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Pnt Exam 2 > Thyroid > Flashcards

Thyroid Flashcards

0
Q

Reference range for TSH

A

0.5 to 4.5 mIU/L

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1
Q

Drugs that inhibit TRH

A

Somatostatin and its analogs

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2
Q

Drugs that can inhibit TSH

A

Dopamine
Dopamine agonists
High levels of glucocorticoid

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3
Q

T4 other name

A

Thyroxine

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4
Q

Free t4 reference range

A

0.7 to 1.9 ng/dL

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5
Q

Half life of thyroxine

A

7-10 days

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6
Q

T3 other name

A

Triiodothyronine

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7
Q

Half life of triiodothyronine

A

24 hours

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8
Q

Hyperthyroidism diagnosis with tsh and t4

A

Tsh low

T4 elevated

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9
Q

Primary causes of hyperthyroidism

A 
Graves' disease
Toxic multinodular goiter
Toxic adenoma
Thyroid cancer
Iodine excess
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10
Q

Most common cause of hyperthyroidism

A

Graves’ disease

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11
Q

Secondary causes of hyperthyroidism

A

Tsh secreting pituitary tumors

Gestational thyrotoxicosis

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12
Q

Which sex is at greater risk for Graves’ disease

A

Female

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13
Q

Tshr-sab antibodies seen in what disease

A

Graves’ disease

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14
Q

Pathology of Graves’ disease

A

Antibodies increase tsh release causing increase t4 release

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15
Q

Visual findings with Graves’ disease

A

Opthalmopathy

Eye lid retraction

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16
Q

Skin signs and symptoms in Graves’ disease

A

Non pitting edema

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17
Q

Treatment options for Graves’ disease

A

Radioactive iodine
Ptu
Mmi
Surgery

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18
Q

Thyroid radiology scan also called

A

Radio iodine uptake RAIU

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19
Q

Thyroid radiology testing contraindicated in who

A

Pregnant or breastfeeding

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20
Q

Symptoms of hyperthyroidism

A 
Nervousness
Fatigue
Weakness
Increased perspiration 
Heat intolerance 
Tremor
Hyperactivity, irritability 
Palpitations
Increased appetite 
Weight loss
Menstrual disturbance
Diarrhea
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21
Q

Signs of hyperthyroidism

A 
Hyperactivity
Tachycardia
Atrial fibrillation 
Hyperreflexia
Warm skin
Moist skin
Goiter
Muscle weakness
Ophthalmopathy (graves disease)
Dermopathy (Graves' disease )
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22
Q

Non pharm therapy for hyperthyroidism

A 
Avoid strenuous exercise
Avoid caffeine 
Avoid Otc decongestant 
Avoid iodine supplement and contrast media
Smoking cessation
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23
Q

Who is indicated for thyroid surgery

A

Large goiters
Thyroid cancer
Unresponsive to therapy

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24
Q

Pharm treatment options for hyperthyroidism

A

Iodine
Radioactive iodine
Anti thyroid drugs
Beta blockers

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25
Q

Anti thyroid drugs used

A

Propylthiouracil

Methimazole

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26
Q

Beta blockers used for hyperthyroidism

A 
Metoprolol 
Atenolol 
Propranolol
Nadolol
Esmolol
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27
Q

How do beta blockers help in hyperthyroidism

A

Alleviate symptoms such as palpitations

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28
Q

When is esmolol used

A

Thyroid storm

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29
Q

Why are non selective beta blockers and nadolol used for hyperthyroidism

A

Reduces the conversion of t4 to t3

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30
Q

Anti thyroid drugs also called

A

Thionamides

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31
Q

Anti thyroid drugs not recommended in who

A

Low RAIU hyperthyroidism

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32
Q

Which anti thyroid drug is usually preferred

A

Methimazole

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33
Q

When is methimazole not preferred

A

Thyroid storm
First trimester
Methimazole allergy

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34
Q

Methimazole duration of treatment

A

Ideally 12-18 months

If euthyroid discontinue

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35
Q

Initial dose of methimazole

A

10-20 mg daily

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36
Q

Propylthiouracil duration of treatment

A

Short time frame

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37
Q

Propylthiouracil initial dose

A

50-150 mg TID

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38
Q

Side effects of anti thyroid drugs

A 
Hepatotoxic 
Agranulocytosis 
Arthralgia 
Skin rash 
GI upset
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39
Q

