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PHARMACOLOGY (sahrgeant) > Antithyroid > Flashcards

Antithyroid Flashcards

1
Q

What are the major indications for the therapeutic use of thyroid hormone?

A

Hormone replacement therapy in hypothyroidism and TSH suppression therapy in thyroid cancer.

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2
Q

What type of preparations are used for thyroid hormone therapy?

A

Synthetic preparations of the sodium salts of natural isomers of thyroid hormones.

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3
Q

What is the form of levothyroxine sodium available for administration?

A

Tablets, liquid-filled capsules, and lyophilized powder for injection.

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4
Q

Where does absorption of levothyroxine occur?

A

In the stomach and small intestine.

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5
Q

What is the absorption rate of levothyroxine tablets?

A

Approximately 80%.

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6
Q

How does taking levothyroxine on an empty stomach affect its absorption?

A

Increases absorption and reduces variability in TSH levels.

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7
Q

When do serum T4 levels peak after oral ingestion of levothyroxine?

A

2-4 hours after ingestion.

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8
Q

What is the plasma half-life (t1/2) of levothyroxine?

A

7 days.

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9
Q

What should a patient do if they miss a dose of levothyroxine?

A

Take a double dose the next day.

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10
Q

How does the T4/T3 ratio in patients taking levothyroxine compare to those with endogenous thyroid function?

A

Slightly higher in patients taking levothyroxine.

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11
Q

When are follow-up blood tests typically done after a dosage change of levothyroxine?

A

About 6 weeks after any dosage change.

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12
Q

What is the intravenous dosing recommendation for levothyroxine if oral intake is not possible?

A

80% of the patient’s daily oral requirement once daily.

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13
Q

What is liothyronine sodium the salt of?

A

T3 (triiodothyronine).

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14
Q

What is the absorption rate of liothyronine?

A

Nearly 100%.

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15
Q

In what situations is liothyronine used?

A

Myxedema coma or rapid termination of action in thyroid cancer preparation.

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16
Q

What are the drawbacks of using liothyronine for chronic replacement therapy?

A

More frequent dosing, higher cost, and transient serum T3 elevations.

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17
Q

How does the required daily dose of liothyronine compare to levothyroxine?

A

About one-third of L-T4 to achieve an equivalent TSH level.

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18
Q

What is the T3 concentration comparison between normalization of TSH with liothyronine versus levothyroxine?

A

Nearly 2-fold higher serum T3 with liothyronine.

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19
Q

What mixture of thyroid hormones is available for therapy?

A

A mixture of levothyroxine and T3 in a 4:1 ratio by weight.

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20
Q

What is equivalent in activity to a 60-mg desiccated thyroid tablet?

A

80 µg of levothyroxine.

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21
Q

Name one drug that may increase levothyroxine dosage requirements.

A

Aluminum-containing antacids.

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22
Q

What factors may impair levothyroxine absorption?

A

Aluminum-containing antacids, bile acid sequestrants, calcium carbonate, food.

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23
Q

What is a drug that may decrease levothyroxine dosage requirements?

A

Metformin.

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24
Q

What factors may increase thyroxine metabolism?

A

Rifampin, carbamazepine, phenytoin, sertraline.

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25
Q

True or False: Advancing age (>65 years) may decrease levothyroxine dosage requirements.

A

True.

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26
Q

What is the hormone of choice for thyroid hormone replacement therapy?

A

Thyroxine

Due to its consistent potency and prolonged duration of action.

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27
Q

Which enzymes convert T4 to T3 in thyroid hormone replacement therapy?

A

D1 and D2

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28
Q

What is the average daily adult full replacement dose of L-T4?

A

1.7 µg/kg body weight (0.8 µg/lb)

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29
Q

On what basis should dosing for thyroid hormone replacement generally be based?

A

Lean body mass

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30
Q

What is the goal of thyroid hormone replacement therapy in hypothyroidism?

A

Normalize serum TSH or free T4 and relieve symptoms

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31
Q

In primary hypothyroidism, what should be monitored instead of free T4?

A

TSH

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32
Q

What is the recommended initial dose for elderly patients or those with cardiac disease?

A

Subreplacement dose of L-T4 (12.5-50 µg/d)

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33
Q

How often can the dose of L-T4 be increased until TSH is normalized?

