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CDM 4 Exam 1 > Lecture 10 - Thyroid Disorders > Flashcards

Lecture 10 - Thyroid Disorders Flashcards

1
Q

T4 vs T3

A

T4&raquo_space;» T3 secretion
T3&raquo_space;> T4 activity

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2
Q

Hypothyroidism

A

Low T4/T3 and TRH/TSH high

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3
Q

Hyperthyroidism

A

High T4/T3 and TSH/TRH low

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4
Q

Hashimoto’s Disease

A

Autoimmune

auto-antibodies target thyroid peroxidsease, thyroglobulin, and other thyroid cell antigens

primary cause

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5
Q

Iatrogenic cause (caused by us)

A

usually secondary to management of hyperthyroidism

meds such as…lithium, amiodarone,etc

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6
Q

Secondary hypothyroidism

A

usually pituitary disease

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7
Q

Risk factors for Hypothyroidism

A

Female
Postpartum women
pts with head/neck thyroid irradiation or surgery
Primary pulmonary hypertension
Down’s/Turner’s syndrome
FH autoimmune thyroid disorders
Other Autoimmune disorders

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8
Q

Clinical presentation of Hypothyroidism

A

weak
slow reflexes
coarse skin and hair
cold or dry skin
bradycardia
slow speech, hoarse voice

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9
Q

Primary hypothyroidism TSH

A

> 4.5

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10
Q

Secondary hypothyroidism TSH

A

maybe within or below reference range

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11
Q

Treatment options hypothyroidism

A

T4 = Levo
T3 = liotrix
Combo = liothyronine

T4 (Levo) usually the answer

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12
Q

Levothyroxine info

A

Pro: Drug of choice, cheap, QD,stable
Cons: Drug/Food interaction impact absorption = empty stomach
* pick 1 manufacturer n stick with*

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13
Q

which thyroid product should be used for patients who want to avoid pork?

A

Thyroid USP = armor thyroid, nature-etc

more likely for SE

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14
Q

Liothyronine info

A

pro: rapid onset, uniform absorption

cons: TID, $$$, higher CV effects, hard to monitor

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15
Q

Starting dose Levothyroxine

A

normal: 1.6mcg/kg IBW

Hx CVD = 25mcg QD
Longstanding disease/elderly = 50mcg QD

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16
Q

adjusting dose levothyroxine

A

Titrate by 12.5-25 mcg/day if pts still hypothyroid

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17
Q

Long-term maintenance levothyroxine

A

Stick with 1 product manufacturer

Recheck in 3 months, then every 6-12 months

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18
Q

Special pop, recheck TSH 4-6wk after adjustment

A

Preg, inc req in 75% of women
Elderly, dec dose req
Weight loss, may need dec dose req

19
Q

Goal TSH?

A

0.5-4.5 for exam purposes

20
Q

Levothyroxine SE

A

Allergic reactions
reduced BMD and inc risk of fracture

excessive doses = HF, angina pectoris, MI

21
Q

DDI Levothyroxine

A

stuff affecting stomach and GI absorption

give before food/meds

22
Q

Levothyroxine CI

A

Hypersensitivity
thyrotoxicosis

23
Q

Levothyroxine pt education

A

several weeks for symptoms to improve
Take empty stomach
Take 4h apart from antacids, iron, calcium supp
pick 1 brand n stick with it

24
Q

Subclinical hypothyroidism definition

A

Elevated TSH (above upper ref range) with normal T4

25
Q

Should you initiate hypothyroidism treatment?

A

TSH > 10 = probs sart levo 25
TSH < 10 = consider based on individual factors

26
Q

Myxedema Coma Treatment

A

Levo IV 300-500 bolus, 75-100 IV maintenance until stable and start PO
Hydrocortisone 100mg Q8H IV until adrenal suppression ruled out
Supportive care

27
Q

Myxedema Coma Symptoms

A

Hypothermia
Hypoventilation
Advanced stages of hypothyroid symptoms
delirium, coma

28
Q

Grave’s Disease

A

autoimmune disorder with thyroid stimulating antibody acting on thyroid

Primary

29
Q

Hyperthyroidism risk factors

A

Female
FH of autoimmune conditions
FH of hyperthyroidism
Pregnancy, some viral infections
Age = young n old, not so much middle

30
Q

Hyperthyroidism clinical presentation

A

Tachycardia
heat intolerance
diarrhea
warm, smooth moist skin
fine hair
gynecomastia

**Exophalmos & retraction of eyelids ** Grave’s Disease

31
Q

Hyperthyroidism treatment options

A

Reduce thyroid hormone:
Antithyroid drugs
Radioactive iodine
Surgery

Adjunctive options:
Symptomatic control ie BB, clonidine, Non-DHP CCBs

32
Q

Antithyroid Drugs

A

Methimazole = generally preferred
Propylthiouricil (PTU) = pref in preg 1st trimester, thyroid storms

Onset: 4-6 wk response, 4-6month max response, 1-2 txm last

33
Q

Who should use ATD?

A

> 40yrs old
low T4/T3 ratio ( < 20)
Small goiter < 50g
short duration disease < 6 month
no prev hx of relapse
therapy > 1-2yrs duration
low TSAb titers at BL

consider use pre-op prep 6-8wk before thyroidectomy

34
Q

Patient education ATD

A

Side effects
Tell doc about rash, jaundice, acolic stool or dark urine, arthralgia, ab pain, nausea, fatigue, fever, pharyngitis

35
Q

Who are ATD 1st line treatment for

A

preg, children, adolescents

36
Q

Radioactive Iodine therapy info

A

consider in: “Hot nodules”, Toxic MNGs, Graves Disease

onset : weeks to see destruction

Kills gland tissue essentially

pretreat with ATD to prevent thyroid storm

37
Q

When should iodine be stated after RAI?

A

3-7 days after to prevent interference of uptake of RAI in thyroid gland

38
Q

RAI ADE & CI

A

CI = pregnancy

Short term ADE: Mild thyroidal tenderness, dysphagia
Long term ADE: Hypothyroidism

39
Q

RAI Pros and Cons

A

Pro:
cure hyperthyroidism
Outpatient therapy
lowest cost adjust QOL
best for toxic nodules and multi nodular goiter

Con:
perm hypothyroidism in >60% pts
can worsen ophthalmopathy
preg deferred 6-12mnth no breastfeeding

40
Q

Surgery thyroid

A

Consider pts with large gland >80g, severe ophthalmopathy, and lack of remission on Anti thyroid drug

adj therapy: pre-treat methimazole 6-8wk, iodides 10-14 day before surgery and propranolol severe weeks preop, and 7-10 days post op

41
Q

Surgery pro and cons

A

Pro:
rapid, effective
thyroid cancer and nodules

Con:
permanent, invasive, scars

42
Q

Iodides info

A

used as adj therapy

ADE: iodize = metallic taste, burning mouth and throat, salivary gland swelling

CI: Toxic MNG

DI: start 3-7 days after RAI

43
Q

Who gets Treated for Subclinical Hyperthyroidism

A

TSH < 0.1 if age >65, or > 65 w/ Heart Disease, Osteoporosis, menopausal (not on estrogens or bisphos), hyperthyroid symptoms

If TSH 0.1-0.4 then consider treating

If < 65 n asymptomatic TSH < 0.1 then consider treating, 0.1-0.4 then observe

44
Q

Thyroid storm

A

medical emergency, mortality ~ 20%

symptoms: > 103F, Tachycardia, tachypnea, dehydration, delirium, coma, nausea, vomiting, diarrhea.

lasts about 72hrs, up to 8 days

CDM 4 Exam 1 (12 decks)

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