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Endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

causes of hyperthyroidism

A

graves’ disease, TSH-secreting pituitary adenomas, toxic adenoma

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2
Q

graves’ disease is an

A

autoimmune syndrome that may include hyperthyroidism, diffuse thyroid enlargement, exophthalmos, pretibial myxedema, thyroid acropachy

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3
Q

in graves’ disease

A

thyroid stimulating immunoglobulin functions as an agonist at the TSH receptor, stimulating hormone production and release

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4
Q

Graves’s disease patients will have antibodies to

A

TPO

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5
Q

about 15% of graves’ patients will

A

spontaneously develop Hashimoto’s

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6
Q

TSH-secreting pituitary adenomas

A

release of biologically active hormone that is unresponsive to normal feedback control and occurs sporadically

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7
Q

toxic adenoma

A

autonomous thyroid nodule, seen as “hot: nodules on radioiodine scan

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8
Q

hyperthyroidism lab values

A

elevated free and total T3 and T4 with a low TSH and elevated RAIU

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9
Q

increased RAIU indicates

A

indicated true hyperthyroidism

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10
Q

decreased RAIU indicates that

A

the excess thyroid hormone is not a consequence of thyroid gland hyperfunction

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11
Q

thioamides

A

methimazole and propylthiouracil

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12
Q

methimazole

A

inhibits thyroid peroxidase (T4/T3 synthesis)

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13
Q

propylthiouracil

A

inhibits thyroid peroxidase, and inhibits 5’ deiodinase

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14
Q

half life of MMI

A

5 hours

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15
Q

half life of PTU

A

1 hour

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16
Q

duration of action of MMI

A

24 hours

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17
Q

duration of action of PTU

A

6-10 hours

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18
Q

metabolic clearance of MMI and PTU

A

decreased in renal and hepatic disease

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19
Q

MMI vs. PTU

A

MMI is 10-12 times more potent than PTU

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20
Q

MMI contraindications

A

pregnancy and breastfeeding

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21
Q

PTU contraindications

A

pregnancy

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22
Q

drug interactions of thioamides

A

warfarin - by correcting the underlying hyperthyroidism, metabolism of clotting factors will be reduced resulting in decreased response to warfarin

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23
Q

pregnancy and thioamides

A

PTU has historically been the preferred agent if treatment is necessary

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24
Q

thioamides - minor adverse effects

A

fever, rash, arthralgias, transient leucopenia

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25
Q

thioamides - major adverse effects

A

agranulocytosis, hepatitis, vasculitis, lupus-like syndrome

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26
Q

PTU initial dose

A

300-600mg divided three to four times daily

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27
Q

PTU maintenance dose

A

50-300mg divided two to three times daily

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28
Q

PTU max dose

A

1200 mg/day

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29
Q

MMI initial dose

A

30-60mg divided three times daily

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30
Q

MMI maintenance dose

A

5-30mg daily

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31
Q

MMI max dose

A

120 mg/day

32
Q

changing doses of thioamides

A

doses should not be changed more than monthly

33
Q

treatment with thioamides

A

treatment is continued for 12-24 months

34
Q

baseline monitoring for thioamides

A

leukocyte count

35
Q

labs to monitor for thioamides

A

TSH, FT4, TT4

36
Q

adverse reactions to monitor for in thioamides

A

weakness, fatigue, easy bruising/bleeding, urinary symptoms

37
Q

Radioactive iodine is used for

A

chemical ablation of thyroid gland

38
Q

MOA of radioactive iodine

A

incorporated into thyroid hormone and thyroglobulin leading to follicular necrosis

39
Q

treatment of choice for graves’ disease

A

radioactive iodine

40
Q

pretreatment for radioactive iodine

A

pretreat with MMI/PTU in geriatric and cardio patients bc RI may transiently elevate thyroid hormone levels following treatment

41
Q

with RI, euthyroid is reached in

A

2-6 months

42
Q

in RI, hypothyroid typically happens within

A

4-12 months

43
Q

contraindications of radioactive iodine

A

pregnancy, women should avoid getting pregnant for 6-12 months following therapy

44
Q

thyroid eye disease and radioactive iodine

A

RAI exacerbates thyroid eye disease

45
Q

exophthalmos treatment

A

begin glucocorticoid (prednisone 0.4-0.5 mg/kg/day) 4 to 7 days after RAI dose an taper over 2-3 months

46
Q

possible reasons for surgery

A
  • pediatric age group with toxic reaction to antithyroid medications
  • pregnant women requiring high doses of PTU or having a toxic reaction to PTU
47
Q

symptomatic treatment of hyperthyroidism

A

beta-blockers and calcium channel blocker

48
Q

beta-blockers

A

inhibit adrenergic effect - control symptoms of tachycardia and hypertension

49
Q

graves disease - most patients over 40 years old should receive

A

radioactive iodine

50
Q

pregnant women and children should receive

A

antithyroid drugs as initial therapy

51
Q

inadequately treated maternal hyperthyroidism can result in

A

fetal tachycardia, severe growth restriction, premature birth, and 9-fold increased incidence of low birth weight

52
Q

PTU is preferred agent in pregnancy because

A

80-90% protein bound, therefor limited transfer into the placenta and breast milk as compared to MMI

53
Q

type one amiodarone-induced thyroiditis

A

occurs due to drug metabolism (iodine-induced)

54
Q

type one treatment of choice

A

thioamides

55
Q

MMI dose for type one

A

40-60 mg/day

56
Q

PTU dose for type one

A

100-150 mg qid

57
Q

for severe type one you add

A

lithium 200-400 mg/day and titrate to serum concentration of 0.6-1.2 mEq/L

58
Q

type two amiodarone-induce thyroiditis

A

occurs due to direct toxic effects (inflammation)

59
Q

type 2 treatment choice

A

glucocorticoids

60
Q

dosing for type 2

A

prednisone 0.5-1.5 mg/kg/day and taper over 2-3 months; for most patients 40-60 mg/day

61
Q

iatrogenic hyperthyroidism

A

patients who receive too much thyroid hormone supplementation

62
Q

acute thyroiditis

A

infection of the thyroid gland

63
Q

symptoms of acute thyroiditis

A

acute onset of severe pain typically accompanied by fever, dysphagia, and erythema

64
Q

thyroid function in acute thyroiditis

A

remains normal but ESR is typically elevated

65
Q

treatment of acute thyroiditis

A

treatment with appropriate antibiotics usually results in complete resolution

66
Q

subacute thyroiditis

A

symptoms similar to pharyngitis and is though to be caused by viral infection

67
Q

the inflammatory process of subacute thyroiditis can lead to

A

destruction of tissue and fibrosis

68
Q

in subacute thyroiditis patient typically presents with

A

symptoms similar to hyperthyroidism at first; after hormone is depleted, will develop hypothyroidism

69
Q

subacute treatment

A

anti-inflammatory doses of ASA or NSAIDs is typically sufficient, if not glucocorticoids may be used

70
Q

thyroid storm

A

uncommon, life-threatening condition characterized by an exaggeration of the manifestation of hyperthyroidism

71
Q

TS has morality of

A

20%

72
Q

precipitating factors of TS

A

surgery, obstetrical delivery, infections, or any other stressful medical illness

73
Q

thyroid storm symptoms

A

high fever, tachycardia, tachypnea, dehydration, delirium, congestive heart failure, and rapid atrial fibrillation

74
Q

treatment of thyroid storm

A

antithyroid drugs via loading dose and then chronic therapy, beta blockers, iodide in some patients

75
Q

supportive care for TS

A

fluids/electrolytes, antibiotics, and APAP for fever

Endocrine (7 decks)

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