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Pharm 2 Final > Chapter 58: Thyroid Gland > Flashcards

Chapter 58: Thyroid Gland Flashcards

1
Q

The thyroid gland is made up of cells arranged how?

A

in circular follicles

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2
Q

what is the function of follicular

A

stores and released thyroid hormone

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3
Q

what is parafollicular cells also known as

A

thyrocalcitonin

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4
Q

when is thyrocalcitonin released

A

it is released when serum calcium levels are high, they are an antagonist to PTH

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5
Q

what are the two hormones that the thyroid gland produces

A

triiodothyronine (T3) and thyroxine (T4)

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6
Q

which hormone is released in a greater amount?

A

T4

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7
Q

most of the released T4 will undergo conversion to T3 by what?

A

peripheral tissue enzymes

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8
Q

how much T3 is converted from T4

A

80%

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9
Q

which hormone is more potent

A

T3

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10
Q

the thyroid function test (TSH) is the most sensitive test for what

A

screening and diagnosing hypothyroidism

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11
Q

what does the thyroid function test (TSH) differentiate bwetween?

A

differentiates between first degree and secondary diseases

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12
Q

what does the serum T3 test diagnose

A

hyperthyroidsm

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13
Q

what is the level for a serum T3 test?

A

230-620 pg/dL

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14
Q

what is a primary form of thyroid hormone deficiency

A

Hashimoto’s thyroiditis (autoimmune)

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15
Q

what lab results would indicate a thyroid hormone deficiency?

A

elevated TSH and a decreased T3/T4 levels

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16
Q

what are some clinical manifestations related to hypothyroidism?

A

peri-orbital edema, intolerance to coldness, brittle hair and nails, extremely low heart rate and body temperature, fatigue, lethargy, impaired mention, weight gain (despite no increases in caloric intake)

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17
Q

what is the prototype of T4 synthetic agent

A

levothyroxine

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18
Q

how can levothyroxine be administered

A

PO and IV

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19
Q

true or false: short-term treatment is require in most thyroid disorders

A

FALSE; long term treatment is usually required.

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20
Q

true or false: pharmacotherapy agents provide symptomatic relief and is NOT a cure.

A

true.

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21
Q

we should educate our patients that it could take how long to begin seeing therapeutic effects from these drugs?

A

4-6 weeks

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22
Q

what half-life do thyroid drugs have?

A

seven days

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23
Q

thyroid medications stimulate the CV system which leads to what? so you should take what precautions?

A

increases cardiac response to catecholamines, limits the intake of caffeine-containing beverages, uses other sympathomimetic agents cautiously.

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24
Q

what levels should we monitor on patients taking thyroid medications and why?

A

lipid and glucose levels, these drugs could cause dyslipiedmia and hyperglycemia.

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25
Q

should you take thyroid medications with food or on an empty stomach?

A

take on an empty stomach in the morning. 30-60 minutes before breakfast.

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26
Q

why do you take thyroid medications on an empty stomach?

A

food can significantly decrease the absorption of the drug

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27
Q

how do you monitor the effectiveness of thyroid drugs?

A

clinical picture and lab tests

28
Q

too much thyroid medications can lead to what

A

a hyperthyroid state

29
Q

how often should you monitor drug effectiveness?

A

every 6-8 weeks initially and when changing doses.

30
Q

why do you monitor drug effectiveness every 6-8 weeks initially?

A

TSH levels are slow to normalize.

31
Q

what is the drug interaction between levothyroxine and warfarin?

A

levothyroxine speeds up the destruction of vitamin-K dependent clotting factors, so you would need to reduce the dose of warfarin because its effects are enhanced.

32
Q

how would you adjust the dose of digoxin when combining with levothyroxine?

A

increase dose when converting hypothyroid state to a euthyroid state

33
Q

what is a primary form of hyperthyroidism?

A

Graves’ disease (most common)

34
Q

what are the lab results you would see with hyperthyroidism?