A

By 25 µg/d every 6 weeks

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34
Q

True or False: Monotherapy with levothyroxine mimics normal physiology.

A

True

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35
Q

What happens to the levothyroxine requirement during pregnancy?

A

It usually requires a higher dose

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36
Q

What adverse effects are associated with overt hypothyroidism during pregnancy?

A

Increased risk of miscarriage, fetal distress, preterm delivery, and impaired psychoneural and motor development

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37
Q

By how much should women increase their levothyroxine dose upon confirming pregnancy?

A

By 30%

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38
Q

When should TSH be measured during pregnancy?

A

In the first trimester and periodically through to 20 weeks’ gestation

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39
Q

What is isolated hypothyroxinemia during pregnancy defined by?

A

Low serum free T4 concentration and normal serum TSH concentration

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40
Q

What is the best test to evaluate thyroid status during pregnancy?

A

TSH

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41
Q

What is myxedema coma?

A

A rare syndrome representing extreme severe, long-standing hypothyroidism

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42
Q

What are common precipitating factors of myxedema coma?

A
  • Infection
  • Congestive heart failure
  • Medical noncompliance
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43
Q

What are the cardinal features of myxedema coma?

A
  • Hypothermia
  • Respiratory depression
  • Decreased consciousness
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44
Q

What is the initial loading dose of levothyroxine for myxedema coma?

A

200-400 µg

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45
Q

What is the recommended initial daily dose of levothyroxine for congenitally hypothyroid infants?

A

10-15 µg/kg

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46
Q

What should be monitored after initiating treatment for congenital hypothyroidism?

A

TSH and free T4 at 2 and 4 weeks, every 1-2 months in the first 6 months, and every 2-3 months until age 3

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47
Q

What may impair levothyroxine absorption in infants?

A

Soy formula

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48
Q

What is the goal for free T4 and TSH levels in congenitally hypothyroid infants?

A
  • Free T4 in the upper half of the reference range
  • TSH in the lower half
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49
Q

True or False: Brand-name and generic levothyroxine are bioequivalent in infants with severe congenital hypothyroidism.

A

False

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50
Q

What are the mainstays of therapy for well-differentiated thyroid cancer?

A

Surgical thyroidectomy, radioiodine, and levothyroxine to maintain a low TSH

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51
Q

Why is TSH suppression important in thyroid cancer treatment?

A

TSH is a growth factor for thyroid cancer

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52
Q

What is a reasonable TSH target range for patients without persistent disease?

A

Low-normal TSH value

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53
Q

What TSH level should be maintained in patients at high risk for recurrence?

A

Mildly subnormal TSH value (~0.1 mU/L)

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54
Q

What are potential risks of TSH suppression therapy?

A

Osteoporosis and atrial fibrillation

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55
Q

What is the most common endocrinopathy?

A

Nodular thyroid disease

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56
Q

What symptoms can thyroid nodules cause?

A

Neck discomfort, dysphagia, and a choking sensation

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57
Q

Are thyroid nodules more common in men or women?

A

Women

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58
Q

What increases the rate of thyroid nodule development?

A

Exposure to ionizing radiation, especially in childhood

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59
Q

What percentage of thyroid nodules that come to medical attention are malignant?

A

Approximately 5%

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60
Q

What should be confirmed by TSH measurement in patients with thyroid nodules?

A

Most patients with thyroid nodules are euthyroid

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61
Q

What are the most useful diagnostic procedures for thyroid nodules?

A

Ultrasound imaging and fine-needle aspiration biopsy

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62
Q

Can levothyroxine be recommended to suppress TSH in euthyroid individuals with thyroid nodules?

A

No, it cannot be recommended as a general practice

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63
Q

When is it appropriate to administer levothyroxine for thyroid nodules?

A

If the TSH is elevated

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64
Q

What are the adverse effects of thyroid hormone typically associated with?

A

Overtreatment

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65
Q

What risks are associated with excess thyroid hormone?

A

Atrial fibrillation, especially in the elderly
Increased risk of osteoporosis, especially in post-menopausal women

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66
Q

What types of compounds interfere with thyroid hormone activity?

