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Endo/Eye/Derm - Women/Men > EXAM 3 Hyperthyroidism Dr. Hess > Flashcards

EXAM 3 Hyperthyroidism Dr. Hess Flashcards

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1
Q

Patient presentation in hyperthyroidism - Head
EXAM!

A

-Nervousness
-Irritability
-Difficulty sleeping

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2
Q

Patient presentation in hyperthyroidism - Face
EXAM!

A

Bulging eyes - Graves disease
Unblinking stare
-Swelling of the thyroid (Goiter)

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3
Q

Patient presentation in hyperthyroidism - inner body

A

-menstrual irregularities/lighter period
-excessive vomiting in pregnancy
-first trisemester miscarriage
-frequent bowel movements
-rapid or irregular heartbeat (tachycardia)
-infertility
-weight loss
-heat intolerance
-sweating
-family history of thyroid disease

-warm, moist palms

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4
Q

Medical term for bulging eyes?

A

Exophthalmos (Proptosis)

patietns may also have double vission (diplopia)
-in severe cases it damages the eye
-no sufficient distribution of tears since the eyelid doesn’t cover the whole eye

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5
Q

Lid lag

A

the upper eyelid is higher than normal
(one lid is lagging behind - seen when looking down)

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6
Q

Which drug works by inhibitng IGF-1 in the eye?

A

Teprotumumab-trbw (Tepezza)

-Tx for Exophthalmos

IGF-1 is responsible for causing bulging eyes

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7
Q

What are the chronic consequences of untreated Hyperthyroidism?

A

-Arrhythmias
-CVD
-Osteoporosis

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8
Q

What is the onset of ß-blockers in Hyperthyroidism treatment?

A

-Hours

-> only treats tachycardia, so start with hormone reducing therapy

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9
Q

Which symptoms are reduced rapidly by ß-blockers?

A

tremors and anxiety

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10
Q

What is the onset of ß-blockers in Hyperthyroidism treatment?

A

hours to days -> max effect after 10 days

-> only short term, before surgery or after radioactive iodine treatment

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11
Q

What is the onset of thionamines in hyperthyroidism treatment?

A

weeks

start with beta-blocker

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12
Q

What is the onset of radioactive iodine (RAI) in Hyperthyroidism treatment?

A

months

-> often leads to hypothyroidism, since the radioactive iodine destroys the hypersecreting thyroid tissue

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13
Q

What is the common drug regimen for a patient who just got diagnosed with Hyperthyroidism?

A

-ß-blocker: tx tachycardia

-Thionamides: short or long -term

-> simultouensly

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14
Q

What is the HR goal when using a ß-blocker in hypothyroidism?

A

HR < 90

may also impair T4 to T3 conversion
-used short-term until T4 and T3 are reduced, then can discontinue (approx. use of 6 months)

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15
Q

Which patients may be prone to DDI with ß-blockers?

A

COPD and asthma patients
-> especially when using a non-selective ß-blocker like carvedilol, labetalol, propranolol, nadolol

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16
Q

Which ß-blockers may impair T4 to T3 conversion?

A

-propranolol
-nadolol

but plays a minor role when choosing a ß-blocker, we even see selective ß-blocker like metoprolol quite often

17
Q

MOA for Methimazole and Propylthiouracil (PTU)

A

-block thyroid peroxidase
->responsible for thyroid synthesis in the gland

-in 40-50% the patient stay in remission and may stop

18
Q

What is the onset of Thionamide agents?

A

6-8 weeks

-it takes 6-8 weeks to work
-> bc there are already synthesized T4s ready to go, and they need to be depleted before we start seeing effects

19
Q

What is the Blackbox warning of PTU

A

hepatoxicity risk

-> Methimazole use is preferred!!!

20
Q

Which of the Thionamides is preferred in the first trimester of pregnancy?

A

PTU for the 1st trimester, then switch back

-> Methimazole has a higher risk for tetragenicity in the 1st trimester

21
Q

Thionamide agents dosing

A

Methimazol (Tapazol):
15-20 mg/day 1x day -> better adherence

Propylthiouracil (PTU):
150-600 mg/day 2-3x per day

22
Q

ADE Thionamides

A

-Hepatoxicty (BBW for PTU, may also cause liver damage with Methimazole but less likely) - in the first 3 months
-Benign transient leukopenia (WBC <4000/mm3)

-Agranulocytosis (rare, can be fatal) - in the first 3 months
-> fever granulocate < 250/mm3)

-Rash
-GI upset
-Arthralgia (joint stiffness)

23
Q

How would a patient present with liver toxicity?

A

-jaundice
-colroing of the urine (brown)
-pale colored feces (ash-color)
-N/V
-abdominal pain

24
Q

Symptoms for Agranulocytosis

A

-fever
-flu-like symptoms
-sore throat

-> they should get a CBC

25
Q

In what time frame should thyroid hormones levels be checked?

A

every 6 weeks until stable

-TSH, T3 and T4

26
Q

Which levels should be monitored?

A

-TSH, T3 and T4
-CBC with diff (all types of white blood cells)
-signs and symptoms of infection
-hepatoxicity

27
Q

MOA of Iodides

A

-acutely decrease the RELEASE (so it works faster than the other drugs) of preformed hormones (iodide)
-> negative feedback when giving high concentration of iodide (Wolff–Chaikoff effect)

28
Q

What is the role of Iodides in therapy?

A

-short-term use prior to surgery (removing the thyroid)in Graves disease (to prevent thyroid release during the procedure) or in thyroid storm
(FYI: thyroid causes diarrhea, patients can die from a thyroid storm because of dehydration)

-to inhibit thyroid release following radioactive iodine treatment -> inhibiting thyroid release temporarily with iodide will help radioactive iodine to manifest in the thyroid and work there

-Lugol’s solution
-saturated solution of potassium iodide (SSKI)

29
Q

When is iodide treatment contraindicated?

A

Pregnancy

also avoid radioactive iodine

30
Q

What is the drug of choice in Graves disease?

A

Radioactive Iodine I-131

31
Q

What is the consequence of radioactive iodine treatment?

A

irreversible destruction of the thyroid glands
-> the patient may end up needing treatment for hypothyroidism
-> LT4 supplementation

32
Q

Onset in radioactive iodine treatment

A

slowest onset

33
Q

What are the thyroid hormone levels in Subclinical Hyperthyroidism?

A

low TSH
free T4 is normal

-treatment controversial
-> increased risk for Afib and bone fractures
- if treated, then with low dose thionamides (radioactive iodine is not appropriate in this case)

34
Q

Treatment regimen - radioactive iodine

A

-continue β blockers until symptoms resolve
-Stop thionamide agents 4-7 days prior and may restart 4 days after
-if iodides used, give 3-7 days after

35
Q

How to treat Graves disease during pregnancy?

A

-Thionamide agents
-> PTU in the first trimester -> then change to Methimazole

-ß-blockers for symptomatic treatment as needed

36
Q

Time frame to monitor thyroid levels

A

monitor TSH, free T4 and free T3 monthly

37
Q

Which drug may cause Hyperthyroidism or Hypothyroidsm?

A

-Amiodarone - similar stutcure to LT4
Hyperthyroidsim (2%) vs hypothyroidism (5%)

-Lithium (used for bipolar disorder)
hyperthyroidism (1%) vs hypothyroidism (20%)

38
Q

Which drug may cause Hypothyroidsm?

A

Tyrosine kinase inhibitors
-Sunitinib (50%)

Endo/Eye/Derm - Women/Men (30 decks)

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