Hyperthyroid

Question 1

What is thyrotoxicosis?

Answer 1

• another word for hyperthyroidism
• result of tissues exposed to excess T4, T3 or both
• occurs more frequently in women

Question 2

Clinical Presentation of HyperT

Answer 2

• nervousness, emotional lability
• easy fatiguability
• heat intolerance
• weight loss w/ increased appetite, anorexia in elderly, increased frequency of bowel movements
• palpitations
• irregular or scant menses

Question 3

What are the therapeutic goals for hyperT treatment?

Answer 3

• relive sxs
• reduce thyroid hormone production to normal levels and achieve biochemical euthyroidism
• prevent long-term adverse sequelae

Question 4

What are the 2 primary agents used in hyperT treatment?

Answer 4

• methimazole

- propylthiouracil

Question 5

AEs of Antithyroid Agents

Answer 5

• minor: pruritic maculopapular rash, arthralgia, fever, benign transient leukopenia
• major: agranulocytosis, arthralgia, lupus-like syndrome, GI intolerance, hepatotoxicity

Question 6

What is 1st line hyperT treatment?

Answer 6

-beta blockers

Question 7

When are iodides used for hyper T treatment?

Answer 7

• rapid decrease in thyroid levels
• used pre-operatively when other meds are ineffective or CI
• can also be used during pregnancy
• can also be used with antithyroid agents

Question 8

What are common side effects of iodides?

Answer 8

• salivary gland inflammation
• conjunctivitis
• acne-form rash

Question 9

What are common side effects of iodides?

Answer 9

• salivary gland inflammation
• conjunctivitis
• acne-form rash

Question 10

What is the treatment of choice for Grave’s disease?

Answer 10

radioactive iodine

Question 11

What is a drawback of tx with radioactive iodine?

Answer 11

-destroys thyroid tissue –> pts become hypothyroid and will need levothyroxine long term

Question 12

What is a drawback of tx with radioactive iodine?

Answer 12

-destroys thyroid tissue –> pts become hypothyroid and will need levothyroxine long term

Question 13

When is radioactive iodine tx CI?

Answer 13

-pregnancy or breastfeeding

Question 14

AEs of Radioactive Iodine

Answer 14

• transient neck soreness
• flushing
• decreased taste

Question 15

AEs of Radioactive Iodine

Answer 15

• transient neck soreness
• flushing
• decreased taste

Question 16

Advantages of Antithyroid Drugs for Grave’s Disease

Answer 16

• noninvasive
• lower initial cost
• low risk of permanent hypoT

Question 17

Disadvantages of Antithyroid Drugs for Grave’s Disease

Answer 17

• low cure rate

- adverse drug reactions

Question 18

Advantages of Radioactive Iodine for Grave’s Disease

Answer 18

• curative

- most cost effective

Question 19

Disadvantages of Radioactive Iodine for Grave’s Disease

Answer 19

• permanent hypothyroidism

- delay pregnancy 6-12 months

Question 20

Advantages of Thyroidectomy for Grave’s Disease

Answer 20

-rapid, effective treatment

Question 21

Disadvantages of Thyroidectomy for Grave’s Disease

Answer 21

• most invasive
• most costly
• permanent hypothyroid
• pain, scar

Question 22

What is required before surgery is done?

Answer 22

-pt must be euthyroid

Question 23

Sxs of Thyroid Storm

Answer 23

• high fever
• tachycardia, tachypnea
• dehydration
• delirium, coma
• GI disturbances

Question 24

Tx of Thyroid Storm

Answer 24

• short acting beta blocker
• IV or oral iodide
• large doses of propylthiouracil
• supportive care: APAP for fever, fluid and electrolyte management
• IV hydrocortisone due to potential presence of adrenal insufficiency