Thyroid

Question 1

what is the function of the thyroid hormone

Answer 1

growth, development, function, maintenance, metabolism, body temp, heart rate

Question 2

what are 3 hyperthyroid diseases

Answer 2

Grave’s disease
Muti-nodular toxic goiter (plummers disease)
Thyrotoxicosis

Question 3

what are 2 types of primary hypothyroism

Answer 3

hasimotos thyroiditis

Iatrogenic

Question 4

what are secondary causes of hypothyrodism

Answer 4

pituitarty disease

hypothalamic disease

Question 5

what drugs decrease secretion of TSH

Answer 5

dopamine
glucocorticoids
octreotide

Question 6

what drugs decrease thyroid hormone secretion

Answer 6

lithium
Iodine and Iodine preparations
Radiocontrast dyes
amiodarone

Question 7

hyperthyroid epidemiology

Answer 7

between 40-60

more common in women

Question 8

what is the treatment for hyperthyroidism

Answer 8

anti-thyroid meds
radio active iodine
thyroidectomy
symptomatic treatment
beta-blockers

Question 9

what are anti-thyroid medications

Answer 9

methimazole-1st line

propylthiouracil (PTU)-thyroid storm 1st trimester

Question 10

what is drug of choice for most patients with hyperthyroidism

Answer 10

methimazole

Question 11

when is PTU best used for

Answer 11

pregnancy

thyroid storm

Question 12

what are predictors of remission

Answer 12

small goiter
mild disease
low or neg thyroreceptor antibody titer

Question 13

how do thioamides work

Answer 13

inhibit thyroid hormone synthesis

Question 14

how does PTU work

Answer 14

inhibits peripheral T4-T3 conversion with in hours of dosin

Question 15

which of the thioamides is compatible with breast feeding

Answer 15

methimazole

Question 16

what are some serious side affects with thioamides

Answer 16

agranulocytosis

hepatotoxicity

Question 17

how do iodides work

Answer 17

inhibit thyroid hormone release
decrease thyroid hormone synthesis
decrease gland vascularity

Question 18

how are iodides used in thyroid disease

Answer 18

reduce vascularity prior to thyroid surgery
prepare pts with graves disease for surgery
decreased thyroiodine accumulation in thyrotixic crisis
prevent thyroid uptake of radioactiv iodine

Question 19

what are some iodide products

Answer 19

saturated solution SSKI

Lugols

Question 20

When to use iodide products in intitial dosing

Answer 20

50-500mg in water or juice
10-14 days prior to surgery
as adjunct to RAI

Question 21

what are adverse effects of iodide drugs

Answer 21

rash, GI upset 
paresthesia, immune rxn
salivary gland swelling
burning throat
metallic taste
sore teeth or gums
cold symptoms

Question 22

when is lithium used in treatment

Answer 22

adjunct to thoamides

decreased radioactive iodine does to cure graves disease

Question 23

what are adverse effects with Lithium

Answer 23

tremors, polyuria, renal failure, seizure, arrhythmia, bradycardia, suicide
DO NOT USE

Question 24

when are beta blockers used

Answer 24

symptomatic treatment of palpitations, tachycardia, tremor, heat intolerance
Thyrotoxicosis
preoperatively adjunct to potassium iodide, radioactive iodine or antithyroid drugs for graves disease
thyroid storm
thyroiditis

Question 25

when is radioactive iodine contraindicated

Answer 25

pregnancy lactation thyroid cancer antithyroid meds

Question 26

when do you used radioactive iodine

Answer 26

surgical removal of body tissue for grave disease women planning pregnancy greater than 4-6 months in future patients with increased surgical risk prior to neck surgery

Question 27

what are the benefits of radioactive iodine

Answer 27

well tolerated | low risk of thyroid storm

Question 28

what are side effects of radioactive iodine

Answer 28

dysphagia | thyroid tenderness

Question 29

what causes thyroid storm

Answer 29

stress from surgery anesthesia, thyroid manipulation in patients abrupt d/c of antithyroid meds

Question 30

what are symptoms of thyroid storm

Answer 30

``` high fever 103> tachchardia A-fib CHF Tachypnea Dehydration N/V coma ```

Question 31

what is the treatment for thyroid stome

Answer 31

``` identify cause and treat cause anti-thyroid meds (give before iodine) inorganic iodine supportive care beta blockade ```

Question 32

when would you use esmolol in a patient

Answer 32

in heart failure or patients who can not take per oral meds

Question 33

what is the cause of subclinical hyperthyroidism

Answer 33

low TSH | amiodarone induced

Question 34

how do you treat subclinical hyperthyroidism

Answer 34

initiante TSH

Question 35

what causes hypothyroidism

Answer 35

anti-thyroid meds, PTU, methimazole

Question 36

what are some complications with subclinical hypothyroidism

Answer 36

TSH above normal levels myxedema (associated with coronary artery disease) myxedema coma Treat w/ TSH>10mIU/L

Question 37

what are signs of hypothyroidism

Answer 37

dry skin, cold intolerance, weight gain, constipation, weakness, lethargy depression

Question 38

what are signs of hypothyroidism

Answer 38

``` coarse skin and hair cold or dry skin periorbital puffiness bradycardia slow hoarse speech ```

Question 39

what are laboratory findings for hypothyroidism

Answer 39

increased cholesterol, LDH, AST, ALT,CPK

Question 40

what are thyroid supplement options

Answer 40

desiccated thyroid and thyroglobulin levothyroxine liothyronine liotrix

Question 41

what is first line for hypothyroidism

Answer 41

synthetic L-thyroxine (synthroid, levoxyl)

Question 42

what are the pharmocokinetics like fore the l-thyroxine

Answer 42

``` 40-80% bioavailibility better with fasting decreases with fiber 99%protein bound 80% hepatic metabolism ```

Question 43

what decreases absorption of l-thyroxine

Answer 43

cholestyramine calcium carb sucralfate soybean fiber food

Question 44

how should levothyroxine be given orally, IV, feeding tube

Answer 44

30min prior to breakfast 4 hours after last meal use 70-50% or oral dose for IV create water suspension wait at least 1 hr to restart feeding

Question 45

What are the disadvantages of Liothyronine T3

Answer 45

higher cardiac effects more expensive hard to monitor lab values

Question 46

what are the disadvantages of liotrix

Answer 46

high cost, lack of therapeutic rationale

Question 47

What is euthyroid essential for

Answer 47

normal neurocognitive development in fetus

Question 48

What should you do with women who are being treated for hypothyroidism?

Answer 48

increased rate of metabolsims for thyroid hormone/transplacental transport so dose of levothyroxine should be increased by 30%

Question 49

what percent of pts attain remission after initial therapy

Answer 49

20-30%

Question 50

how long should treatment be continued for?

Answer 50

12-18 months then taper or d/c if euthyroid at that time

Question 51

when should a person stop anithyroid meds

Answer 51

when they have normal TSH, FT4, T3 1 year after

Question 52

when should a patient who is in remission follow up

Answer 52

retest every 1-3 months for 6-12 months after initial remission and d/c methimazole

Question 53

when should you start monitoring FT4 level

Answer 53

4 months after start of therapy | then every 4-8 weeks until normalized then every 2-3 months

Question 54

Which medication of the thiomaides do you need to do LFTS on

Answer 54

PTU with sign of liver damage, jaundice, joint pain, ab pain, light stool, dark urine

Question 55

what is the half life of RAI

Answer 55

5 days