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P&T P3 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Where thyroglobulin is stored

A

colloid

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2
Q

2 important TSH-inducible transcription factors

A

PAX-8, TTF-1

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3
Q

alpha subunits that TSH GPCR is coupled to

A

Galpha-s (normal) and Galpha-q (only at high TSH levels)

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4
Q

What is used to uptake iodide into follicular cells

A

Sodium-iodide symporter (NIS): 2Na for every 1 iodide

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5
Q

Enzyme that oxidizes iodide using H2O2 and is localized on the apical side of the thyrocyte (near the colloid) and also allows coupling of 2 tyrosine rings (oxidative condensation)

A

Thyroid peroxidase (TPO)

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6
Q

The predominant thyroid hormone in circulation

A

T4

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7
Q

The active form of thyroid hormone that has much higher affinity for thyroid receptor

A

T3

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8
Q

Enzymes that convert T4 to T3 within target cells

A

Deiodinases

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9
Q

Synthetic T4

A

levothyroxine

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10
Q

Synthetic T3

A

liothyronine

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11
Q

2 thionamides used to treat hyperthyroidism

A

methimazole, propylthiouracil

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12
Q

Target of thionamides

A

thyoid peroxidase, thus inhibiting iodination of thyroglobulin and coupling of MIT and DIT to generate T3 and T4

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13
Q

Additional mechanism of propylthiouracil besides targeting TPO

A

Inhibits D1 and D2, inhibiting peripheral conversion of T4 to T3

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14
Q

MOA of radioactive iodine

A

Uptake by NIS and concentrated in the colloid where it emits beta particles that destroy the follicle

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15
Q

Ionic inhibitor used for hyperthyroidism that competitively inhibits NIS

A

Perchlorate

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16
Q

Primary function of thyroid hormones

A

Maintain metabolism in the body

17
Q

Function of hypothalamus in thyroid regulation

A

Releases thyrotropin-releasing hormone (TRH)

18
Q

Function of the pituitary in thyroid regulation

A

releases thyrotropin, also known as thyroid-stimulating hormone (TSH)

19
Q

Normal TSH level

A

0.5 - 2.5 mcgU/mL

20
Q

Normal T4 levels

A

0.7-1.9 Ngo/mL

21
Q

autoimmune hypothyroidism

A

Hashimoto’s disease

22
Q

The precursor for thyroid hormones

A

Thyroglobulin (TG)

23
Q

Normal starting dose of levothyroxine for hypothyroidism

A

1-1.6 mcg/kg/day (use IBW for obesity)

24
Q

Starting levothyroxine dose for elderly and patients with CVD

A

25-50 mcg

25
Q

Reason why synthetic T4 (levothyroxine) is used over synthetic T3 (liothyronine)

A

half-life of T4 is 6-7 days, whereas T3 is only 2 days

26
Q

How often TSH/free T4 should be monitored in a pt with uncontrolled hypothyroidism

A

every 6-8 weeks

27
Q

How much should a levothyroxine dose be titrated by

A

10-20%

28
Q

How often TSH/free T4 should be checked in a patient with controlled hypothyroidism

A

annually or if symptoms

29
Q

Levothyroxine dose conversion from PO to IV

A

Give 1/2 of normal PO dose

30
Q

Dose of levothyroxine if a patient has subclinical hypothyroidism (TSH 5-10 mcgU/mL)

A

25-50 mcg/day

31
Q

Very advanced hypothyroidism with very high TSH linked to 60-70% mortality

A

myxedema coma

32
Q

Treatment of myxedema coma

A

IV levothyroxine and corticosteriods

33
Q

Autoimmune hyperthyroidism

A

Grave’s disease

34
Q

3 drugs that can cause hypothyroidism

A
  1. lithium
  2. amiodarone
  3. interferon-alpha
35
Q

BB that can be used for symptomatic relief of tachycardia associated with hyperthyroidism and also inhibits peripheral conversion of T4 to T3

A

Propranolol

36
Q

Thionamide that is preferred in pregnancy

A

Propylthiouracil

37
Q

Labs needed for thionamide monitoring

A
  1. TSH/fT4 every 4-6 weeks
  2. LFTs
  3. CBC (if reason such as cough or fever)
38
Q

3 parts of treatment for thyroid storm (severe thyrotoxicosis)

A
  1. IV BB and iodide
  2. Methimazole or PTU
  3. hydrocortisone

P&T P3 (10 decks)

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