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2016 Endocrine > exam 3 thyroid disorders > Flashcards

exam 3 thyroid disorders Flashcards

1
Q

Thyroid Disorders

A

Hypothyroidism: underactive thyroid

Hyperthyroidism: overactive thyroid

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2
Q

Thyroid Function Tests

A
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3
Q

Laboratory Parameters

A

Serum TSH is the single best screening test for thyroid dysfunction

Serum Free T4 (FT4) is recommended to confirm suspicion of hypothalamic or pituitary disease

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4
Q

HYPOTHYROIDISM

A

Under-production of thyroid hormones

More common in females and incidence increases with age

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5
Q

Hypothyroidism causes

A

Hashimoto’s disease – most common

  • Autoimmune condition in which a patient’s antibodies attack their own thyroid gland

Iodine deficiency

Surgical removal of part or all of the thyroid gland

Congenital hypothyroidism

Drugs: amiodarone, interferons, lithium, nitroprusside, tyrosine kinase inhibitors

Thyroid gland ablation with radioactive iodine (secondary hypothyroidism)

Pituitary failure (secondary hypothyroidism)

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6
Q

hypothyroidism complications

A

Cardiovascular disease

  • Cardiomyopathy, heart failure, hyperlipidemia, coronary artery disease

Myxedema coma

  • End stage of long-standing uncorrected hypothyroidism requiring IV thyroid hormone

Depression

Infertility

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7
Q

hypothyroidism signs and symptoms

A

Cold intolerance

Bradycardia

Weight gain

Weakness

Fatigue

Constipation

Coarse, thinning hair

Myalgias

Menorrhagia

Goiter

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8
Q

hypothyroidism lab values

A

↑ TSH (always collected) and ↓ FT4 (may or may not be collected)

↓ T4, ↓ T3 – not routinely measured

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9
Q

hypothyroidism treatment

A
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10
Q

other hypothyroidism treatments

A

Desiccated thyroid (Armour Thyroid ®): T3 and T4

  • Discouraged since preparations can contain variable amounts
  • Conversion of desiccated to levothyroxine: 1 grain (60-65 mg) = 100 mcg

Liotrix (Thyrolar ®): T3 and T4 in 1:4 ratio

  • Also not recommended

Liothyronine (Cytomel ®, Triostat ®): T3

  • Also not recommended
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11
Q

subclinical hypothyroidism

A

↑ TSH with normal FT4

Controversy if should treat with levothyroxine

  • Likely to benefit: TSH > 10 mIU/L
  • Consider treatment: TSH 5-10 mIU/L + symptoms
  • Benefits clearest in younger populations

Generally lower dose compared to when treating hypothyroidism (e.g. levothyroxine 25-75 mcg/day)

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12
Q

hypothyroidism drug interactions

A
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13
Q

hypothyroidism monitoring

A

Observe clinical signs and symptoms

Check TSH levels (T4 rarely):

  • Initially every 4 - 8 weeks until levels are normal or when change dose or preparation
  • 6 months
  • Yearly

Over-dosing in elderly patients leads to atrial fibrillation and fractures

  • May need dose reduction as patient ages
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14
Q

hypothyroidism in pregnancy

A

Pregnant women with hypothyroidism may have children at risk of impairment in their intellectual function and motor skills, unless appropriately treated

Levothyroxine – pregnancy risk factor A

  • Preferably initiated prior to pregnancy
  • Will require 30-50% ↑ in dose throughout pregnancy course
  • Mother will require ↑ dose for several months post-partum – monitored freqently

Upper limit of normal TSH goals

  • 1st trimester – 2.5 mIU/L
  • 2nd trimester – 3 mIU/L
  • 3rd trimester – 3.5 mIU/L
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15
Q

hypothyroidism counseling

A

Take in the morning on an empty stomach ≥ 30 - 60 minutes before breakfast

  • Increases absorption

Different brands of levothyroxine may not work the same

  • If your new pills look different, ask the pharmacist

Tell your doctor if you become pregnant during treatment

  • If you become pregnant, your dose will likely need to be increased

You may notice a slight reduction in symptoms within 1 to 2 weeks, but the full effects can take up to two months

Even if you feel better, continue taking this medication for the rest of your life

Your blood will need to be tested at least annually to make sure your dose is optimal

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16
Q

HYPERTHYROIDISM

A

Over-production of thyroid hormones

17
Q

hyperthyroidism causes

A

Grave’s disease – most common cause

  • Autoimmune disorder where the antibodies simulate the thyroid to produce too much T4

Toxic Multinodular Goiter

  • Growth of multiple thyroid nodules that results in unregulated T3 and T4

Toxic Adenoma

  • Growth of a single, usually benign thyroid nodule that produces unregulated T3 and T4

Thyroiditis

  • Inflammation of the thyroid gland commonly due to a viral infection

Drugs: iodine, amiodarone, interferons, excessive doses of thyroid hormone

18
Q

hyperthyroidism signs and symptoms

A

Heat intolerance

Goiter

Weight loss

Exophthalmos

Agitation

Diplopia

Anxiety

Fine, thinning hair

Palpitations

Tachycardia

Fatigue

Tremor

Muscle weakness

Irregular menses

Diarrhea

Insomnia

19
Q

hyperthyroidism lab values

A

↓ TSH and ↑ FT4

↑ T4, ↑ T3 – not routinely measured

20
Q

hyperthyroidism complications

A

Arrhythmias

Heart failure

Osteoporosis

21
Q

hyperthyroidism symptom control

A

Beta blockers

  • Reduce palpitations, tremors, and tachycardia
    • However, does not correct underlying disorder (only treats the symptoms)
  • May use any beta blocker, although propranolol and nadolol may block T4 to T3 conversion at high doses (not clinically significant) – this is an advantage
22
Q

hyperthyroidism treatment

A
  • Anti-thyroid medications, radioactive iodine (RAI-131), or surgery
  • Anti-thyroid medications
    • Thionamides – inhibit synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland (decrease levels of thyroid hormones)
      • Additional mechanism of Propylthiouracil: inhibits peripheral conversion of T4 to T3
    • Onset of action is not seen until stored hormone is depleted, which may take 4-8 weeks (monitor TSH)
      • When clinical symptoms begin to diminish and thyroid function tests begin to decline, the dose is decreased to a maintenance dose (prevents hypothyroid state)
      • Continued for 12-24 months until the patient is in remission – high relapse rate
23
Q

anti-thyroid medications

A
24
Q

RAI-131 – radioactive iodine

A
25
Q

hyperthyroidism surgery

A
26
Q

thyroid storm

A
27
Q

drugs of choice

A
28
Q

Case 1

S/sx: fatigue, constipation, Low T4, High TSH

A
29
Q

Case 2

S/sx: weight loss, increased appetite, low TSH, high T4, increased HR, Temp

A

2016 Endocrine (19 decks)

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