A

Antithyroid drugs
Iodine inhibitors
High concentrations of iodine
Radioactive iodine
Adjuvant therapy with non-specific drugs

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67
Q

What is the mechanism of action for perchlorate and thiocyanate?

A

Lodide uptake inhibition

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68
Q

What do thionamides do in thyroid hormone synthesis?

A

Interfere with the organification of iodine

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69
Q

Which agents can block hormone release from the thyroid gland?

A

Li* salts and iodide

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70
Q

What can accelerate hepatic metabolism of thyroid hormones?

A

Phenobarbital
Rifampin
Carbamazepine
Phenytoin
Sertraline
Bexarotene

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71
Q

What are the main antithyroid drugs with clinical utility?

A

The thioureylenes, which belong to the family of thioamides, with propylthiouracil as the prototype.

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72
Q

How do antithyroid drugs inhibit thyroid hormone formation?

A

By interfering with the incorporation of iodine into tyrosyl residues of thyroglobulin and inhibiting the coupling of iodotyrosyl residues to form iodothyronines.

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73
Q

What enzyme do antithyroid drugs inhibit?

A

Peroxidase enzyme.

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74
Q

What is the effect of inhibiting hormone synthesis by antithyroid drugs?

A

Depletion of stores of iodinated thyroglobulin as the protein is hydrolyzed and hormones are released into circulation.

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75
Q

What additional effect does propylthiouracil have compared to methimazole?

A

Partially inhibits the peripheral deiodination of T4 to T3.

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76
Q

What is the typical time frame for improvement of the thyrotoxic state after starting antithyroid drugs?

A

3-6 weeks.

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77
Q

What factors influence the clinical response to antithyroid drugs?

A

The dose of antithyroid drug, size of the goiter, and pretreatment serum T3 concentration.

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78
Q

What are the potential consequences of overtreatment with antithyroid drugs?

A

Hypothyroidism.

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79
Q

How often should thyroid function tests be measured after initiating treatment?

A

Every 2-4 months.

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80
Q

What should be done once euthyroidism is established?

A

Follow-up every 4-6 months.

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81
Q

What are the two antithyroid compounds currently used in the U.S.?

A
  • Propylthiouracil (6-n-propylthiouracil)
  • Methimazole (1-methyl-2-mercaptoimidazole)
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82
Q

What is the mechanism of action of carbimazole?

A

Its antithyroid action is due to its conversion to methimazole after absorption.

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83
Q

What is the absorption time for propylthiouracil after oral dosing?

A

20-30 minutes.

84
Q

What is the half-life (t1/2) of propylthiouracil in plasma?

A

75 minutes.

85
Q

What is the half-life (t1/2) of methimazole?

A

4-6 hours.

86
Q

What is the most serious side effect of antithyroid drugs?

A

Agranulocytosis.

87
Q

When does agranulocytosis usually occur during therapy?

A

In the first few weeks or months, but sometimes later.

88
Q

What should patients be instructed to report while on antithyroid drugs?

A

Development of sore throat or fever.

89
Q

What is a common mild reaction to antithyroid drugs?

A

Mild urticarial papular rash.

90
Q

What are some less-frequent complications of antithyroid drugs?

A
  • Pain and stiffness in joints
  • Paresthesias
  • Headache
  • Nausea
  • Skin pigmentation
  • Loss of hair
91
Q

What is the drug of choice for Graves disease?

A

Methimazole.

92
Q

What is the usual starting dose for methimazole?

A

15-40 mg per day.

93
Q

What is the usual starting dose for propylthiouracil?

A

100 mg every 8 hours.

94
Q

What percentage of pregnancies are affected by thyrotoxicosis?

A

About 0.2%.

95
Q

What is the treatment of choice for thyrotoxicosis in pregnancy?

A

Antithyroid drugs; radioactive iodine is contraindicated.

96
Q

Which antithyroid drug is usually avoided in the first trimester of pregnancy?

A

Methimazole.

97
Q

What should be the goal for serum FT4 index during pregnancy?

A

Upper half of the normal range or slightly elevated.

98
Q

What is a common outcome for Graves disease after delivery?

A

Relapse or worsening.

99
Q

What is the role of B Adrenergic receptor antagonists in the treatment of thyrotoxicosis?