Boxed warning on propylthiouracil

A

Hepatotoxic

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40
Q

Define thyrotoxicosis

A

Any syndrome with increased thyroid hormones

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41
Q

Risk with hyperthyroidism in pregnancy

A

Increased risk of miscarriage

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42
Q

Pregnancy effect of hyperthyroidism

A

Worsens

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43
Q

Why use propylthiouracil in first trimester

A

Methimazole teratogenic in first trimester

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44
Q

Which anti thyroid drug to use while breastfeeding

A

Methimazole

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45
Q

Which hyperthyroidism treatment preferred in pediatric

A

Methimazole

Consider beta blockers

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46
Q

Avoid which two hyperthyroidism treatments during pregnancy

A

Radioactive iodine

Surgery if possible

47
Q

What is thyroid storm

A

Severe form of thyrotoxicosis

48
Q

Thyroid storm labs

A

Tsh undetectable

T4 and t3 elevated

49
Q

Signs and symptoms of thyroid storm

A 
High fever
Tachycardia 
Tachypnea 
Dehydration delirium 
Coma
GI disturbances
50
Q

Causes of thyroid storm in a hyperthyroidism patient

A

Trauma
Surgery
Radioactive iodine treatment
Sudden withdrawal from anti thyroid meds

51
Q

Treatment options for thyroid storm

A 
Supportive care
Steroids
Short acting beta blockers
Oral lodine
Anti thyroid drugs
52
Q

Iodide MOA

A

Inhibit thyroid hormone synthesis and release

53
Q

Iodide recommended when

A

Prior to thyroid surgery (graves)
Thyroid storm
Non thyroid patients post nuclear attack

54
Q

Name two iodide solutions

A

Potassium iodide

Lugols solution

55
Q

Recommended dose of iodide

A

120-400 mg per day

56
Q

Side effects of iodide treatment

A

Palpitations
Depression
Gynecomastia
Pustular skin pockets

57
Q

MOA of radioactive iodine

A

Thyroid cell necrosis over a few weeks

58
Q

When is radioactive iodine recommended

A

Graves’ disease
Toxic adenomas
Toxic multinodular goiters

59
Q

When is radioactive iodine contraindicated

A

Pregnancy

60
Q

Do you give radioactive iodine with high t4 levels

A

Pretreat with methimazole. Discontinue methimazole within 7 days of radioactive iodine

61
Q

Side effects of radioactive iodine

A

Hypothyroidism
Sialadentis
Can worsen graves orbitopathy

62
Q

What is sialadenitis

A

Salivary gland inflammation

63
Q

What is subclinical hyperthyroidism

A

Low tsh
Normal t4
Maybe symptoms

64
Q

How often to monitor tsh for subclinical hyperthyroidism without treatment

A

Every 6 months

65
Q

Treat which patients with subclinical hyperthyroidism

A

Tsh less than 0.1 mIU/L
Post menopausal women
Cardiovascular disease

66
Q

Why treat subclinical hyperthyroidism

A

Increase risk of bone density loss

Increase risk of cardiovascular events

67
Q

Screen who for hyperthyroidism

A

High risk

Women over 50

68
Q

Which individuals are at high risk for hyperthyroidism

A

Presence of nodular goiters
Concurrent endocrine disorders
Concurrent medications
Concurrent medical conditions

69
Q

Which medications cause high risk of hyperthyroidism

A 
Amiodarone
Alpha interferon 
Lithium
Interleukin 2 
Iodide contrast
70
Q

Which medical conditions cause high risk of hyperthyroidism

A

Osteoporosis
Atrial fibrillation
Supra ventricular tachycardia

71
Q

Hypothyroidism lab findings

A

High tsh

Low t4

72
Q

Causes of hypothyroidism

A 
Primary gland failure
Insufficient gland stimulation by hypothalamus
Autoimmune thyroid disease
Iatrogenic causes
Drug causes
Disorder causes
73
Q

What causes primary gland failure

A

Hashimoto disease
Iodine deficiency
Congenital abnormalities

74
Q

What are iatrogenic causes of hypothyroidism

A

Post thyroid surgery

Radioactive iodine treatment

75
Q

Which drugs cause hypothyroidism

A 
Lithium
Amiodarone
Interferon alpha
Interleukin 2 
Ethionamide
Sulfonylurea 
Valproic acid
Tyrosine kinase inhibitors
76
Q

