Endocrine: Antithyroid drugs Flashcards
Carbimazole with levothyroxine sodium daily may be used in what regimen?
A combination of carbimazole with levothyroxine sodium daily, may be used in a blocking-replacement regimen; therapy is usually given for 18 months. The blocking-replacement regimen is not suitable during pregnancy.
Is block and replace therapy suitable in pregnancy?
A combination of carbimazole with levothyroxine sodium daily, may be used in a blocking-replacement regimen; therapy is usually given for 18 months. The blocking-replacement regimen is not suitable during pregnancy.
How long is block and replace therapy normally continued for?
A combination of carbimazole with levothyroxine sodium daily, may be used in a blocking-replacement regimen; therapy is usually given for 18 months. The blocking-replacement regimen is not suitable during pregnancy.
Radioactive sodium iodide solution is used for what?
Radioactive sodium iodide (131I) solution is used increasingly for the treatment of thyrotoxicosis at all ages, particularly where medical therapy or compliance is a problem, in patients with cardiac disease, and in patients who relapse after thyroidectomy.
What beta blocker is used for the rapid relief of thyrotoxic symptoms and may be used in conjunction with antithyroid drugs or as an adjunct to radioactive iodine?
Propranolol hydrochloride
Thyroid storm is treated how?
Thyrotoxic crisis (‘thyroid storm’) requires emergency treatment with intravenous administration of fluids, propranolol hydrochloride and hydrocortisone (as sodium succinate), as well as oral iodine solution and carbimazole or propylthiouracil which may need to be administered by nasogastric tube
How is hyperthyroidism managed in pregnancy?
Radioactive iodine therapy is contra-indicated during pregnancy. Propylthiouracil and carbimazole can be given but the blocking-replacement regimen is not suitable. Rarely, carbimazole has been associated with congenital defects, including aplasia cutis of the neonate, therefore propylthiouracil remains the drug of choice during the first trimester of pregnancy. In the second trimester, consider switching to carbimazole because of the potential risk of hepatotoxicity with propylthiouracil. Both propylthiouracil and carbimazole cross the placenta and in high doses may cause fetal goitre and hypothyroidism—the lowest dose that will control the hyperthyroid state should be used (requirements in Graves’ disease tend to fall during pregnancy).
What is the drug of choice in the first trimester of pregnancy for hyperthyroidism?
Radioactive iodine therapy is contra-indicated during pregnancy. Propylthiouracil and carbimazole can be given but the blocking-replacement regimen is not suitable. Rarely, carbimazole has been associated with congenital defects, including aplasia cutis of the neonate, therefore propylthiouracil remains the drug of choice during the first trimester of pregnancy. In the second trimester, consider switching to carbimazole because of the potential risk of hepatotoxicity with propylthiouracil. Both propylthiouracil and carbimazole cross the placenta and in high doses may cause fetal goitre and hypothyroidism—the lowest dose that will control the hyperthyroid state should be used (requirements in Graves’ disease tend to fall during pregnancy).
Why in the second trimester of pregnancy should a switch from propylthiouracil to carbimazole be considered?
Radioactive iodine therapy is contra-indicated during pregnancy. Propylthiouracil and carbimazole can be given but the blocking-replacement regimen is not suitable. Rarely, carbimazole has been associated with congenital defects, including aplasia cutis of the neonate, therefore propylthiouracil remains the drug of choice during the first trimester of pregnancy. In the second trimester, consider switching to carbimazole because of the potential risk of hepatotoxicity with propylthiouracil. Both propylthiouracil and carbimazole cross the placenta and in high doses may cause fetal goitre and hypothyroidism—the lowest dose that will control the hyperthyroid state should be used (requirements in Graves’ disease tend to fall during pregnancy).