A

They antagonize the sympathetic/adrenergic effects, reducing tachycardia, tremor, and relieving palpitations, anxiety, and tension.

Examples include propranolol and atenolol.

100
Q

What is the initial dosage for propranolol in the treatment of thyrotoxicosis?

A

20-40 mg four times daily.

Atenolol can also be used at 50-100 mg daily.

101
Q

What is the purpose of Ca2+ channel blockers in managing thyrotoxicosis?

A

To control tachycardia and decrease the incidence of supraventricular tachyarrhythmias.

Examples include diltiazem.

102
Q

How long is short-term treatment with β-adrenergic receptor antagonists or Ca2+ channel blockers typically required?

A

2-6 weeks.

Treatment should be discontinued once the patient is euthyroid.

103
Q

What type of immunotherapy is used for Graves hyperthyroidism?

A

B-lymphocyte-depleting agent rituximab combined with methimazole.

This combination prolongs remission of Graves disease.

104
Q

What is thyroid storm?

A

A life-threatening complication of thyrotoxicosis, usually precipitated by an intercurrent medical problem.

It occurs in untreated or partially treated thyrotoxic patients.

105
Q

What are common precipitating factors for thyroid storm?

A
  • Infections
  • Stress
  • Trauma
  • Surgery
  • Diabetic ketoacidosis
  • Heart disease
  • Rarely, radioactive iodine treatment.

These factors can trigger a thyrotoxic crisis.

106
Q

What are the cardinal features of thyroid storm?

A
  • Fever (>38.5°C)
  • Tachycardia out of proportion to fever
  • Nausea
  • Vomiting
  • Diarrhea
  • Agitation
  • Confusion.

Coma and death may ensue in up to 20% of patients.

107
Q

What is the preferred antithyroid drug in the treatment of thyroid storm?

A

Propylthiouracil.

It is preferred because it also impairs peripheral conversion of T4 to T3.

108
Q

What is the function of ionic inhibitors in the thyroid gland?

A

They interfere with the concentration of iodide by the thyroid gland.

Examples include perchlorate and thiocyanate.

109
Q

How does perchlorate function as an ionic inhibitor?

A

It blocks the entrance of iodide into the thyroid by competitively inhibiting the NIS.

Perchlorate can also be transported by NIS into the thyroid gland.

110
Q

What are the potential risks of excessive perchlorate use?

A

It can cause fatal aplastic anemia when given in excessive amounts (2-3 g daily).

750 mg daily has been used in the treatment of Graves’ disease.

111
Q

What is the effect of lithium on thyroid hormones?

A

It decreases secretion of T4 and T3, which can cause overt hypothyroidism in some patients.

Lithium is often used for the treatment of mania.

112
Q

What is iodide known for in relation to thyroid gland disorders?

A

Iodide is the oldest remedy for disorders of the thyroid gland.

Iodide has been used historically to treat various thyroid conditions.

113
Q

How does high concentration of iodide affect thyroid function?

A

High concentration of iodide can influence several important functions of the thyroid gland.

Specifically, it can inhibit synthesis of iodotyrosines and iodothyronines.

114
Q

What is the Wolff-Chaikoff effect?

A

The Wolff-Chaikoff effect is when iodide limits its own transport and acutely inhibits the synthesis of iodotyrosines and iodothyronines.

This is a feedback mechanism that prevents excessive thyroid hormone production.

115
Q

What is a significant clinical effect of high plasma iodide concentration?

A

Inhibition of the release of thyroid hormone, particularly effective in severe thyrotoxicosis.

This action occurs rapidly and can be crucial in emergency situations.

116
Q

What happens to patients with hyperthyroidism when treated with iodide?

A

Release of thyroid hormone is rapidly blocked, and synthesis is mildly decreased.

Vascularity of the thyroid gland is reduced, and colloid reaccumulates in the follicles.

117
Q

How long does it take for the maximal effect of iodide therapy in hyperthyroidism?

A

The maximal effect occurs after 10-15 days of continuous therapy.

This duration allows for significant changes in thyroid function.

118
Q

What is the role of iodide therapy in the preoperative period for thyroidectomy?

