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Endocrine > Hypothyroidism > Flashcards

Hypothyroidism Flashcards

1
Q

most common cause

A

Hashimoto’s disease

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2
Q

hypothyroidism results in

A

generalized slowing down of metabolic process

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3
Q

in Hashimoto’s B and T cells

A

infiltrate the gland as a result of genetic or environmental changes

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4
Q

B and T cell infiltration results in

A

cell destruction by necrosis or induced apoptosis

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5
Q

atrophic thyroiditis

A

cytokines released by T cells as well as native thyroid cells propagate the destructive process

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6
Q

cytokine therapy (IFN-alpha) is associated with

A

increase autoimmune thyroid disease

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7
Q

what antibodies are present in atrophic thyroiditis

A

antibodies to TPO and thyroglobulin (useful markers of disease), possible TSH antibodies also

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8
Q

TSH receptor antibodies in atrophic thyroiditis

A

prevent stimulation of TSH

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9
Q

iatrogenic hypothyroidism follows

A

exposure to radiation or surgery for treatment of hyperthyroidism or head and neck cancers

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10
Q

iatrogenic hypothyroidism usually occurs within

A

3-12 months after I131 and within 1 month of the following surgery

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11
Q

most common cause of hypothyroidism worldwide

A

iodine deficiency

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12
Q

pituitary disease and hypothalamic disease can cause

A

secondary hypothyroidism

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13
Q

an increase in TSH is

A

the first sign of primary hypothyroidism

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14
Q

T3 levels in hypothyroidism

A

will often remain in the normal level despite decreased T4

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15
Q

primary hypothyroidism lab values

A

increased TSH

decreased T4

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16
Q

secondary hypothyroidism lab values

A

normal to decreased TSH

decreased T4

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17
Q

subclinical hypothyroidism lab values

A

mildly increased TSH

normal T4

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18
Q

levothyroxine

A

its synthetic T4, results in a pool thyroid hormone that is readily and consistently converted to T3

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19
Q

levothyroxine is DOC because

A

chemically stable, low cost, no antigenicity, and uniform potency

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20
Q

half life of levo

A

7 days

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21
Q

absorption of levo

A

40-80%, effected by food and some medications

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22
Q

distribution of levo

A

predominantly protein bound

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23
Q

contraindications of levothyroxine

A

untreated thyrotoxicosis, acute MI, and untreated adrenal insufficiency

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24
Q

precautions of levothyroxine

A

NTI, elderly, CV disease, and mucosal disease

25
Q

levothyroxine drug interactions - increased absorption from GI tract

A

cholestyramine, calcium carbonate, sucralfate, aluminum hydroxide, ferrous sulfate, dietary fiber supplements

26
Q

levothyroxine drug interactions - increased T4 clearance

A

carbamazepine, phenytoin

27
Q

levothyroxine drug interactions - blocked conversion of T4 to T3

A

amiodarone

28
Q

IV dosage forms of levothyroxine

A

200 mcg and 500 mcg vials

29
Q

IV to PO conversion of levothyroxine

A

IV * 1.33

30
Q

new dose of levothyroxine at about

A

every 12 mcg

31
Q

levothyroxine average maintenance dose for most adults around

A

125 mcg/day

32
Q

levothyroxine starting dose for healthy adults

A

50 mcg/day; increase by 25-50 mcg q6-8 weeks

33
Q

levo; most recent guidelines suggest

A

1.6 mcg/kg/day as a starting dose in younger, healthy people

34
Q

levo starting dose for elderly

A

25 mcg/day; increase by 12.5-25 mcg

35
Q

levo dose requirements may increase during _____ and decrease _____

A

pregnancy; with age

36
Q

levothyroxine should be

A

taken on an empty stomach and separated from other medicates by at least one hour

37
Q

complete resolution of symptoms may take

A

several months, should see improvement in 2-3 weeks

38
Q

liothyronine

A

synthetic T3

39
Q

liothyronine is generally reserved for

A

myxedema or nontoxic goiter - when rapid therapy is needed to rapidly suppress TSH

40
Q

disadvantages of liothyronine

A

short half life - fluctuations in hormone concentrations; divided daily dosing usually required
higher incidence of cardiac adverse effects

41
Q

Liotrix

A

attempts to mimic natural secretion; 4:1 ratio of T4:T3

42
Q

disadvantages in liotrix

A

expensive, lack of therapeutic rationale, not used anymore

43
Q

desiccated thyroid is extracted from

A

hog, beef, or sheep thyroid gland

44
Q

desiccated thyroid is generally reserved for

A

those who insist on natural product or feel that synthetic levothyroxine has stopped working for some reason

45
Q

disadvantages of desiccated thyroid

A

standardized but unpredictable amount of hormone in each tablet, unpredictable patient response, may be antigenic in allergic or sensitive patients

46
Q

monitor TSH at least

A

q6-8 weeks until patient is euthyroid, then at least annually

47
Q

FT4 can be used to determine

A

adherence or malabsorption

48
Q

TSH and monitoring

A

not helpful in monitoring patients with secondary hypothyroidism

49
Q

subclinical hypothyroidism

A

patients may or may not present with symptoms, guidelines recommend to treat only if patient is experiencing symptoms

50
Q

hypothyroidism during pregnancy leads to

A

increased rate of still-births and possibly lower psychological scores in infants born by women with inadequate thyroid hormones

51
Q

thyroid hormones must come from mother during

A

first 2 months of gestation

52
Q

pregnancy dosing of levothyroxine

A

may increase as much as 25-50%

53
Q

pregnancy and TSH

A

TSH should be monitored, minimally, at the end of the first and second trimester

54
Q

myxedema coma

A

end stage of uncontrolled hypothyroidism, needs to be treated in ICU and has a mortality of 60-70%

55
Q

clinical features of myxedema coma

A

hypothermia, advanced stages of hypothyroid symptoms, delirium/coma

56
Q

patients with myxedema coma usually require

A

intubation and mechanical ventilation

57
Q

treatment of myxedema coma

A

IV T4 300-500 mcg, then 75-100 mc daily, switch to PO

58
Q

supportive treatment of myxedema coma

A

IV steroids and fluids

59
Q

with treatment of myxedema coma

A

improvements in consciousness/TSH/vital signs are expected within 24 hours

Endocrine (7 decks)

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