others (thyroid, etc)

Question 1

MOA osteroporosis Hyperhyroid

Answer 1

1) direct stimulation of bone resorption
2) inc calcium from bone breakdown > inc alkphos, osteocalcin, P > stimulates inc PTH > dec hydroxylation of vit D > dec intestinal absorption of Ca and inc urinary excretion

Question 2

adverse effects of methimazole

Answer 2

in pregnancy: aplasia cutis, embryopathy
GI upset
agranulocystosis
rash

Question 3

MOA PTU

Answer 3

dec peripheral conversion of t4 to t3

Question 3

Meds for hyperthyroid

Answer 3

Methimazole 10-20mg OD
Propranolol 20-40mg OD
Lugols iodine 2 drops in water
PTU 50-150 mg OD –> 100-200 in pregnancy

Question 4

normal TSH

Answer 4

0.4 - 4.5 uu/ml

Question 4

MOA methimazole

Answer 4

dec organification –> dec production of t3 and t4

Question 5

normal ft4

Answer 5

0.8-2ng/dl

Question 6

tx hypothy

Answer 6

LT4 25-50mcg/day, inc by 25 mcg/week
check lt4 q8 weeks

Question 7

goals for hypo thy TSH

Answer 7

lower limit
0.4-2 uu/ml

Question 8

changes in thyroid metab as we age

Answer 8

dec peripheral conversion of T4-T3
inc tsh
dec thyroid production
dec metabolism/excretion/clearance

Question 9

thyroid changes in pregnancy

Answer 9

inc TBG due to inc estrogen and inc hepatic synthesis and dec clearance

dec iodide due to inc reqts from higher metab and fetus (prone to hypothy in iodine deficient areas)

Question 9

post partum thyroiditis

Answer 9

in 5-10%
screen 3 and 6 mo postpartum
reassess after 1 yr
20% chance to develop hypothy after 5-10 yrs

Question 9

screening for thyroid disease

Answer 9

q5 years at 35
q2 yrs at 60
earlier if with ssx

Question 10

in pregnant goals TSH

Answer 10

1st 0.1-2.5
2nd 0.2-3
3rd 0.3-3