A

Iodide therapy is used to prepare patients for thyroidectomy and in conjunction with antithyroid drugs and propranolol in thyrotoxic crisis.

This helps stabilize patients prior to surgery.

119
Q

How does iodide protect the thyroid from radioactive iodine fallout?

A

Administration of stable iodine decreases the thyroid uptake of radioactive iodine.

This is crucial in the event of nuclear accidents.

120
Q

What are the components of strong iodine solution (Lugol solution)?

A

5% iodine and 10% potassium iodide, yielding about 8 mg of iodine per drop.

This solution is commonly used in medical treatments.

121
Q

What is the typical dosage for Lugol solution?

A

16-36 mg (2-6 drops) three times a day.

This dosage helps achieve the desired therapeutic effects.

122
Q

What is the adult dose of potassium iodide product (Thyroshield) for radiation emergencies?

A

2 mL (130 mg) every 24 hours, as directed by public health officials.

This dosage is critical for blocking radioiodine uptake.

123
Q

What condition may develop in euthyroid patients exposed to large amounts of iodine?

A

Iodine-induced hypothyroidism.

This can occur due to the acute Wolff-Chaikoff effect.

124
Q

What are the prominent symptoms of sensitivity to iodine?

A

Angioedema and laryngeal edema may lead to suffocation.

Hypersensitivity reactions can be severe.

125
Q

What symptoms are associated with chronic intoxication with iodide (iodism)?

A

Unpleasant brassy taste, burning in the mouth and throat, increased salivation, and irritation of the eyes.

These symptoms can resemble a cold.

126
Q

What are potential severe reactions to prolonged use of iodides?

A

Rarely severe eruptions (ioderma) resembling those caused by bromism.

These eruptions can be serious and require withdrawal of iodide.

127
Q

What gastrointestinal symptoms may occur with iodism?

A

Symptoms of gastric irritation, diarrhea (sometimes bloody), fever, anorexia, and depression.

These symptoms reflect the systemic effects of iodide.

128
Q

What procedures can increase renal excretion of iodide?

A

Osmotic diuresis, chloruretic diuretics, and salt loading.

These methods can alleviate symptoms of iodism.

129
Q

What is the iodine content of Amiodarone?

A

75 mg/200 mg tablet

Amiodarone is an antiarrhythmic medication that contains a significant amount of iodine.

130
Q

What is the iodine content of Iodoquinol (diiodohydroxyquin)?

A

134 mg/tablet

Iodoquinol is used for treating intestinal infections and contains iodine.

131
Q

What is the iodine content of Echothiophate iodide ophthalmic solution?

A

5-41 g/drop

This is an ophthalmic medication used in the treatment of glaucoma.

132
Q

What is the iodine content of Iodoquinol?

A

134 mg/tablet

Iodoquinol is the same as diiodohydroxyquin, emphasizing its iodine content.

133
Q

What is the iodine content of Idoxuridine ophthalmic solution?

A

18 ug/drop

Idoxuridine is an antiviral medication used to treat viral infections in the eye.

134
Q

What is the iodine content of Lugol solution?

A

5-6 mg/drop

Lugol solution is a solution of iodine in water and is used as an antiseptic.

135
Q

What is the iodine content of saturated solution of KI (KISS)?

A

38 mg/drop

KISS is used for various medical purposes including thyroid protection.

136
Q

What is the iodine content of Clinoquinol cream?

A

Topical antiseptic

Clinoquinol is used topically and contains iodine.

137
Q

What is the iodine content of Povidone-iodine?

A

Topical antiseptic

Povidone-iodine is a widely used antiseptic with iodine.

138
Q

What is the iodine content of Diatrizoate meglumine sodium?

A

12 mg/g

This is a radiographic contrast agent used in imaging procedures.

139
Q

What is the iodine content of lothalamate?

A

10 mg/mL

Lothalamate is another radiographic contrast agent with iodine.

140
Q

What is the iodine content of loxaglate?

A

370 mg/mL

Loxaglate is used in radiographic imaging.

141
Q

What is the iodine content of lopamidol?

A

320 mg/mL

Lopamidol is a contrast agent used in medical imaging.

142
Q

What is the iodine content of Iohexol?

A

370 mg/mL

Iohexol is a non-ionic contrast agent used in various imaging studies.

