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Therapeutics > Lecture 38: Thyroid Disorders > Flashcards

Lecture 38: Thyroid Disorders Flashcards

1
Q

Thyroid Tests for adults

A

-TSH
-Free T4
-ATgA (autoimmune)
-TPO-Ab (autoimmune)
-TRAb (autoimmune)

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2
Q

TSH test

A

-pituitary TSH level
-0.5-5.0 mlU/L
-gold standard

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3
Q

Free T4 test

A

-direct measurement of free thyroxine
-0.7-1.9 ng/dL
-most accurate

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4
Q

ATgA test

A

-antibodies to thyroglobulin
-positive in autoimmune thyroid disease
-undetectable in remission

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5
Q

TPO-Ab test

A

-thyroperoxidase antibodies
-more sensitive of the 2 antibodies

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6
Q

TRAb test

A

-thyroid receptor stimulating antibody
-confirms Grave’s disease

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7
Q

Drug induced HYPERthyroidism cause

A

-excessive thyroid supplementation:
-iodinated compounds
-amiodarone (>250mcg)
-interferons a and B
-Lithium

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8
Q

HYPERthyroidism Treatment

A

-thioamides
-radioactive iodine (RAI)
-Surgery (thyroidectomy)

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9
Q

Thioamide drugs

A

-Propylthiouracil
-Methimazole** preferred

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10
Q

Propylthiouracil facts

A

-1-2.5 hour half life
-q8-12h
-blocks T4 to T3 conversion
-do not use if lactating
-less potent
-preferred in first trimester then switch to methimazole

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11
Q

Methimazole facts

A

-6-9 hour half life
-qd
-start after 16 weeks pregnancy
-10x potent
-acute pancreatitis side effect
-use PTU for first trimester then switch

preferred drug of choice if patient is not pregnant

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12
Q

Propylthiouracil (PTU) dosing

A

-initial: 50-150mg TID
-maintenance: 50mg BID or TID
-maximal: 1,200mg/day

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13
Q

Methimazole dosing

A

-initial: 5-40mg/day depending on Free T4
-maintenance: 5-10mg/day
-maximal: 60mg/day

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14
Q

Methazole initial dosing

A

-1-1.5xULN: 5-10mg/day
-1.5-2: 10-20mg/day
->2: 20-40mg/day

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15
Q

Thioamide side effects

A

-GI upset
-Rash (macropapular or wheals/hives)
-Agranulocytosis
-Hepatitis

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16
Q

Thioamide maculopapular rash

A

-no systemic systems
-treat w diphenhydramine/other antihistamines
-may try another thioamide

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17
Q

Thioamide Wheals, hives, SOB side effect

A

-type I anaphylactoid
-50% cross reactivity
-must use RAI or surgery

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18
Q

Agranulocytosis

A

-low dangerous white blood cell count
-immunocompromised
-flu symptoms, mouth sores look out for
-reversible, discontinue thioamides

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19
Q

Hepatits

A

-obtain baseline LFT and PRN
-disc thioamides, give RAI or surgery

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20
Q

Thioamide efficacy monitoring

A

-/T4, T3, TSH initially until euthyroid
-use w minimal dose of medication
-then /Q3-6 months while on thioamides
-TSH can be misleading - remain suppressed after T4 and T3 normalize

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21
Q

Thioamide remission rate

A

-40% after 1-2 years
-80% after 5-10 years

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22
Q

ONce disc thioamide,

A

-/Q4-6 weeks for first 3-4 months
-then yearly after

23
Q

Radioactive Iodine (RAI) 131I

A

-slow destruction of thyroid w isotope
-capsule dissolved in water
-colorless and tasteless
-avoid physical contact and secrection >5days

24
Q

RAdioactive Iodine warnings

A

-DO NOT USE IN PREG, LAC, PLANIING PREG < 6 months
-avoid physical contact and secretion >5days
-euthyroid delayed (3-6 months)
-hypothyroidism likely
-WORSENS Graves orbitopathy

25
Q

Thyroidectomy recommended for

A

-large glands (obstructive)
-mulitnodular goitor
-cancer
-med failure
-ophtalmophathy
-pregnacy 2nd trimester

26
Q

Thyroidectomy risks

A

-vocal cord damage
-removal of parathyroid glands

27
Q

Thyroidectomy monitoring

A

-evaluate 2 months post-surgery

28
Q

B-blockers for Hyperthyroidism

A

-short term symptom relfief
-use in pt w HR>90bpm
-prefer cardio selective B-blockers to maintain HR 60-90 bpm

29
Q

B-Blocker drugs for hyperthyroidism

A

-Atenolol (25-100mg qd)
-Metoprolol (25-50mg BID)
-Propranolol (10-40mg q6 or q8

-partially blocks peripheral T4 to T3 conversion bust slow onset (7-10 days) propranolol only?

