Hyper Treatment

Question 1

Define thyrotoxicosis

Answer 1

State resulting from inappropriately high thyroid hormone

Question 2

Hyper =

Answer 2

Graves

Question 3

Diagnosis

Answer 3

Elevated free T4

Decreased TSH

Question 4

Presentation

Answer 4

Weight loss
Lid lag
Nervousness
Sweating
Exophthalamos

Question 5

Methimazole

Answer 5

iodination and coupling
10-30 mg/d for 12-18 months taper/discontinue if TSH is normal
Avoid in prego

Question 6

Methimazole Monitor

Answer 6

LFT
CBC
TSH/T4

Question 7

Propylthiouracil

Answer 7

Inhibits iodination and coupling and T4 to T3
100 mg TID
First line in prego and thyroid storm

Question 8

Propylthiouracil Monitor

Answer 8

LFT
CBC
TSH
Hepatotoxicity

Question 9

Radioactive Iodine

Answer 9

Pretreat with methimazole but dc 3-5 d before and restart 3-7 d after

Question 10

Radioactive Iodine Monitor

Answer 10

TSH T3 T4 for hypo and when it happens start levo

Question 11

Potassium Iodine

Answer 11

Decrease vascularity and size

Question 12

Thyroidectomy

Answer 12

Iodide TID x 10 d before
Wean beta blockers after surgery
Initiate levo with hypo occurs
Monitor Ca

Question 13

Thyroid Storm

Answer 13

Life threatening hyper via abrupt stop of antithyroid drugs, surgery, radioative iodine

Question 14

Thyroid Storm Meds

Answer 14

Propyluracial
Methimazole
Propranolol
Iodine
Hydrocortisone (against adrenal insuff)
APAP

Question 15

Amiodarone induced thyrotoxicosis

Answer 15

Type 1: Methimazole
Type 2: Prednisone
Not sure? Start both