143
Q

What is the iodine content of Ioxilan?

A

350 mg/mL

Ioxilan is also a contrast agent used in imaging.

144
Q

What is the iodine content of Iohexol?

A

370 mg/mL

Iohexol is frequently used in CT and other imaging studies.

145
Q

What is the iodine content of Amiodarone?

A

75 mg/200 mg tablet

Amiodarone is an antiarrhythmic medication that contains a significant amount of iodine.

146
Q

What is the iodine content of Iodoquinol (diiodohydroxyquin)?

A

134 mg/tablet

Iodoquinol is used for treating intestinal infections and contains iodine.

147
Q

What is the iodine content of Echothiophate iodide ophthalmic solution?

A

5-41 g/drop

This is an ophthalmic medication used in the treatment of glaucoma.

148
Q

What is the iodine content of Iodoquinol?

A

134 mg/tablet

Iodoquinol is the same as diiodohydroxyquin, emphasizing its iodine content.

149
Q

What is the iodine content of Idoxuridine ophthalmic solution?

A

18 ug/drop

Idoxuridine is an antiviral medication used to treat viral infections in the eye.

150
Q

What is the iodine content of Lugol solution?

A

5-6 mg/drop

Lugol solution is a solution of iodine in water and is used as an antiseptic.

151
Q

What is the iodine content of saturated solution of KI (KISS)?

A

38 mg/drop

KISS is used for various medical purposes including thyroid protection.

152
Q

What is the iodine content of Clinoquinol cream?

A

Topical antiseptic

Clinoquinol is used topically and contains iodine.

153
Q

What is the iodine content of Povidone-iodine?

A

Topical antiseptic

Povidone-iodine is a widely used antiseptic with iodine.

154
Q

What is the iodine content of Diatrizoate meglumine sodium?

A

12 mg/g

This is a radiographic contrast agent used in imaging procedures.

155
Q

What is the iodine content of lothalamate?

A

10 mg/mL

Lothalamate is another radiographic contrast agent with iodine.

156
Q

What is the iodine content of loxaglate?

A

370 mg/mL

Loxaglate is used in radiographic imaging.

157
Q

What is the iodine content of lopamidol?

A

320 mg/mL

Lopamidol is a contrast agent used in medical imaging.

158
Q

What is the iodine content of Iohexol?

A

370 mg/mL

Iohexol is a non-ionic contrast agent used in various imaging studies.

159
Q

What is the iodine content of Ioxilan?

A

350 mg/mL

Ioxilan is also a contrast agent used in imaging.

160
Q

What is the iodine content of Iohexol?

A

370 mg/mL

Iohexol is frequently used in CT and other imaging studies.

161
Q

What are the primary isotopes used for the diagnosis and treatment of thyroid disease?

A

123I and 131I

123I is primarily used in diagnostic studies, while 131I is used therapeutically.

162
Q

What is the half-life of 123I?

163
Q

What type of radiation does 131I emit?

A

Y rays and ß particles

164
Q

What is the half-life of 131I?

165
Q

What is the primary therapeutic use of 131I?

A

Thyroid destruction of an overactive or enlarged thyroid and thyroid ablation in cancer

166
Q

How does the chemical behavior of radioactive isotopes of iodine compare to stable iodine?

A

Identical to that of stable isotope 127I

167
Q

Where is 131I rapidly and efficiently trapped in the body?

A

Thyroid gland

168
Q

What is the effect of 131I on surrounding tissue?

A

Little or no damage

169
Q

True or False: The effects of radiation depend on the dosage.

170
Q

What is the usual total dose of 131I for treatment?

171
Q

What should be monitored alongside TSH concentrations after 131I therapy?

A

Free T4 and serum T3 concentrations

172
Q

What is the recommended target dose of 131I to deliver to the thyroid gland?

A

8 mCi based on 24-h radioiodine uptake

173
Q

Fill in the blank: Radioactive iodine is effective in patients with _______.

A

toxic nodular goiter

174
Q

What are the advantages of radioactive iodine treatment?

A

Low cost, no hospitalization required, minimal discomfort

Patients can continue their usual activities during treatment.

175
Q

What is a significant disadvantage of radioactive iodine treatment?

