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Fall Therapeutics > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Medications that can affect TSH secretion

A

Decrease TSH
-dopamine, high dose glucocorticoids, octreotide (GOD)

Increase TSH
-dopamine antagonists, amiodarone (ADD)

GOD ADDs to your life, start low to high

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2
Q

Interpreting Thyroid Function Tests

A
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3
Q

Hypothyroidism SX

A
  • weight GAIN
  • low energy
  • depression
  • COLD intolerance
  • constipation
  • bradycardia
  • dry skin

most common: hashimoto’s

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4
Q

Drug-induced Hypothyroidism

A
  • Amiodarone
  • Carbamazepine
  • Interferons
  • Lithium
  • Tyrosine kinase inhibitors (sunitinib, sorafenib)

CAL IT!

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5
Q

Hypothyroidism TX options

A
  • T4 replacement: levothyroxine (synthetic, man made)
  • T3 replacement: liothyronine (Cytomel)
  • T3/T4 combination: Armour Thyroid (FROM PIGS, DONT USE IF PORK ALLERGY)
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6
Q

Levothyroxine (Synthroid): dose, CI, warning, how to take

A

Drug of choice

-1.6 ug/kg/day (elderly need 20-25% less, >50 yo)
-cardiac diseases: 12.5-25 ug daily

-Warning: NOT for obesity or weight loss, toxicity

-CI: adrenal insufficiency, glucocorticoid therapy initiation

-with water, same time each day, 30-60 min before bfast or 3 hr after din, don’t crush/chew

-brand name recommended (or same generic preparation)

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7
Q

Levothyroxine Titration

A
  • In increments of 12.5-25 ug
  • Titrate every 4-6 weeks until TSH is normal, then 4-6 months, then yearly
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8
Q

Check Free T4 for: selected patients

A
  • poor absorption
  • Pregnancy
  • central hypothyroidism (defect in pituitary production of TSH)

T4 for PPP

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9
Q

Liothyronine (Cytomel)

A
  • 25 mcg PO daily
  • Titrate in 12.5-25 mcg increments
  • Maintenance: 25-75 mcg PO daily
  • Titrate Q 1-2 weeks
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10
Q

Armour Thyroid (desiccated thyroid)

A

**1 grain = 60 mg = 100 mcg levothyroxine++

  • Initial: 15-30 mg PO daily (15 mg in CAD patients)
  • Titrate by 15 mg q2-3 weeks
  • Maintenance: 60-120 mg/day

SE: increase rate of hypersensitivity

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11
Q

Medications to separate by 4 hours

A
  • Medications containing polyvalent cations (iron, calcium, aluminum)
  • Bile-acid sequestrants
  • Sucralfate
  • Orlistat
  • Sevelamer
  • Sodium polystyrene sulfonate

MOB triple SSS

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12
Q

Medications to separate by 3 hours

A

Patiromer

pat is 3

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13
Q

Medications to separate by 2 hours

A

Lanthanum

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14
Q

Effect of hypothyroidism on medications

A

Digoxin: decrease doses achieve therapeutic levels

Warfarin: increase doses needed due to slowed catabolism of clotting

BUT IF YOU FIX IT OPPOSITE

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15
Q

Hyperthyroidism SX

A
  • weight LOSS
  • tachycardia, palp
  • insomnia
  • nervous, anxiety
  • HEAT intolerance
  • diarrhea
  • tremor, weak muscles
  • onyvholysis (nails), bulging eyes, goiter**

most common cause is grave’s

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16
Q

Hyperthyroidism TX

A

Thioamide: PTU and MMI

Radioactive iodine

Surgery

17
Q

Propylthiouracil (PTU), Methimazole (MMI) MOAs

A

-Block synthesis of thyroid hormone (BOTH)

-PTU (ONLY) blocks peripheral conversion of T4 to T3

18
Q

PTU and MMI dosing

A

MMI
-Initial: 15-40 mg/day PO 1-2x/day
-Main: 5-15 mg/day

PTU
-Initial: 50-150 mg PO TID
-Main: 50 mg PO BID-TID

19
Q

PTU/MMI AE

A

Rash
Pancreatitis
*Agranulocytosis
Arthralgias and lupus-like syndrome
*Vasculitis
*GI effects
*Hepatotoxicity: children are more susceptible to hepatotoxic reactions from PTU than are adults

GAAV the RPH

20
Q

PTU/MMI Monitoring

A

-FT4 and total T3 should be obtained 2–6 weeks after initiation
-Once euthyroid, dose of MMI can be decreased by 30%–50%, testing repeated in 4–6 wk
-Then test every 2-3 mo, if longterm >18mo then every 6 mo
-If med is primary therapy, should be continued for 12–18 mo, then d/c if TSH and TRAb levels are normal at that time
-AST/ALT/Alk Phos/WBC/ANC labs

CBC and LFTs

21
Q

Adjunctive therapies: Beta Blockers

A

-Blocks T4 to T3

*Atenolol: 25-50 mg a day
*Propranolol: 20-40 mg a day

SE: hypotension, bradycardia, av block (BP HR EKG)

22
Q

Adjunctive therapies: Iodides

A
  • dilute in full glass of liquid
  • take with food or milk

SE: HS rxn, salivary gland swelling, metallic taste or mouth/throat irritation, sore gums/teeth, diarrhea

SMD HP (contra: preg)

CI: iodine HS, pregnancy/BF

10 days prior to surgery OR 3-7 days after radiotherapy

23
Q

Myxedema Coma TX

A

T4 200-400 ug IV a
AND
hydrocortisone 100 mg IV q8h
AND
supportive, treat underlying disorder

24
Q

Thyroid Storm TX

A

-103+ fever, sweat, tachy, A fib, dehydration, delirium

PTU preferred, 500-1000 mg load then 250 mg q4h
+ BB + iodine + steroid

25
Q

Pregnancy

A

HYPO
-increased levothyroxine requirement during and months post partum

HYPER
-PTU during first tri
-MMI for rest of pregnancy

26
Q

TSH Normal Ranges

A

0.27-4.2

27
Q

T4 and free T4 Normal Ranges

A

T4: 4.5-10.9

Free T4: 0.93-1.7

28
Q

T3 Total

A

0.8-2

29
Q

Colors of Levothyroxine/Synthroid/Levoxyl

A

Orangutans will vomit on you right before they become large proud giants

-Orange: 25 mcg
-White: 50
-Violet: 75
-Olive: 88
-Yellow: 100
-Rose: 112
-Brown: 125
-Teal: 137
-Blue: 150
-Lilac: 175
-Pink: 200
-Green: 300

Fall Therapeutics (34 decks)

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