solution) work?

A

blocks thyroid hormone production

33
Q

Hyperthyroidism:

When should iodine (Lugol solution) be given in relation to antithyroid drugs?

A

1 hour after administration of an antithyroid drug

34
Q

Hyperthyroidism:

What can methimazole and PTU cause?

A

neutropenia

35
Q

Hyperthyroidism:

How can corticosteroids help?

A

they lower the level of free T3

36
Q

Hyperthyroidism:

Place of selenium in therapy?

A

Selenium 100mcg BId may prevent worsening of mild Graves orbitopathy and can be considered as supplemental therapy

37
Q

How do you treat thyroid storm?

A
  • antithyroid meds, BB and corticosteroids
  • use acetaminophen for hyperthermia
  • plasmapheresis can be considered in unresponsive cases
38
Q

Hyperthyroidism and Pregnancy:

Wait how long after radioactive iodine before conceiving ?

A

6 months

39
Q

Hyperthyroidism and Pregnancy:

____ is preferred antithyroid for 1st trimester of pregnancy

A

PTU

40
Q

Hyperthyroidism and Pregnancy:

Can you give MTZ?

A

if PTU is CI

41
Q

Hyperthyroidism and Pregnancy:

What is the treatment for 2nd and 3rd trimester?

A

MTZ

42
Q

Hyperthyroidism and Pregnancy:

What are some other options?

A

BBs or iodine in 1st trimester with careful monitoring

43
Q

Hyperthyroidism and Pregnancy:

What do you monitor and how often?

A

TSH, fT3, fT4 q6-8 weeks

44
Q

Hyperthyroidism and Pregnancy:

What do you need to measure at 22 weeks gestation

A

TRAb titre should be measured

-if positive, repeat at 30-34 weeks

45
Q

Hyperthyroidism and Pregnancy:

A high titre of TRAb means what?

A

increased risk of hyperthyroidism for the baby

46
Q

When on antithyroid drugs, when will neutropenia be seen if it happens?

A

1st 90 days

47
Q

When on antithyroid drugs, when will hepatic effects be seen if it happens?

A

1st 120 days

48
Q

Hyperthyroidism and Breastfeeding:

What antithyroid drug is preferred?

A
  • MTZ preferred but can use PTU

- can use BBs

PEBC (130 decks)

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