metabolic mc 4

Question 1

initial therapy for hyperthyroid

Answer 1

BB even before diagnosis

Question 2

how do BB work in hyperthyroidism

Answer 2

decrease beta-adrenergic tone stopping palpitations, tachycardia, tremulousness, anxiety, and heat intolerance

Question 3

how long should you use BB

Answer 3

until hyperthyroidism is gone

Question 4

propanolol act in hyperthyroidism

Answer 4

in high doses can inhibition of the 5’-monodeiodinase

Question 5

5’-monodeiodinase job

Answer 5

converts T4 to T3

Question 6

example of a thionamide

Answer 6

carbimazole

Question 7

how is carbimazole converted

Answer 7

first pass in the liver

Question 8

what is carbimazole converted to

Answer 8

methimazole

Question 9

Thionamides action

Answer 9

inhibit thyroid peroxidase

Question 10

half life of T4

Answer 10

long

Question 11

how long does it take for Thionamides to work

Answer 11

4-6 weeks

Question 12

effect of Thionamides in autoimmune thyroid disease

Answer 12

immunosuppressant effect

Question 13

how do Thionamides get into the thyroid

Answer 13

active transport

Question 14

PTU extra effect

Answer 14

inhibits the 5’-monodeiodinase that converts thyroxine (T4) to triiodothyronine (T3) in extrathyroidal tissue

Question 15

advantages of carbimazole over PTU

Answer 15

The serum half-life of carbimazole is longer
The intrathyroidal carbimazole concentration is high for longer
Perchlorate discharge tests

Question 16

half life of carbimazole

Answer 16

4-6 hours

Question 17

half life of PTU

Answer 17

75mins

Question 18

how long does carbimazole stay high in the thyroid

Answer 18

20 hours

Question 19

which is least teratogenic out of antithyroid

Answer 19

PTU

Question 20

what does carbimazole cause in newborns commonly not so bad

Answer 20

aplasia cutis

Question 21

what is aplasia cutis

Answer 21

a scalp defect

Question 22

serious congential conditions in newborns with carbimazole

Answer 22

tracheoesophageal fistulas, patent vitellointestinal duct, choanal atresia, omphalocele, and omphalomesenteric duct anomaly

Question 23

when to discontinue PTU

Answer 23

abnormal liver enzymes

Question 24

complication of thionamide

Answer 24

agranulocytosis

Question 25

how long does it take for agranulocytosis to occur

Answer 25

within first 2 months of treatment

Question 26

methods of treating thyrotoxicosis

Answer 26

Titration therapy and block and replace therapy

Question 27

caution before radioactive

Answer 27

carbimazole before radiotherapy because There is a small risk of inducing thyroid storm

Question 28

when not to give radiotherapy

Answer 28

pregnancy

thyroid eye disease - orbitopathy

Question 29

Glucocorticoid replacement therapy

Answer 29

hydrocortisone

Question 30

how to monitor hydrocortisone

Answer 30

you cant

Question 31

what is preserved in secondary adrenal insufficiency

Answer 31

mineralocorticoid function is preserved in secondary adrenal insufficiency, it is controlled as part of the renin angiotensin aldosterone system (RAAS) rather than by pituitary control

Question 32

TSH def treatment

Answer 32

T3 and T4

Question 33

why should you hold off on T4

Answer 33

T4 should not be administered until adrenal function, including corticotropin (ACTH) reserve, has been evaluated and either found to be normal or treated

Question 34

hypothyroidism and hypoadrenal risk of giving T4

Answer 34

increase the clearance of the little cortisol that is produced, thereby increasing the severity of the cortisol deficiency

Question 35

can you use TSH to guide levothyroxine treatment

Answer 35

no

Question 36

LH and FSH def treatment in secondary hypogonad

Answer 36

testosterone (not want kids)