30
Q

Alternatives to B-blockers for hyperthyroidism

A

-Calcium channel blockers

31
Q

calcium channel blocker drugs

A

-Diltiazem
-Verapamil

32
Q

Avoid B-blocker agents w intrinsic sympathomimetic activity

A

-dont use acebutolol, cartelol, penbutol, pinbutol

33
Q

HYPOthyroidism metabolic state

A

HYPOmetabolic

34
Q

Drug-induced HYPOthyroidism caused by

A

-Amiodarone
-Lithium
-Interferons

35
Q

HYPOthyroidism replacement therapy recommendation

A

-LEVOTHYROXINE (T4) first choice in all patients`

36
Q

Levothyroxine black box warning

A

-weight loss at high doses

37
Q

Levothyroxine mech

A

-peripheral T4 to T3 conversion
-provides hormone w/o bolus effects of T3
-long half life allows daily dosing
-25-300mcg

38
Q

Levothyroxine (T4) counseling

A

-empty stomach (before breakfast OR
-bedtime 4 hours after dinner

39
Q

Levothyroxine drug interactions cause by

A

-dec T4 absorption
-inc T4 requirement
-inc serum TBG concentration
-disease-drug interaction

40
Q

drugs that dec T4 absorption

A

-DRUG INTERACTION w LEVOTHYROXINE (T4)
-bile acid sequestrants
-antacids
-ferrous sulfate
-sucralfate
-calcium supplements

41
Q

drugs that inc T4 requirement

A

-DRUG INTERACTION WITH LEVOTHYROXINE (T4)
-enzyme inducers
-pheytoin
-carbamazepine
-rifampin
-phenobarbital

42
Q

Drugs that inc serum TBG concentration

A

-DRUG INTERACTION w LEVOTHYROXINE (T4)
-estrogen

43
Q

Disease-drug interaction w Levothyroxine (T4)

A

-Warfarin

44
Q

Liothyronine (T3)

A

-rapid absorption of T3 can cause hyperthyroid symptoms = cardiac toxicities
-short t1/2 = BID-QID
-more expensive

45
Q

Liothyronine (T3) use

A

-short-term hormone replacement
-diagnostic agent in T3 suppression test

46
Q

Desiccated Thyroid USP

A

-natural from pork thyroid glands
-unpredicatble potency (based on iodine content) result in over- and under- supplementation
-no justification to use this product!!

47
Q

Risks of desiccated thyroid USP

A

-allergic reaction to animal protein

48
Q

Hypothyroidism efficacy monitoring

A

-Normal TSH and FT4 monitor q6-8 weeks after any dose change
-until TSH normalized then q3-6months for first year then yearly
-reversal of signs/symptoms in 2-3 weeks
-anemia, hair, skin changes may take 6 months
-maintain euthyroid state

49
Q

Pregnancy HYPOthyroidism treatment

A

-LEVOTHYROXINE
-essential to continue throughout pregnancy
-require higher dose (T4 turnover prenatal vitamin?)
-+/-25mcg, TSH qtrimester
-resume to pre-preg dose after birth
-re TSH in 6-8 weeks

50
Q

Patients might experience high TSH despite levothyroxine dose because of:

A

-poor adherence
-drug-food interaction
-drug-drug interaction

51
Q

HYPOthyroidism lab values

A

-high TSH
-low free T4
-low T3

52
Q

HYPERthyroidism lab values

A

-LOW TSH
-high free T4
-high T3

53
Q

Levothyroxine (T4) dose

A

-healthy: 1.6mcg/kg/day
-elderly: same but start at 25-50mcg/day
-CVD: start 12.5-25mcg/day

-inc dose 12.5-25 mcg q6-8 weeks if TSH high

Therapeutics (78 decks)

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