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Pharm > Endocrine: Thyroid > Flashcards

Endocrine: Thyroid Flashcards

1
Q

TRH

A

thyrotropin releasing hormone

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2
Q

TSH

A

thyroid stimulating hormone

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3
Q

T3, T4

A

circulating thyroid hormones

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4
Q

low T3 and T4…

A

sends signal to hypothalamus to release TRH

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5
Q

TRH activates…

A

pituitary to release TSH, stimulating thyroid to produce more t3 and t4.

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6
Q

graves disease

A

TSH antibodies mimic TSH, stimulate T3 and T4 production.

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7
Q

pituitary adenomas

A

excessive TSH secretion that doesnt respond to T3 negative feedback

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8
Q

toxic adenoma

A

leads to thyroid nodules

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9
Q

drug induced hyperthyroid disorder

A

excessive thyroid hormone dosage

or amiodarone tx

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10
Q

presentation of hyperthyroid

A 
weight loss
heat intolerance
goiter
fine hair
tachy
warm/moist skin
anxiety
insomnia
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11
Q

hyperthyroid: diagnostics

A

elevates t4
suppressed TSH
radioactive iodine uptake
thyroid antibodies

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12
Q

radioactive iodine uptake in hyperthyroidism

A

elevated if thyroid gland is actively and excessively secreting T4/T3.

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13
Q

tx for hyperthyroid

A

ablation
thiouereas
nonselective b blockers
iodines/iodides

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14
Q

2 examples of thioureas

A

methimazole (MMI)

propylthiouracil (PTU)

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15
Q

thiourea MoA

A

inhibits iodination and synth of thyroid hormones.

PTU will also block t3/t4 conversion in periphery.

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16
Q

thiourea onset of action

A

4-6 weeks. slow.

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17
Q

which is more potent, MMI or PTU?

A

MMI by 10x.

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18
Q

pregnant patients and thioureas

A

PTU in 1st tri

switch to MMI for 2nd and 3rd

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19
Q

AE thioureas

A 
hepatotoxicity
arthralgia
fever
rash
agranulocytosis
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20
Q

black box: PTU

A

hepatotoxicity

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21
Q

methimazole (MMI) dose

A

15-60mg/day in 3 divided doses

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22
Q

onset methimazole

A

12-18 hr

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23
Q

protein binding PK/PD

A

none

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24
Q

metabolism of PK/PD

A

hepatic

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25
Q

PTU dosing

initial & maintenance

A

initial: 300 mg/day in 3 doses
maintenance: 100-150mg/day in 3 doses.

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26
Q

onset PTU

A

24-36hr

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27
Q

protein binding: PTU

A

high. 80-85%

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28
Q

metabolism of PTU

A

hepatic

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29
Q

Nonselective B blocker for hyperthyroid

A

propranolol

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30
Q

propranolol MoA for hyperthyroid

A

blocks manifestations mediated by B adrenergic receptors

can block conversion of t4 to t3.

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31
Q

nonselective B blockers in hyperthyroid are

A

primarily for symptom relief

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32
Q

AE of b blockers for hyperthyroid

A

Brady
hypoTN
dizzy
cardiac ischemia

33
Q

blackbox: nonselective B blocker for hyperthyroidism

A

cardiac ischemia

34
Q

Iodines/Iodides

drug

A

lugol solution

potassium iodide

35
Q

MoA Iodines/iodides

A

inhibits release of stored thyroid hormone and can reduce vascularity of gland prior to surgery

36
Q

when is iodine/iodide used?

A

before surgery
after ablation
or thyroid storm

37
Q

AE iodine/iodide

A

metallic taste
hypersensitivity
burning mouth

38
Q

thyroid storm

A

life threatening decompensated thyrotoxicosis

39
Q

causes of thyroid storm

A

trauma
infection
noncompliance c meds
severe inflammation of thyroid

40
Q

thyroid storm presentation

A 
fever
tachy
dehydrated
coma
delirium
tachypnea
41
Q

tx of thyroid storm

A

PTU or MMI

42
Q

PTU and MMI as initial tx for thyroid storm

A

give loading doses, then around the clock

43
Q

in thyroid storm, when should iodide be started?

A

1 hour after PTU

44
Q

symptom control in thyroid storm

A

b blocker
acetaminophen for fever
corticosteroids

45
Q

corticosteroids for thyroid storm

A

IV loading dose

then around the clock x 1-3 days.

46
Q

hypothyroid disorders (4)

A

hashimoto
iatregenic
iodine deficiency
secondary causes

47
Q

Hashimoto disease

A

autoimmune-induced thyroid injury characterized by decrease in thyroid secretion

48
Q

iatrogenic hypothyroid

A

thyroid resection

49
Q

iodine deficiency

A

most common cause of hypothyroidism

50
Q

secondary causes of hypothyroidism

A 
pituitary insufficiency
drug induced (amiodarone, lithium)
51
Q

drugs that cause hypothyroid

A

amiodarone

lithium

52
Q

hypothyroid presentation

A 
cold 
weight gain
fatigue
bradycardia
slow reflexes
dry skin
coarse hair
53
Q

hypothyroid diagnostics

A

low T4
elevated TSH
presence of thyroid abs

54
Q

who should be screened for hypothyroid? and how?

A

patients >60 y.o

thyroid panel

55
Q

tx for hypothyroid

A

levothyroxine

56
Q

levothyroxine MoA

A

synthetic T4

57
Q

dosing of hypothyroid

A

1.6 mcg/kg/day

58
Q

which bodyweight to use for levothyroxine?

A

ideal

59
Q

titrate levothyroxine based off of

A

T4

TSH

60
Q

onset of action: levothyroxine

A

3-4 days oral

6-8 hr IV

61
Q

peak therapeutic effect of levothyroxine

A

4-6 wks

62
Q

protein binding of levothyroxine

A

> 99%

63
Q

metabolism of levothyroxine

A

hepatic metabolism to T3

64
Q

elimination of levothyroxine

A

urine

65
Q

levothyroxine monitoring

A

monitor TSH q4-8wks after initiation/change

66
Q

AE levothyroxine

A

hyperthyroidism
cardiac
inc risk fractures

67
Q

myxedema coma

A

life threatening decompensated hypothyroidism

68
Q

causes of myxedema coma

A

trauma
infection
HF
drug induced

69
Q

drugs which can induce myxedema

A

narcotics
anesthesia
lithium
amiodarone

70
Q

myxedema coma presentation

A

not always coma

AMS, hypoventilation, hypothermia

71
Q

tx of myxedema

A

iv thyroid hormone replacement
empiric abx
corticosteroids

72
Q

IV hormone replacement in myxedema

A

loading dose of IV levothyroxine then

large daily dose until PO meds are tolerated

73
Q

abx in myxedema

A

empiric if infection is suspected

74
Q

corticosteroids in myxedema

A

q8 hydrocortisone

75
Q

normal TSH

A

0.5 - 4.5

76
Q

normal T4

A

0.8 - 1.9

77
Q

low TSH, high T4

A

hyperthyroid

78
Q

high TSH, low T4

A

hypothyroid

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