thyroid

Question 1

triiodothyronine

Answer 1

T3

Question 2

thyroxine

Answer 2

T4

Question 3

hypothyroidism is

Answer 3

deficiency and consequently an elevation in TSH

Question 4

key drugs that cause hypothyroidism

Answer 4

I TALC

Interferons (can also cause hyperthyroidism)
Tyrosine kinase inhibitors
Amiodarone (can also cause hyperthyroidism)
Lithium
Carbamazepine

condition:
hashimoto’s disease (autoimmune)

Question 5

myxedema coma

Answer 5

fatal complication when hypothyroidism is left untreated

tx. IV levothyroxine

Question 6

symptoms of hypothyroidism

Answer 6

cold intolerance/sensitivity
dry skin
fatigue
muscle cramps
weight gain
constipation
weakness
etc.

Question 7

low free T4
high TSH
this is

Answer 7

diagnosis of hypothyroidism
normal T4= 0.9-2.3
normal TSH: 0.3-3

monitor 4-6 weeks

Question 8

levothyroxine

Answer 8

is (T4)
synthroid, Levoxyl, unithyroid
60 min before breakfast or a bedtime (3hours after last meal)
IV:PO 0.75:1 (use immediately upon reconstitution)
contra: uncorrected adrenal insufficiency
potentially toxic for obese or overweight pt boxed warning

Question 9

thyroid, desiccated USP

Answer 9

is T3 and T4
Armour Thyroid, NP thyroid
“natural thyroid”- natural porcine-derived- less predictable potency and stability
contra: uncorrected adrenal insufficiency
potentially toxic for obese or overweight pt boxed warning

Question 10

liothyronine

Answer 10

is T3
cytomel
shorter t1/2 causes fluctuations in T3 levels

Question 11

levothyroxine tablet colors

Answer 11

Orangutans Will Vomit On You Right Before They Become Large Proud Giants
25mcg- orange
50mcg- white (no dye)
75mcg- violet
88mcg- olive
100mcg- yellow
112mcg- rose
125mcg- brown
137mcg- turquoise
150mcg- blue
175mcg- lilac
200mcg- pink
300mcg- green

Question 12

drugs that decrease levo absorption

Answer 12

• antacids and polyvalent cations such as iron, calcium, aluminum, mag, multivitamins etc. sevelamer, sucrafate: sperate by 4 hours
• sodium polystyrene sulfonate and patiromer (veltassa)
• lanthanum: separate doses by 2 hrs

Question 13

hyperthyroidism

Answer 13

T4 high
TSH low
graves’ disease is autoimmune

monitor 4-6 weeks

Question 14

symptoms of hyperthyroidism

Answer 14

heat intolerance, increased sweating
weight loss
insomnia
tremor
thinning hair
agitations, anxiety, nervousness
goiter (possible)

Question 15

thionamides are

Answer 15

inhibit synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid glad

PTU also inhibits peripheral conversion of T4 to T3
propylthiouracil (PTU)
Methimazole (tapazole)

Question 16

PTU

Answer 16

propylthiouracil
boxed warning: severe liver injury and acute liver failure
preferred 1st trimester of prego due to methimazole cause fetal abnormalities
Dile, agranulocytosis
PTU preferred in thyroid storm if methimazole is not tolerated

Question 17

methimazole

Answer 17

tapazole
drug of choice due to lower liver damage
prego: PTU preferred in the 1st trimester, methimazole can be used in 2nd and 3rd trimester to avoid liver tox

Question 18

Iodides

Answer 18

temporarily inhibit secretion of thyroid hormones T4 and T3 will be reduced for several weeks but effect will not be maintained

potassium iodide and iodide soutoin (lugol’s solution)
saturated solution of potassium iodide (SKKI, thyroSafe)

Question 19

symptoms of thyroid storm

Answer 19

fever
tachycardia
tachypnea
agitation
delirium
dehydration
profuse sweating
psychosis
coma