Name a disorder that can cause hypothyroidism

A

Postpartum thyroiditis

77
Q

Who gets screened for hypothyroidism

A

Only high risk patients

78
Q

Who is high risk for hypothyroidism

A 
History or first degree relative with autoimmune
Radioactive iodine therapy
Head and neck radiation
Presence of a goiter
Family history of a goiter
Drugs that affect thyroid
Psych disorders
79
Q

Who is at higher risk of hypothyroidism wig interferon alpha

A

Asians

Thyroid antibodies

80
Q

How does lithium cause hypothyroidism

A

Inhibits thyroid hormone secretion and synthesis

81
Q

How does amiodarone cause hypothyroidism

A

Blocks conversion of t4 to t3

Decreases t3 receptor binding

82
Q

Effects of amiodarone on thyroid labs

A

Decrease t3
Increase t4
Increase tsh

83
Q

Symptoms of hypothyroidism

A 
Fatigue
Lethargy
Mental impairment
Depression 
Cold intolerance
Dry skin
Weight gain
Decreased perspiration
Menstrual disturbances
Hair thinning or loss
Muscle weakness
Constipation
84
Q

Signs of hypothyroidism

A 
Slow speech
Hoarseness
Bradycardia 
Delayed reflexes 
Nonpitting edema 
Diastolic hypertension
Elevated c reactive protein 
Increased creatinine kinase
Increased triglycerides
Increased ldl
Hypothermia
85
Q

Treatment options for hypothyroidism

A

Levothyroxine
Liothyronine
Dessicated thyroid
Liotrix

86
Q

Levothyroxine brand name

A

Synthroid

Levoxyl

87
Q

Levothyroxine contains which thyroid hormones

A

T4

88
Q

Gold standard for hypothyroidism

A

Levothyroxine

89
Q

Levothyroxine typical dose

A

1-1.6 mcg/kg/day

90
Q

Liothyronine brand name

A

Cytomel

91
Q

Liothyronine thyroid hormones

A

T3

92
Q

Dessicated thyroid brand name

A

Armour thyroid

93
Q

Desiccated thyroid contains what thyroid hormones

A

T4 and t3

94
Q

Liotrix brand name

A

Thyrolar

95
Q

Liotrix thyroid hormones

A

T4 and t3 in a 4:1 ratio

96
Q

When to check thyroid labs if brand and generic are switched

A

6 weeks

97
Q

Dose of levothyroxine in patients less than 65 with no cardiovascular disease

A

1.6 mcg/kg/day

98
Q

Levothyroxine dose in persons over 75

A

1mcg/kg/day

Typical starting dose 25-50mcg

99
Q

When to check tsh after starting levothyroxine

A

4-8 weeks

100
Q

Separate levothyroxine how with calcium, iron, or prenatals

A

2 hours before or 6 hours after

101
Q

Monitoring for levothyroxine

A

Tsh every 6-12 months with evaluations of symptoms

102
Q

Hypothyroidism to euthyroid warfarin effects

A

Decrease dose as become euthyroid

103
Q

Starting dose of levothyroxine in elderly with ischemic heart disease

A

12.5-50 mcg

104
Q

After what age do pediatrics get adult doses of levothyroxine

A

12 years

105
Q

Pregnancys effect on thyroid hormone

A

Increase demand

106
Q

Give what to patients on levothyroxine with normal labs but symptoms

A

T3/t4 combination

107
Q

Possible cause of symptoms of hypothyroidism on treatment with normal labs

A

Type 2 deiodinase polymorphism

108
Q

Triggers of myxedema coma in long standing hypothyroidism

A

Trauma
Infection
Stroke
Hypnotics or opiates

109
Q

Signs or symptoms of myxedema coma

A

Cns depression
Respiratory depression
Cardiac complications

110
Q

Treatment options for myxedema coma

A

Levothyroxine bolus Iv
Glucocorticoid
Combination t4/t3

111
Q

Lab findings of subclinical hypothyroid

A

Elevated tsh (4.5-10)
Normal t4
Maybe symptoms

112
Q

Treat who with subclinical hypothyroidism

A 
Tsh greater than 10
Elevated antibody levels
Signs and symptoms
Pregnant
Tsh 5-10
113
Q

Dangers of subclinical hypothyroidism

A

Increased cardiac mortality
Increased ldl
Neuropsychiatric signs
Decreased exercise tolerance

114
Q

Hypothyroidism is linked to what other diseases

A 
High cholesterol 
Increased vascular resistance 
Decreased cardiac output
Increased diastolic blood pressure 
Dementia like state
Increased risk of miscarriage

Pnt Exam 2 (11 decks)

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