Endocrine therapeutics Flashcards
What are four causes of thyrotoxicosis?
- Autoimmune (Grave’s)
- Single or multiple nodular
- Drugs like amiadarone
- Destructive thyroiditis
In which type are eyes affected?
Autoimmine
What are three treatments for thyrotoxicosis?
Thionamides
Radioactive iodine
Surgery
How long does it take for thionamines to work?
4 weeks
How long should thionamides be given for Graves?
Name two thionamides
Carbimazole and propylthiouracil
What do thionamides target?
Thyroid peroxidase
Because it takes a while for thionamides to work, what treatments can be given initially?
Beta blockers
What is a dangerous side effect of thionamides?
RARE: agranulocytosis
What happens if a patient on a thionamide gets a cold or fever?
Should stop drug and go to GP or doctor
What is the most common thyroid disease in UK? What cause?
Autoimmune hypothyroidism
How is hypothyroidism treated?
50-150mcg of levothyroxine
What is the ratio of T4:T3 in healthy people?
13:1
What converts T4 to T3?
DIO2
How are non functioning poituitary tumours treated?
Pressure on optic chiasm if Y (do sugery) and if N (surveillance)
What is 1st and 2nd line treatment for prolactinoma?
1st line = dopamine agonists, 2nd line - surgery
What is 1st, 2nd and 3rd line for other functioning pituitary tumours?
- Surgery. 2. Medical treatment 3. Radiotherapy
Name some drugs for Cushing’s?
Cortisol synthesis inhibitor: Medications to control the production of cortisol.
Ketoconazole . Mitotane . Metyrapone
Glucocorticoid type II receptor antagonist: Blocks the effect of cortisol.
Mifepristone
What are side effects of somatostain analogues?
Gallstones, abdo cramps, diarrhea, hairloss, hyperglycaemia
What is subacute thyroiditis?
Subacute thyroiditis (also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.
There are typically 4 phases;
phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
Investigations
thyroid scintigraphy: globally reduced uptake of iodine-131
Management
usually self-limiting - most patients do not require treatment
thyroid pain may respond to aspirin or other NSAIDs
in more severe cases steroids are used, particularly if hypothyroidism develops
What are the side effects of the drigs used in diabetes?
Biguanides
Lactic acidosis and GI disturbance.
Sulfonylureas
Hypoglycaemia and weight gain.
Thiazolidinediones
Fluid retention, weight gain and worsening heart failure.
SGLT2 Inhibitors
Diabetic Ketoacidosis when used with insulin and increased risk of urinary tract infections.
DPP4-Inhibitors
Hypoglycaemia and GI upset.
GLP1 Analogues
Hypoglycaemia, GI upset and may increase the risk of pancreatitis when used with DPP4-inhibitors.
Intestinal alpha-glucosidase inhibitors
Flatulence and GI disturbance.
