Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics 1 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the difference between T3 and T4 hormones?

A

-T4 is solely secreted from the thyroid
-T3 is mostly produced by conversion of T4 (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What lab values indicate hyperthyroidism?

A

increased T3, increased T4, decreased TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define: Thyrotoxicosis

A

clinical state resulting from inappropriately high levels of thyroid hormone (T3 and T4) that could be caused by many factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define: Hyperthyroidism

A

inappropriately high synthesis and secretion of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the signs and symptoms of hyperthyroidism?

A

-cardiac (palpitations, tachycardia, atrial fibrillation, heart failure)
-dermatologic (hair loss/fine hair, warm/moist skin, heat intolerance)
-anxiety/irritable/fatigue
-gastrointestinal (increased appetite, weight loss, diarrhea, dysphagia)
ophthalmologic (decreased tears, exophthalmos, diplopia)
-menstruation changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does radioactive iodine uptake (RAIU) indicate?

A

-elevated= thyroid gland is over producing hormone, hyperthyroidism
-suppressed= thyrotoxicosis due to thyroid inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyperthyroidism + normal or increased RAIU indicates…

A

-GRAVES DISEASE
-toxic adenoma
-toxic multinodular
-TSH-producing pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyperthyroidism + decreased RAIU indicates…

A

-painless thyroiditis
-amiodarone-induced thyroiditis
-latrogenic thyrotoxicosis
-ingestion of thyroid hormone
-thyroid cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the goals of therapy when treating hyperthyroidism?

A

-eliminate excess thyroid hormone (normalize TSH and T4)
-minimize symptoms
-reduce long-term consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the long-term consequences of untreated hyperthyroidism?

A

atrial fibrillation, heart failure, vision loss, osteoporosis, thyroid storm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the treatment options for hyperthyroidism?

A

-symptom management
-anti-thyroid medication
-radioactive iodine (RAI)
-surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs can be used for symptom management of hyperthyroidism?

A

-beta blockers (propranolol, metoprolol) or non-DHP calcium channel blockers (verapamil, diltiazem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the indication for using symptom management treatment?

A

-overt clinical symptoms
-heart rate > 90 or cardiovascular symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are characteristics for favorable outcomes using anti-thyroid medication?

A

-female sex
-patients > 40 yo
-low T4:T3 ratio
-small goiter
-short duration of disease (<6 months)
-no previous history of relapse
-low TSAb titers at baseline or reduced with treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drugs are anti-thyroid?

A

methimazole, propylthiouracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA: anti-thyroid medication

A

inhibits oxidation of iodine in the thyroid gland, blocks synthesis of T4 and T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What anti-thyroid medication cannot be used in the first trimester pregnancy?

A

methimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What medication may be used in the case of a thyroid storm?

A

propylthiouracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Adverse Effects: Anti-thyroid medication

A

-RASH, FEVER, MYALGIA
-HEPATOTOXICITY (higher with PTU)
-congenital defects (MMI)
-leukopenia
-agranulocytosis
-aplastic anemia
-arthralgia (lupus-like syndrome)
-GI disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What types of hyperthyroidism is radioactive iodine indicated for?

A

-GRAVES DISEASE
-toxic autonomous nodules
-toxic multinodular goiters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MOA: Radioactive Iodine

A

rapid concentrates in the thyroid, initially disrupts thyroid hormone synthesis, overtime leads to necrosis/destruction of thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How often should TSH/T4 be monitored after radioactive iodine therapy?

A

4-6 weeks, then every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adverse effects: radioactive iodine

A

-thyroid tenderness
-dysphagia
-cancer risk

24
Q

What are the instructions to minimize radioactive exposure?

A

-sleep in separate beds
delay return to work
-maximize distance from children
-limit time in public spaces (2-3 days)
-do not travel via public transport or with others for prolonged periods of time (2-3 days)
-drink plenty of fluids
-flush the toilet 2-3 times after urination
-sleep in separate bed or at least 6 feet away from pregnant partners or children ( for up to 20 days)
-avoid conception both men and women (4-6 months)

25
Q

When would patients be considered for surgery?

A

-large thyroid gland
-low RAIU results
-malignancy
-severe ophthalmopathy
-planning pregnancy in less than 4-6 months
-lack of remission on anti-thyroid drug treatment

26
Q

What are contraindications to surgery to treat hyperthyroidism?

A

substantial comorbid condition, 1st and 2nd trimester pregnancy

27
Q

What is the pre-treatment for surgery for hyperthyroidism?

