Thyroid

Question 1

Treatment options for hyperthyroidism

Answer 1

1. Anti-thyroid medications (mostly used in young, healthy patients for ~1-2 years)
2. Radioactive iodine
3. Surgery

Question 2

Thionamides (antithyroid drugs)

Answer 2

Propylthiouracil (PTU) and Methimazole (Tapazole)

Can cause agranulocytosis, drowsiness, headaches, alopecia, skin rashes

Question 3

Methimazole

Answer 3

Preferred agent but not recommended in pregnancy

Question 4

Propylthiouracil (PTU)

Answer 4

Preferred agent in pregnancy

***Black box warning for liver failure***

Question 5

Goals for hypothyroid treatment

Answer 5

1. Resolve symptoms
2. Euthyroid state
3. Reduce goiter size

Question 6

Thyroid replacement education

Answer 6

Take on empty stomach before breakfast

Do not take with other meds

Question 7

Levothyroxine (Synthroid) Adverse Effects

Answer 7

• CV: angina, BP increase, flushing, palpitations,
• CN: anxiety, headache, insomnia

Generally minimal side effects if adequate level maintained

Question 8

Levothyroxine contraindications

Answer 8

Caution in pts with CV disease (relative contraindications - start with a lower dose)

Avoid after recent MI, thyrotoxicosis

Question 9

Levothyroxine in pregnancy

Answer 9

• Levothyroxine is safe in pregnancy
• Increases in dose may be required