Propylthiouracil, Methimazole, Levothyroxine

Question 1

most common cause of Hyperthyoridism

Answer 1

Grave’s disease

Question 2

symptoms of hyperthyroidism

Answer 2

associated with hypermetabolic and hyperadrenergic symptoms

• tachycardia
• palpitations
• heat intolerance
• weight loss
• increased BMR
• exophthalmos →Grave’s ophthalmopathy
  (“Bulging infrared goggles”)
• insomnia
• anxiety
• tremor

(“(“Anxious henchman with big bowtie”)

Question 3

hyperthyroidism due to Grave’s disease can be treated with…

Answer 3

-ablating doses of radioactive iodine (131-I)
(“green radioactive vial”)

Question 4

radioactive iodine treatment Side Effects

Answer 4

-can cause hypothyroidism
(“Undone bowtie”)

-can exacerbate HYPERthyroidism
(“Anxious radioactive henchman”)

-can exacerbate Grave’s ophthalmopathy
(“Bulging radioactive goggles”)

Question 5

Propylthiouracil MOA

(“PTU” ! Agent)

Answer 5

-treats hyperthyroidism by inhibiting TPO
(““PTU!” agent firing at the transporter”)

-treats hyperthyroidism by inhibiting 5’ deiodinase →

• decreased conversion of T4 into T3
  (““PTU!” agent firing at the bomb trigger”)

Question 6

Methimazole MOA

(“evil math equations”)

Answer 6

• inhibiting TPO
• inhibit iodine organification

X10 TIMES MORE POTENT THAN PTU
→USE IN CHILDREN

(“Evil math equations striking transporter”)

Question 7

which class of drugs can be used to treat the hyperadrenergic symptoms of hyperthyroidism

Answer 7

Beta blockers

• treat hyperthyroidism by inhibiting 5’ deiodinase → decreased conversion of T4 into T3

(“Silenced bugle gun pointed at catfish”)
(“Silenced bugle gun pointed at trigger”)

Question 8

Glucocorticoids are useful in hyperthyroidism therapy since they …

Answer 8

treats hyperthyroidism by inhibiting 5’ deiodinase → decreased conversion of T4 into T3
(“Moon face death coaster blocking trigger”)

treat Grave’s ophthalmopathy
(“Moon face death coaster hitting goggles”)

Question 9

Thyroid storm treatment

(“Thwarted Dr. Storm”)

Answer 9

1) Beta blockers

• blocking sympathetic effects

​————————————————————————-​——-

2) blocking thyroid hormone synthesis
Propylthiouracil /Methimazole

• By inhibiting TPO

3) Blocking conversion of T3 to T4 by inhibiting 5’ deiodinase in periphery

• Beta blockers
• Propylthiouracil
• Glucocorticoids

Question 10

Propylthiouracil
Side Effects

Answer 10

Propylthiouracil

can cause severe hepatotoxicity
(“Broken liver beaker”)

can cause a maculopapular rash
(“Chemical spots”)

can cause ANCA-associated vasculitis
(“Inflamed leash”)

Question 11

Methimazole Side Effects

Answer 11

is a first trimester teratogen

(“Tarantula drawn on chalk board with evil math equations “)

Question 12

Propylthiouracil/Methimazole Side Effects

Answer 12

-Agranulocytosis
(“self destruct sand timer”)

-can cause aplastic anemia
(“Plastic chew bones”)

-can cause drug induced lupus
(“Guard wolf”)

Question 13

Symptoms of Hypothyroidism

(“Fat, cold, fatigued mixologist”)

Answer 13

-dry brittle hair, lethargy, fatigue, weakness, decreased BMR, cold intolerance, and myxedema

• untreated hypothyroidism can lead to
  myxedema coma
  (“Mixing cold drinks”)

→progressive weakness, stupor,
hypothermia hypoventilation,
hypoglycemia, hyponatremia, death

(“Fat, cold, fatigued mixologist”)

Question 14

What can be used for treatment of HYPOthyroidism

(“fat, cold ,fatigued myxologist”)

Answer 14

Levothyroxine (synthetic T4) treats hypothyroidism
(“Synthetic T4 time bombs”)

Question 15

Levothyroxine therapy Side Effects

(“synthetic T4 bombs”)

Answer 15

-can cause HYPERthyroidism
(“Anxious agent taking cover”)

Question 16

treatment for accidental radioactive iodine exposure

Answer 16

Anions -such as perchlorate, pertechnetate and thiocyanate competitively inhibit the sodium-iodide transporter

(“Obstructive box of anions”)