A

-anti-thyroidism: achieve euthyroid state prior
-beta blocker: maintain HR < 90 beats/min
-potassium iodine solution: decreases thyroid flow, vascularity, and intraoperative blood loss

28
Q

How often should thyroid hormone (T4) be monitored after surgery for hyperthyroidism?

A

monthly

29
Q

How often should TSH be monitored after surgery for hyperthyroidism?

A

6-8 weeks

30
Q

What are the signs and symptoms of thyroid storm?

A

-decompensated thyrotoxicosis
-high fever
-tachycardia, tachypnea
-dehydration
-delirium, coma
-N/V, diarrhea

31
Q

What may cause thyroid storm?

A

-infection
-trauma
-surgery
-radioactive iodine therapy
-withdrawal from anti-thyroid medications

32
Q

What is the treatment plan for thyroid storm?

A

-suppression of thyroid hormone: methimazole and propylthiouracil
-beta blocker therapy
-inorganic iodine
-corticosteroids
-treat complications or precipitating factors

33
Q

What drugs may cause hyperthyroidism?

A

amiodarone, lithium, interferon alpha, interleukin 2

34
Q

Indication: teprotumumab

A

treats thyroid eye disease to reduce bulging eyes, improve double vision, relief of eye pain, redness, and swelling

35
Q

What are the signs and symptoms of hypothyroidism?

A

-bradycardia
-constipation
-depression
-infertility
-dermatologic (thickening of the skin, cool rough dry skin, loss of hair, decreased sweating)
-cold intolerance
-edema
-weight gain
-fatigue

36
Q

What lab values indicate hypothyroidism?

A

decreased T3, decreased T4, increased TSH

37
Q

What are the diseases that cause PRIMARY hypothyroidism?

A

-autoimmune disease (HASIMOTOS DISEASE)
-iatrogenic (radioactive iodine therapy or surgery)
-congenital
-iodine deficiency
-enzyme defects

38
Q

What are the diseases that cause SECONDARY hypothyroidism?

A

-pituitary tumors
-hypothalamic diseases

39
Q

What are the goals of therapy for hypothyroidism?

A

-restore normal thyroid hormone concentration (initiate treatment when TSH > 10mIU/L)
-systematic relief
-prevent neurologic deficits in newborns and children
-reverse the biochemical abnormalities
-avoid overtreatment

40
Q

What is levothyroxine?

A

synthetic T4

41
Q

What is liothyronine?

A

synthetic T3

42
Q

What is liotrix?

A

synthetic T4:T3 in 4:1 ratio

43
Q

What is thyroid USP?

A

desiccated pork thyroid gland

44
Q

What are the advantages of levothyroxine?

A

-minimal adverse effects
-adequate absorption
-long half-life
-inexpensive

45
Q

What is the dosing of levothyroxine?

A

start at 1.6 mcg/kg daily, check TSH in 6 weeks, may increase or decrease dose 12.5-25 mcg at this time
note: elderly or pt with cardiovascular disease start at 12.5-25mcg daily

46
Q

What are important counseling points for levothyroxine?

A

-take on an empty stomach (30 mins before breakfast or 4 hours after last meal)
-side effects of excessive dosing include heart failure, angina, MI
-do not switch between levothyroxine brands

47
Q

What are the monitoring parameters while taking levothyroxine?

A

TSH and T4 every 6 weeks until euthyroid then yearly

48
Q

What can decrease the absorption of levothyroxine?

A

-vitamins and minerals: iron, calcium, aluminum
-GI medications: fiber, bile acid sequesters, sucralfate, PPIs
-oral bisphosphonates

49
Q

What can increase the absorption of levothyroxine?

A

-antiepileptic medications: phenobarbital, phenytoin, carbamazepine
-sertraline
-estrogens

50
Q

When would liothyronine be used in therapy over levothyroxine?

A

if pt is unable to convert T4 -> T3

51
Q

What medication may suppress TSH?

A

-glucocorticoids
-dopamine
-bromocriptine
-somatostatin
-rexinoids

52
Q

What medications may inhibit T4/T3 synthesis or secretion?

A

-propylthiouracil
-methimazole
-lithium
-iodide
-amiodarone
-thalidomide

53
Q

What is myxedema coma?

A

decompensated hypothyroidism

54
Q

What are the signs and symptoms of myxedema coma?

A

hypothermia, advance stages of hypothyroid symptoms, altered mental status (delirium coma)

55
Q

What is the treatment for myxedema coma?

A

200-400 mcg IV levothyroxine, then 1.6mcg/kg daily reduced 20% for IV dosing, then may transition to oral therapy
note: mortality is %60-70

Therapeutics 1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions