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Pharmacy Stage 3 > Hyper and Hypothyroidism > Flashcards

Hyper and Hypothyroidism Flashcards

1
Q

what is hypothyroidism?

A

clinical consequence of impaired production of the thyroid hormones thyroxine (T4) and tri-iodothyronine (T3)

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2
Q

what are the thyroid hormones essential for?

A

normal growth, development, and metabolism

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3
Q

How is hypothyroidism classified?

A
  1. Time of onset - congenital or acquired
  2. Level of dysfunction
  3. Severity - overt or subclinical
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4
Q

what are the 2 levels of endocrine dysfunction?

A
  1. primary (thyroid gland)

2. secondary (central — pituitary or hypothalamic dysfunction)

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5
Q

what is primary hypothyroidism?

A

when the thyroid gland is unable to produce hormones because of iodine deficiency or abnormality of the gland itself.

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6
Q

what is secondary hypothyroidism?

A

the result of insufficient production of bioactive TSH due to a pituitary or hypothalamic disorder

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7
Q

what is postpartum thyroiditis (PPT)

A

development of thyrotoxicosis, hypothyroidism, or both < 1 year after giving birth in women who were euthyroid prior to pregnancy

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8
Q

which drug can commonly cause hypothyroidism?

A

amiodarone

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9
Q

what drugs reduce conversion of T4 to T3?

A
  • b-blockers
  • propylthiouracil
  • amiodarone
  • glucocorticoids
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10
Q

what drugs reduce T4 and T3 binding?

A
  • furosamide
  • salicylates
  • NSAIDs
  • heparin
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11
Q

what drugs increase thyroglobulin levels?

A
  • oestrogen and tamoxifen

* opiates and methadone

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12
Q

what drugs alter T4 and T3 metabolism (increase hepatic metabolism)?

A
  • phenytoin
  • rifampicin
  • carbamazepine
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13
Q

before treating a patient suffering hypothyroidism with T4, what must you exclude? And why?

A
  • you must exclude glucocorticoid deficiency

- to prevent precipitation of adrenal crisis

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14
Q

what hormone does levothyroxine replace?

A

thyroxine - (LT4)

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15
Q

what instructions must be given to patients taking levothyroxine?

A

preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (e.g. coffee, tea), or other medication (impaired absorption)

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16
Q

what drug is used in severe hypothyroid states when a rapid response is desired?

A

Liothyronine sodium

17
Q

what is the treatment of choice in hypothyroid coma?

A

Liothyronine by IV

18
Q

what is the starting dose and the maintenance dose of levothyroxine in adults with no heart disease and less than 50yrs old?

A
  • start with 50mcg daily

- increase by 25/50mcg every 3-4 weeks up to a maintenance dose of 100-200mcg daily

19
Q

what is the starting dose and the maintenance dose of levothyroxine in adults with heart disease and over 50yrs old?

A
  • start with 25mcg daily

- increase by 25mcg every 4 weeks up to a maintenance dose of 50-200mcg daily if necessary

20
Q

why is a lower dose required in those with heart disease?

A

If treated too quickly, it may cause:

  1. severe angina or MI (myocardial infarction)
  2. heart failure
  3. cardiac arrhythmias
21
Q

what is used to determine any future dosage adjustments required?

A

TSH concentration as it is the best indicator of the thyroid state

22
Q

how often should serum TSH be monitored in those stable and on levothyroxine?

A

at least once a year

23
Q

what characteristics are presented in myxoedema coma?

A
  1. the usual features of hypothyroidism plus:
  2. hypothermia (as low as 23°C)
  3. coma
  4. seizures
24
Q

what is hyperthyroidism?

A

production of excess thyroid hormones

25
Q

what is thyrotoxicosis?

A

clinical syndrome associated with prolonged exposure to raised thyroid hormone levels

26
Q

what does a bruit over the thyroid gland indicate?

A

vascular murmur due to increased blood flow to the thyroid gland

27
Q

what diagnostic tests indicate hyperthyroidism?

A
  1. a low TSH level

2. elevated free T4 and T3 levels

28
Q

what drug is used for the rapid relief of adrenergic symptoms from hyperthyroidism?

A

beta-blockers - but only in non-asthmatics

29
Q

what is the preferred beta-blocker of choice for treating hyperthyroidism symptoms?

A

propranolol - tapered and stopped once patient is euthyroid and asymptomatic

30
Q

what is the class of antithyroid drugs used to treat hyperthyroidism?

A

thionamides

31
Q

what is the first line antithyroid drug?

A

carbimazole - a prodrug of methimazole

32
Q

what is given as an alternative to carbimazole?

A

Propylthiouracil

33
Q

what are the 2 main problematic side effects of antithyroid drugs?

A

neutropenia and agranulocytosis

Pharmacy Stage 3 (51 decks)

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