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Thyroid > therapeutics > Flashcards

therapeutics Flashcards

1
Q

where does primary thyroid disease affect

A

thyroid gland

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2
Q

where does secondary thyroid disease affect

A

pituitary gland

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3
Q

where does tertiary thyroid disease affect

A

the hypothalamus

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4
Q

where is the thyroid located

A

below the larynx in the neck region

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5
Q

causes of primary hypothyroidism

A

autoimmune disease
previous treatment for hyperthyroidism
iodine imbalance
congenital hypothyroidism

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6
Q

risk factors of primary hypothyroidism

A

female

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7
Q

symptoms of hypothyroidism

A 
lethargy/weakness
dry scaly skin 
depression 
hair loss 
memory loss 
weight gain 
constipation 
sensitive to cold weather
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8
Q

what is primary hypothyroidism

A

high levels of TSH but low levels of unbound t4

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9
Q

what thyroid function tests are carried out

A

TSH and unbound t4

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10
Q

management of primary hypothyroidism

A

treat with lifelong t4 If TSH >10 or TSH 5-10 with low t4.

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11
Q

what is the daily maintenance dose of thyroxine

A

50-200mcg

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12
Q

what initial dose of thyroxine should a person with heart disease and over 50 have

A

25mcg od adjusted by 25mcg

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13
Q

what initial dose of thyroxine can a person under 50 have

A

50-100mcg adjusted by 25-50mcg

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14
Q

how long after prescribing thyroxine should TSH be measured

A

after 8-12 weeks

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15
Q

what is he half life of t4

A

7 days

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16
Q

how often should TSH levels be monitored in adults and children when prescribed thyroxine

A

every year for adults and every 4-6 months for children until they hit puberty

17
Q

during thyroxine treatment what should be carefully monitored

A

angina

18
Q

what other combination treatments can be considered for hypothyroidism

A

liothyronine and levothyroxine or natural thyroid extraction`xt

19
Q

are there any prescription charges for thyroxine

A

no

20
Q

what should you not take at the same time as thyroxine

A

calcium iron containing preparations or any caffeine beverages

21
Q

what is hyperthyroidism

A

low TSH high unbound t4

22
Q

what causes hyperthyroidism

A

stimulation of thyroid gland by antibodies on the TSH receptor

23
Q

risk factors

A

females

24
Q

symptoms

A

anxious, palpitations, tremor, weight loss, tachycardia, goitre, warm moist skin, heat intolerance, difficulty sleeping

25
Q

what is the most common drug therapy used for hyperthyroidism

A

carbimazole (methimazole is active metabolite)

26
Q

moa for hyperthyroidism drugs

A

inhibit thyroperoxidase activity in follicular lumen

27
Q

what drug is used to treat hyperthyroidism in pregnancy

A

propylthiouracil 200-400mg DIVIDED DOSES maintenance 50mg tds.

28
Q

carbimazole regimen

A

15-40mg od until TFTs normal then maintain for 12-18months then decrease monthly until 5-15mg.

29
Q

what is the blocking replacement regimen

A

carbimazole 40-60mg for 4 weeks the carb + thyroxine 50-100mg = temporarily hypothyroid. treat for 18 months

30
Q

are prescription charge necessary for treatment of hyperthyroidism

A

yes

31
Q

why can’t carbimazole be used in pregnancy

A

increased foetal nail abnormalities. advise on contraception

32
Q

carbimazole side effects

A

agranulocytosis e.g. sore throat, mouth ulcer, bruising

33
Q

propythioluracil side effects

A

hepatic dysfunction

34
Q

in which case is radioactive iodine treatment considered

A

severe disease, failure to drug treatment, relapse after drugs, cardiac disease

35
Q

risks of surgery

A

high chance of long term hypothyroidism, damage to parathyroid gland, scarring

36
Q

what other combination treatments are considered for hyperthyroidism

A

beta blockers - relieve symptoms of palpitations/tremor (not in asthma)
propranolol - may ned to be given more frequently as increased metabolism

37
Q

what happens with an overdose of iodine

A

inhibition of t3/4 release from thyroid

38
Q

why does amiodarone cause problems in thyroid disease

A

it contains organic iodine which inhibits t3/4 in hypothyroidism and increases TSH and t4 in hyperthyroidism

39
Q

problems associated with lithium

A

prevents t3+4 release as it inhibits iodine uptake

Thyroid (2 decks)

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