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Endocrine > Hyper / Hypo thyroidism & Osteoporosis > Flashcards

Hyper / Hypo thyroidism & Osteoporosis Flashcards

1
Q

What is Hyperthyroidism?

A

Over secretion of thyroid hormones, leading to thyrotoxicosis (an excess of circulating thyroid hormones)

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2
Q

What characterises hyperthyroidism?

A
  • Low TSH (thyroid stimulating hormone)
  • High Thyroxine [T4]
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3
Q

What is the active form of T4?

A

T3 - triiodothyronine

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4
Q

What are the signs and symptoms of hyperthyroidism?

A
  • A goitre
  • Disturbed sleep
  • Hyperactivity
  • Heat intolerance
  • Unintentional weight loss
  • Complications (like thyroid storm, pregnancy complications, HF, AF, reduced bone mineral density)
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5
Q

What are the signs and symptoms of hyperthyroidism?

A
  • A goitre
  • Disturbed sleep
  • Hyperactivity
  • Heat intolerance
  • Unintentional weight loss
  • Complications (like thyroid storm, pregnancy complications, HF, AF, reduced bone mineral density)
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6
Q

What are the two reasons antithyroid drugs are given?

A

To prepare for thyroidectomy

OR

For long term management

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7
Q

What are the two reasons antithyroid drugs are given?

A

To prepare for thyroidectomy

OR

For long term management

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8
Q

What drugs is mainly used for hyperthyroidism? And what do they do?

A

Carbimazole
Or Propylthiouracil as an alternative

They interfere with synthesis of thyroid hormones

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9
Q

What can antithyroid drugs cause during pregnancy?

A

It can cause fetal goitre

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10
Q

What can over treatment if antithyroid drugs cause?

A

Hypothyroidism

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11
Q

What is blocking replacement therapy?
Can it be used in pregnancy?

A

Because antithyroid drugs can lead to hypothyroidism, thyroid has to be given when thyroid levels (FT4) get to a certain range

This therapy needs to be avoided in pre

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12
Q

What drugs are used in blocking replacement regimen? Can this regimen be used in pregnancy?

A

Carbimazole + Levothyroxine

Cannot be used in pregnancy

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13
Q

What other drugs are used in thyroidism?

A

Iodine - used with antithyroid drugs (not did long term use)

Radioactive sodium iodide - treatment of thyrotoxicosis

Propranolol - reliefs thyrotoxic symptoms (can be used in conjunction with iodine)

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14
Q

What is used to treat thyroid storm (thyrotoxic crisis)?

A
  • I.V fluids
  • Propranolol
  • Hydrocortisone
  • Oral iodine solution, Carbimazole, Propylthiouracil
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15
Q

Which antithyroid drugs can be used in pregnancy?

A

Carbimazole and Propylthiouracil can be be given; but never radioactive iodine.

Propylthiouracil is used in 1st trimester because Carbimazole causes congenital effects

Then switch to Carbimazole in 2nd trimester because there is a risk of hepatotoxicity with Propylthiouracil

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16
Q

What are are the signs of hepatotoxicity?

A
  • dark urine
  • jaundice
  • anorexia
  • pruritus
  • vomiting
  • fatigue
  • nausea
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17
Q

What are the main side effects of Carbimazole?

A

Neutropenia & Agranulocytosis.
Shown by:
- Bone marrow suppression (stop treatment immediately)

  • Signs of infection like sore throat (report immediately)

Then white blood cells should be performed if any sign of infection.
And stop Carbimazole immediately if any clinical or laboratory evidence of neutropenia

18
Q

What advice must be given to Carbimazole?

A

Advice to report immediately, any signs of:
- sore throat
- mouth ulcers
- bruising
- fever
- malaise
- development of non-specific illness

19
Q

What MHRA advice is given with Carbimazole?

A

Can cause congenial malformations esp in 1st trimester, and at high doses.

  • Women of child bearing age should use contraception.

Can cause acute pancreatitis. Stop drug immediately if occurs

20
Q

What monitoring is required for Propylthiouracil?

A

Monitor hepatotoxicity

  • Discontinue if severe liver-enzyme abnormalities develop
21
Q

What monitoring is required for Propylthiouracil?

A

Monitor hepatotoxicity

  • Discontinue if severe liver-enzyme abnormalities develop
22
Q

What patient advice should be given with Propylthiouracil?

A
  • Recognise signs of liver disorders
  • Seek medical immediately if:
    • dark urine
    • jaundice
    • abdominal pain
    • vomiting
    • fatigue
23
Q

What is the cause for hypothyroidism?

