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Spring 15 - Pharm Unit IV > Hypothyroid > Flashcards

Hypothyroid Flashcards

1
Q

Clinical Presentation of Hypothyroidism

A
  • dry skin
  • cold intolerance
  • weight gain, periorbital puffiness
  • constipation
  • weakness, lethargy, fatigue
  • depression
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2
Q

Normal Range for TSH

A

0.4-4.8 mU/L

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3
Q

Normal Range for Free T4

A

0.8-1.7 ng/dL

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4
Q

What does the TSHR-Sab test for?

A

-positive will confirm Grave’s disease

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5
Q

What are the TSH and T4 findings for hypothyroidism?

A
  • high TSH

- low free T4

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6
Q

What are potential sequelae of hypothyroidism?

A
  • hypercholesterolemia
  • increased DBP
  • dementia-like syndrome in older adults
  • fetal risks: increased risk miscarriage
  • myxedema coma
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7
Q

What are the goals of therapy in hypothyroidism?

A
  • replace missing thyroid hormones
  • relieve sxs
  • achieve stable biochemical euthyroid state
  • prevent neurological deficits in newborns and kids
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8
Q

List the thyroid preparations used in treating hypothyroidism.

A
  1. thyroid USP (Armour Thyroid = dessicated beef or pork thyroid gland)
  2. thyroglobulin (partially purified pork thyroglobulin)
  3. levothyroxine (synthetic T4)
  4. Levoxyl, Thyro-Tabs, Unithroid (synthetic T3)
  5. Liotrix
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9
Q

What are the TSH and T4 findings for hypothyroidism? What is the gold standard for testing for hypoT?

A
  • high TSH
  • low free T4

-TSH is gold standard test

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10
Q

List the thyroid preparations used in treating hypothyroidism.

A
  1. thyroid USP (Armour Thyroid = dessicated beef or pork thyroid gland)
  2. thyroglobulin (partially purified pork thyroglobulin)
  3. levothyroxine (synthetic T4)
  4. Levoxyl, Thyro-Tabs, Unithroid (synthetic T3)
  5. Liotrix
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11
Q

What are the drawbacks with armour thyroid (beef/pork gland)?

A
  • unpredictable hormonal stability

- inexpensive generic brands may not be bioequivalent

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12
Q

What are the drawbacks of thyroglobulin?

A
  • more expensive than thyroid extract

- no clinical advantage

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13
Q

What are advantages of levothyroxine?

A
  • stable
  • predictable potency
  • generics are bioequivalent
  • BUT variable absorption between products
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14
Q

What are advantages of Levoxyl/Thyro-Tabs?

A
  • uniform absorption

- rapid onset

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15
Q

What are advantages and disadvantages of Liotrix?

A
  • AD: stable, predictable

- DISAD: expensive, lacks therapeutic rationale b/c T4 is converted to T3 peripherally

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16
Q

What is the drug of choice for hypoT?

A

levothyroxine

17
Q

AEs of Levothyroxine

A
  • HTN, tachycardia
  • insomnia
  • diarrhea
  • excessive dose = HF, angina, MI, reduced bone density
  • rare allergic or idiosyncratic reactions
18
Q

AEs of Levothyroxine

A
  • HTN, tachycardia
  • insomnia
  • diarrhea
  • excessive dose = HF, angina, MI, reduced bone density
  • rare allergic or idiosyncratic reactions
19
Q

What factors require a decreased levo dose?

A
  • age
  • delivery of pregnancy
  • withdrawal of interacting substances
20
Q

What factors require an increased levo dose?

A
  • malabsorption syndromes
  • green tea, orange/apple/grapefruit juice
  • Ca, Fe, Al
  • fiber, soy
  • sucralfate, tube feeding, cholestyramine
  • pregnancy, cirrhosis, tamoxifen
  • rifampin, carbamazepine, phenytoin
21
Q

What is the average/usual levo dose?

A

1.7 mcg/kg/day (100-125 mcg/day)

22
Q

When and how should levo be taken?

A
  • first thing in the morning
  • empty stomach
  • wait 4 hours to take Ca, Fe, magnesium, Al, sucralfate, cholestyramine, orlistat
23
Q

What does the initial dose determination depend upon?

A
  • patient age
  • presence of associated disorders
  • severity and duration of hypoT
24
Q

How does levo dosing change for pts 50?

A

25-50 mcg/day

25
Q

How does levo dosing change for pts >50 who have known cardiac dz>

A

12.5-25 mcg/day

26
Q

How does levo dosing change for myxedema coma?

A

200-500 mcg IV

27
Q

What labs are monitored for hypoT treatment?

A
  • monitor TSH only

- don’t monitor T4 b/c we are giving them T4 so it’s not an accurate level

28
Q

When is monitoring done for hypoT treatment?

A
  • check q6-8 weeks and adjust dose as needed until euthyroid

- periodically q6-12 months thereafter

Spring 15 - Pharm Unit IV (11 decks)

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