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Pharmacology Exam #2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What are the three thyroid hormones?

A

Triiodothyronine (T3)
Tetraiodothyronine (T4, thyroxine)
Calcitonin

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2
Q

What is a Calcitonin?

A

A Ca+2 regulatory hormone- decreases plasma calcium concentration by incorporating it into the bone and increasing elimination in the kidneys

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3
Q

Which thyroid hormone is more potent?

A

Triiodothyronine (T3) is more potent than T4

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4
Q

Which hormone is inactive?

A

Reverse T3 (rT3)

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5
Q

Which hormone is active and how does it become this way?

A

T4 gets converted intracellularly to T3, which is the active hormone

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6
Q

What is released from the hypothalmus and causes the release of TSH?

A

TRH

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7
Q

What is released from the anterior pituitary and stimulates production of T3 and T4?

A

TSH

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8
Q

How does Iodide get transported into the thyroid follicle epithelial cells intially?

A

By the Na+/I- symporter in the basement membrane

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9
Q

What inhibits Iodide transportation by Na+/I-?

A

SCN, TcO4, ClO4

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10
Q

What transports Iodide in the apical membrane?

A

Pendrin- which is also found in the cochlea of the inner ear

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11
Q

What does Pendrin deficiency cause?

A

Deafness and Goiter (hypothyroidism) (Pendred’s Syndrome)

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12
Q

What converts Iodide into Iodine?

A

Thyroidal peroxidase

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13
Q

What is thyroidal peroxidase blocked by?

A

High Iodide levels and thioamide drugs

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14
Q

After converting Iodide into Iodine, Thyroidal peroxidase then does what?

A

Iodinates tyrosine residues in thyroglobulin to form mono-iodotyrosine (MIT) & di-iodotyrosine (DIT)

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15
Q

The process of Thyroidal peroxidase conversion of iodide to iodine, and tyrosine to MIT & DIT is called:

A

Iodide Organification

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16
Q

MIT and DIT combine and form what?

A

combination of T3 and two DIT, which then forms T4

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17
Q

T4 and T3 are released how?

A

By proteolytic cleavage of thyroglobulin and exocytosis.

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18
Q

High Iodide inhibits what?

A

Proteolysis of thryoglobulin, inhibiting T3/T4 release

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19
Q

What are T3 and T4 bound to in the plasma?

A

TBG

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20
Q

What removes the outer ring of Iodide and what does it form?

A

5’ deiodinase removes the ring and forms active T3 (3,5,3’ triiodothyronine)

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21
Q

Removal of the INNER ring of Iodide gives what?

A

inactive reverse T3

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22
Q

Hypothyroidism is marked by what?

A

Elevated TSH levels and low free T4 and T3

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23
Q

Hypothyroidism is cased by:

A

1) Hashimoto’s thyroiditis (autoimmune disease)
2) Congenital (cretinism in children)
3) Radiation
4) 131 Iodide
5) Thyroidectomy
6) Dis-hormogenesis
7) Drug Induced- Amiodarone, Ipodate
8) Iodine Deficiency

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24
Q

Hyperthyroidism is caused by:

A

1) Grave’s Disease (autoimmune)
2) Toxic uninodular goiter and multinodular goiter
3) Subacute thyroiditis
4) Thyroid Storm (acute)

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25
Q

List the thyroid preparations:

A

1) Synthetic

2) Animal Origin

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26
Q

Synthetic thyroid preparations of T4 are:

A

Levothyroxine (T4)- DOC**

  • generic
  • Synthroid
  • Levoxyl
  • Levo-T
  • Levothyroid
  • Levolet
  • Novothyrox
  • Unithroid
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27
Q

Synthetic thyroid preparations of T3 are:

A

Liothyronine (T3)

  • generic
  • Cytomel
  • Triostat
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28
Q

What drug has a combo of T4 & T3?

A

Thyrolar (Liotrix) (4:1 T4:T3)

29
Q

Animal origin prep’d thyroid:

A

Dessicated thyroid

  • generic
  • Armour Thyroid
  • Thyroid Strong
  • Thyrar
30
Q

Anti-thyroid agents are…

A 
Thioamides
Anion Inhibitors
Iodides
Iodinated contrast media
Radioactive Iodine
B-adrenoceptor blocking drug
31
Q

Examples of Thioamide anti-thyroid agents are:

A

Methimazole (Tapazole)
Propylthiouracil (generic)
Used for thyro-toxicosis

32
Q

Anti-thyroid agents are used for:

A

thyro-toxicosis

33
Q

What inhibits Iodide transport mechanism?