A

High incidence of delayed hypothyroidism

176
Q

What types of cancer may show a small increase after radioiodine therapy?

A

Stomach, kidney, and breast cancers

177
Q

What is the main contraindication for using 131I therapy?

178
Q

What is the purpose of withdrawing thyroid hormone replacement therapy before administering 131I?

A

To promote endogenous TSH stimulation for effective treatment

179
Q

What is the range of an ablative dose of 131I for treating metastases?

A

30 to 150 mCi

180
Q

What can be used instead of thyroid hormone withdrawal to prepare a patient for radioiodine ablation?

A

Recombinant thyrotropin alpha (recombinant human TSH)

181
Q

True or False: Recombinant human TSH is currently approved for use in preparing patients for radioiodine ablation of metastatic disease.

182
Q

What are the two primary histological classifications of thyroid carcinomas?

A

Papillary and follicular carcinomas

183
Q

What is the primary treatment approach for most thyroid carcinomas?

A

Surgery, radioiodine, and levothyroxine to suppress TSH

184
Q

What can be used to treat thyroid carcinomas that progress despite standard therapies?

A

Oral tyrosine kinase inhibitors sorafenib or lenvatinib

185
Q

Is the response to sorafenib and lenvatinib dependent on specific oncogene mutations?

186
Q

What is the recommended daily dose of sorafenib?

A

400 mg twice daily without food

187
Q

List some adverse reactions associated with sorafenib

A
  • Palmar-plantar erythrodysesthesia
  • Diarrhea
  • Alopecia
  • Fatigue
  • Weight loss
  • Hypertension
  • Others
188
Q

What is the recommended daily dose of lenvatinib?

A

24 mg once daily with or without food

189
Q

What should the lenvatinib dose be reduced to in patients with severe renal or hepatic impairment?

190
Q

List some adverse reactions associated with lenvatinib

A
  • Hypertension
  • Diarrhea
  • Fatigue
  • Decreased appetite
  • Decreased weight
  • Nausea
  • Stomatitis
  • Musculoskeletal pain
  • Others
191
Q

What type of thyroid cancer originates from parafollicular cells?

A

Medullary thyroid carcinomas

192
Q

Are medullary thyroid carcinomas responsive to radioiodine or TSH suppression?

193
Q

What can be used to treat medullary thyroid carcinomas that progress despite surgery?

A

Oral tyrosine kinase inhibitors vandetanib and cabozantinib

194
Q

Can vandetanib and cabozantinib be prescribed regardless of RET gene mutational status?

195
Q

What mutation was suggested to have a higher response rate in the phase III vandetanib trial?

A

RET M918T mutation

196
Q

What did the phase III cabozantinib trial demonstrate regarding progression-free survival?

A

Longer progression-free survival in patients with RET M918T tumors and possibly RAS mutations

197
Q

What is the recommended dose for vandetanib?

A

300 mg once daily with or without food

198
Q

What is the reduced dose of vandetanib in moderate-to-severe renal impairment?

199
Q

What black-box warning is associated with vandetanib?

A

QT prolongation

200
Q

List some adverse reactions associated with vandetanib

A
  • Diarrhea
  • Rash
  • Nausea
  • Hypertension
  • Headache
  • Others
201
Q

What is the typical starting dose for cabozantinib?

A

60 to 100 mg on an empty stomach

202
Q

What are the black-box warnings for cabozantinib?

A
  • GI perforations and fistulas
  • Hemorrhage
203
Q

List some adverse reactions associated with cabozantinib

A
  • Diarrhea
  • Palmar-plantar erythrodysesthesia
  • Decreased weight and appetite
  • Nausea
  • Fatigue
  • Stomatitis
204
Q

When should treatment with tyrosine kinase inhibitors continue?

A

Until the patient is no longer clinically benefiting or until unacceptable toxicity occurs

205
Q

What should be monitored carefully in patients taking protein tyrosine kinase inhibitors?

A

TSH levels

206
Q

Fill in the blank: Resistance to one tyrosine kinase inhibitor does not necessarily imply resistance to _______.

207
Q

What can dosage reductions achieve in the treatment of thyroid cancer?

A

Mitigate toxicity

PHARMACOLOGY (sahrgeant) (3 decks)

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