A

Caused by underproduction and secretion of thyroid hormones

24
Q

What characterises hypothyroidism?

A

High TSH - above range
Low free thyroxine [FT4]

25
Q

Which levels are considered during pregnancy in thyroidism?

A

Only TSH levels, not FT4

26
Q

What are the signs and symptoms of Hypothyroidism?

A
  • Fatigue
  • Wight gain
  • Constipation
  • Menstrual irregularities
  • Depression
  • Dry skin
  • Intolerance to the cold
  • Complications like HF, CHD etc
27
Q

What are the primary causes of hypothyroidism?

A

Primary causes:
- Iodine deficiency
- Autoimmune disease (hashimoto thyroiditis)
- Radiotherapy
- Surgery
- Drugs

Secondary causes:
- Pituitary or hypothalamic disorder

28
Q

What are the treatments of Hypothyroidism?

A

Levothyroxine - 1st line for maintenance

Liothyronine - more rapidly metabolised & more rapid effects, so used in more severe hypothyroid states when a rapid response is required

I.V Liothyronine - used for hypothyroid coma

29
Q

What is Osteoporosis?

A

Progressive bone disease
Increases risk of fractures

30
Q

What are the risk factors for osteoporosis?

A
  • Postmenopausal women
  • Men over 50 years
  • Patients taking long term oral corticosteroids (glucocorticoids)
  • Vitamin D deficiency
  • Low calcium intake
  • Early menopause
  • Family history of hip fractures
  • Low body mass index (BMI)
  • Rheumatoid arthritis & Diabetes - also associated with osteoporosis
31
Q

What lifestyle changes need to be done for those with osteoporosis?

A
  • Increase physical activity
  • Stop smoking
  • Maintain normal BMI (20-25kg/m2)
  • Reduce alcohol intake
  • Increase dietary intake of Vitamin D n Calcium
  • Elderly patients have an increased risk of falls
32
Q

What drugs are used in Postmenopausal Osteoporosis?

A
  • Oral bisphosphonates, alendronic acid & risedronate sodium - are 1st like treatment

Alendronic acid and risedronate are used to reduce fractures

If both contraindicated, ibandronic acid, denosumab or raloxifene

33
Q

What drugs are used in Postmenopausal Osteoporosis?

A
  • Oral bisphosphonates, alendronic acid & risedronate sodium - are 1st like treatment

Alendronic acid and risedronate are used to reduce fractures

If both contraindicated, ibandronic acid, denosumab or raloxifene

34
Q

Who can be given HRT and why?

A

Younger postmenopausal women because in older postmenopausal women, there is an increased risk of cardiovascular disease and cancer

35
Q

Which drug can induce osteoporosis?

A

Glucocorticoids - as they can cause bone loss and increase risk of fractures.

Occurs early after initiation of glucocorticoid and increases with dose and duration.

36
Q

What is the prevention and treatment of glucocorticoid?

A
  • Oral bisphosphonates
  • Alendronic acid
  • Risedronate
37
Q

What is the drug treatment for osteoporosis in men?

A
  • Oral bisphosphonates
  • Alendronic acid
  • Risedronate
38
Q

What is the drug action for Bisphosphonates?

A

They are absorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution and therefore reducing the rate of bone turnover

39
Q

What are the MHRA/patient advice for Bisphosphonates?

A

Advice is mainly for patients taking it long term 2+ years.

1) Atypical fermoral fracture - report any thigh, hip, or groin pain during treatment

2) Osteonecrosis of the jaw (jaw bone starved of blood) - during treatment maintain good oral hygiene( routine dental check ups, report any oral symptoms. Risk rather with I.V than oral bisphosphonates.

3) Ostenecrosis of external auditory canal - report any ear pain, discharge from ear, or an ear infection during treatment

40
Q

What are the side effects of Alendronic acid?

A

Oesophageal reactions

So advice patients to seek medical advice if symptoms develop:
- Dysphagia
- New or worsening heartburn
- Pain on swallowing
- Retrosternal pain

41
Q

What is the dose for Alendronic acid?

A

10mg DAILY or 70mg once WEEKLY - Postmenopausal osteoporosis women

10mg DAILY in men

42
Q

What are the counselling points for Alendronic acid?

A
  • Swallow whole
  • Oral solution should be swallowed as single 100ml dose
  • Take doses with plenty of water while sitting or standing
  • Take on empty stomach at least 30 mins before breakfast (or any other oral med)
  • Stand or sit upright for at least 30 mins after administration

Endocrine (7 decks)

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