A

decreased TSH levels and increased T3 and T4

35
Q

what are some clinical manifestations of hyperthyroidism?

A

tachycardia/dysrhythmias, forceful cardiac contractions/angina, nervousness and insomnia, intolerance to heat, skin is warm and moist, increase in appetite but weight loss.

36
Q

graves disease can cause what to the eyes?

A

exophthalmos

37
Q

what is exophthalmos?

A

immune mediated infiltration of the EOMs and orbital fat

38
Q

how can you treat exophthalmos?

A

high dose glucocorticoids and/or surgery

39
Q

what are the drug treatments of hyperthyroidism?

A

radioactive iodine, thionamides, non radioactive iodine solutions (Lugol’s), beta-adrenergic blockers (used to treat symptoms like elevated blood pressure and tachycardia)

40
Q

what is the goal of treating hyperthyroidism?

A

euthyroid state

41
Q

too much drugs to treat hyperthyroidism can induce what

A

hypothyroid state

42
Q

methimazole inhibits what two things?

A

inhibits the synthesis of thyroid hormones, inhibits the conversion of T4 to T3 in the tissues.

43
Q

what effect does methimazole have on stores of thyroid hormone

A

no effect

44
Q

how long does it take methimazole to induce a euthyroid state

A

3-12 weeks

45
Q

what is the major ADR of methimazole?

A

agranulocytosis (risk of infection)

46
Q

what are the early signs of agranulocytosis

A

sore throat and fever

47
Q

how does agranulocytosis develop

A

it develops rapidly, but may not see CBC changes quickly.

48
Q

what is the major ADR of propylthiouracil?

A

sudden onset of hepatotoxicity and rash

49
Q

what are the four differences between propylthiouracil and methimazole?

A

can cause severe liver injury, short half life (2-3 daily doses), crosses placenta less readily (given to pregnant women in 1st trimester), has an effect on existing stores of thyroid hormone.

50
Q

what is propylthiouracil most effective in treating?

A

thyrotoxic crisis

51
Q

what class is sodium iodide-131

A

radioactive iodine solutions

52
Q

where does sodium iodide-131 concentrate in and where does it get destroyed?

A

concentrated in the thyroid gland and is radioactivity destroyed in the thyroid tissue

53
Q

what is the goal of sodium iodide-131?

A

only partially destroy the gland so the amount of TH produced and secreted is low

54
Q

what is sodium iodide-131 also used for?

A

a diagnostic test to identify the extent of thyroid activity

55
Q

how do the dose of sodium iodide-131 differ when being used for thyroid cancer?

A

doses are larger due to exposing the person to higher amounts of radioactivity.

56
Q

what is the nonradioactive iodine?

A

lugol’s solution

57
Q

what is lugol’s solution used for?

A

used to suppress thyroid function 10 days before surgery

58
Q

lugol’s solution reduced iodine to what

A

iodide in the GI tract before being absorbed.

59
Q

in high concentrations, iodide has paradoxical suppressant effects on the thyroid by what 3 mechanisms?

A

reducing iodine uptake by the thyroid, inhibiting TH synthesis, and inhibiting the release of TH into the blood

60
Q

chronic ingestion of lugol’s solution produce?

A

iodism

61
Q

what are the clinical manifestations of iodism

A

brassy taste in mouth, burning sensation in the mouth/throat, sore gums, nasal congestion, increased salivation.

62
Q

iodine is corrosive and overdose could cause what?

A

GI tract injury

63
Q

what are signs and symptoms of GI tract injury?

A

abdominal pain, nausea and vomiting, and diarrhea.

64
Q

what is a complication of GI injury due to iodine OD?

A

swelling of the glottis–>asphyxiation

65
Q

what is treatment for GI injury due to OD on iodine?

A

gastric lavage and giving Na thiosulfate.

Pharm 2 Final (3 decks)

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