A

Anion inhibitors:

  • Perchlorate (ClO4 2-)
  • Pertechnate (TcO4 2-)
  • Thiocyanate (SCN-)
34
Q

Methimazole MOA:

A

inhibits Iodine organification

35
Q

Iodides are rarely…

A

used as sole therapy

36
Q

Examples of Iodinated contrast media anti-thyroid agents are:

A

Diatrizoate (Hypaque)

Iohexol (Omnipaque)

37
Q

What is useful in treating thyro-toxicosis by preventing conversion of T4 to T3?

A

Iodinated contrast media anti-thyroid agents:

  • Diatrizoate (Hypaque)
  • Iohexol (Omnipaque)
38
Q

Examples of Radioactive Iodine anti-thyroid agents are:

A

131 Iodine (radioiodine)

39
Q

131 Iodine is C/I’d in:

A

pregnancy and nursing mothers

40
Q

Examples of B-adrenoceptor blocking drug anti-thyroid agents are:

A

Metoprolol
Propranolol
Atenolol

41
Q

What is a goiter?

A

An enlarged thyroid gland

42
Q

What is used to treat HYPOthyroidism?

A

replacement therapy:

levothyroxine, liothyronine, dessicated thyroid

43
Q

What do you monitor when treating hypothyroidism?

A

TSH levels

44
Q

Elderly patients with CAD often develop:

A

Myxedema (severe hypothyroidism- swelling of the affected area)

45
Q

Thyroxine treatment in Elderly patients with CAD can cause

A

arrhythmia, MI, angina pectoris

46
Q

Myxedema coma is what?

A

And end stage untreated hypothyroidism and is a MEDICAL EMERGENCY that must be carefully managed in the ICU

47
Q

Hypothyroidism may result in:

A

anovulation

48
Q

Fetal brain development depends on:

A

maternal T4 that gets through the placenta, therefore hypothyroid in pregnant women must be carefully managed

49
Q

Subclinical hypothyroidism is what?

A

A high TSH with a normal thyroid hormone level

50
Q

Subclinical hypothyroidism requires what treatment?

A

T4 or monitored carefully

51
Q

What drugs can induce hypothyroidism?

A

Amiodarone (Iodide (I-) containing molecule)

52
Q

Hyperthyroidism is also known as:

A

thyrotoxicosis

53
Q

What is Grave’s Disease and it’s MOA?

A

autoimmune disease: autoantibodies bind TSH receptors in the thyroid and stimulate release of the thyroid hormone.

54
Q

How do you manage Grave’s Disease?

A

Anti-thyroid Drugs, surgical thyroidectomy, and treatment with Radioiodine (131 I)

55
Q

Anti-thyroid drug therapy is treatment with:

A

methimazole/ propylthiouracil

56
Q

Propylthiouracil vs. Methimazole:

A

Propylthiouracil is highly protein bound and less likely to cross the placenta- so could be used in pregnancy, whereas Methimazole cannont be used in pregnancy

57
Q

Radioiodine (131 I) does what?

A

It is a B emitter and gets concentrated in the thyroid and destroys the thyroid cells.

58
Q

When taking 131 I, what must be avoided?

A

Iodides, in order to maximize uptake of 131 I

59
Q

What hyperthyroidism treatments are C/I’d in Pregnancy?

A

Methimazole and 131 I

60
Q

Beta adrenergic therapy is used in hyperthyroidism as…

A

adjunct therapy

61
Q

Neonatal Grave’s Disease is caused by:

A

maternal anti-TSHR autoantibodies and is self-limiting (otherwise needs management)

62
Q

Amiodarone may cause…

A

hyperthyroidism

63
Q

Hyperthyroidism Type I is due to:

A

Increased levels of T3 and T4

64
Q

Hyperthyroidism Type I is treated with:

A

Thioamides

65
Q

Hyperthyroidism Type II is treated with:

A

Glucocorticoids

66
Q

Hyperthyroidism Type II is due to:

A

inflammatory damage to gland causing increased release of hormone

67
Q

Nontoxic goiters are caused by:

A

iodine deficiency

68
Q

How do you treat nontoxic goiters?

A

Iodine supplements (potassium iodide KI)

69
Q

Thyroid neoplasm (tumor) is treated:

A

Radioactive treatment following thyroidectomy and lifelong treatment with levothyroxine

Pharmacology Exam #2 (4 decks)

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