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Sophomore - Pharm test 3 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Thyroid stimulating hormone - stimulates the thyroid to do what?

A

Iodinize thyroglobulin and produce thyroxine (T4) and triiodothyronine (T3)

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2
Q

What does thyroid peroxidase do?

A

Oxidizes iodide to form iodine atoms which are then added onto thyroglobulin to produce thyroid hormones

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3
Q

What percentage of thyroid hormone secreted by the thyroid is T4?

A

80%

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4
Q

What percentage of thyroid hormone secreted by the thyroid is T3?

A

20%

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5
Q

What is the primary extra-thyroidal site of T3 production?

A

The liver

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6
Q

Thyroid effect on the brain?

A

Promote normal brain development

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7
Q

Thyroid effect on bones?

A

Promote normal growth and skeletal development

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8
Q

Thyroid effect on the heart?

A

Increases sympathetic response (increased B-receptors)

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9
Q

Thyroid effect on lungs?

A

Increased ventilation

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10
Q

Thyroid effect on kidneys?

A

Overall increase in renal function

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11
Q

Thyroid effect on overall metabolism?

A

Increased rate of carbohydrate consumption

Increased body temp

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12
Q

Primary hypothyroidism - describe?

A

90% of all cases of hypothyroidism are primary

Problem is malfunctioning thyroid

Increased TSH (Hellooooo, McFly!!)

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13
Q

Primary causes of hypothyroidisim - name three

A
  1. Hashimoto
  2. Surgery or radiation
  3. Iodine deficiency
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14
Q

What is going wrong in Hashimoto’s Disease?

A

Autoantibodies target thyroid peroxidase, resulting in decreased T3/T4 production

Hypothyroid disease

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15
Q

Secondary hypothyroidism - describe:

A

Hypothalamus or pituitary insufficiency (lack of TRH or TSH)

Thyroid gland itself is fine

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16
Q

Hypothyroidism - S/S?

A 
Intolerance to cold
Facial/eyelid edema
Fatigue
Anorexia
Brittle nails and hair
Menstrual disturbances
Lethargy
Dry skin
Constipation
Muscle aches
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17
Q

A neck goiter would be seen in…?

A

Iodine deficiency hypothyroidism

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18
Q

What is cretinism?

A

Severely stunted mental and physical retardation due to sustained congenital hypothyroidism

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19
Q

What is the drug of choice for treatment of primary hypothyroidism?

A

Levothyroxine (Synthroid)

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20
Q

Monitoring for thyroid replacement therapy?

A

Baseline TSH and FT4

Every 6 to 8 weeks until normal

Every 6 to 12 months if controlled

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21
Q

What type of drug is Levothyroxine?

A

Synthetic T4

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22
Q

Dessicated thyroid - problems?

A

Animal source

Greatest risk of hypersensitivity

Varied potency

Mad cow disease risk

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23
Q

Levothyroxine - note regarding older adults with cardiac disease?

A

They should start on a lower dose (25mcg/day)

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24
Q

Liothyronine - MOA?

A

Synthetic T3

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25
Q

Liothyronine - notable for..?

A

Good option for patients who cannot convert T4 to T3

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26
Q

Liotrix - MOA?

A

T4/T3 4:1 ratio (mimic the body’s natural balance)

Remember LioTRIX is a MIX of T4 and T3

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27
Q

Myxedema coma - describe:

A

The end state of untreated hypothyroidism

Loss of brain function

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28
Q

Myxedema coma - tx?

A

Levothyroxine

Hydrocortisone (until adrenal suppression can be rules out)

29
Q

Thyrotoxicosis - describe:

A

Condition caused by overactive thyroid leading to too much thyroid hormone in the body

30
Q

Hyperthyroidism - values for TSH and FT4?

A

Low TSH (pituitary saying “stop making it!”)

High FT4 (thyroid making too much)

31
Q

Thyroid storm - describe:

A

Decompensated form of thyrotoxicosis

Can be fatal

32
Q

What is the most common cause of hyperthyroidism?

A

Graves Disease (60-80% of cases)

33
Q

Describe Graves Disease:

A

Autoimmune disorder

Autoantibodies that mimic TSH stimulate T4/T3 production in the thyroid

34
Q

What is Plummer’s Disease?

A

Excessive thyroid secretion from autonomous hyperfunctioning nodules

35
Q

Hyperthyroidism - S/S?

A 
Hyperthermia
Exopthalmos
Facial flushing
Tachycardia
Hypertension
Muscle wasting
Tremors
Diarrhea

Older patients: anorexia, confusion, constipation

36
Q

What is the treatment of choice for non-pregnant patients with Graves Disease, multinodular goiter, or toxic ademona?

A

Radioactive iodine

37
Q

What is a common unintended effect of radioactive iodine?

A

Patients become hypothyroid (then we can just give synthroid)

38
Q

Contraindication for radioactive iodine?

A

Pregnancy

39
Q

Treatment of choice for severe hyperthyroidism?

A

Partial or total thyroidectomy

40
Q

Thioamide - MOA?

A

Inhibits thyroid perioxidase, blocking iodination of thyroid hormones

May block T4-T3 conversion in the periphery, as well

Takes several weeks to work

41
Q

What is the preferred agent for pharmacologic tx of hyperthyroid?

A

Methimazole (Tapazole)

42
Q

Methimazole - pregnancy category?

A

D

43
Q

Propythiouracil (PTU) - use?

A

Tx of Hyperthyroid

Drug of choice for pregnancy, nursing, and thyroid storm

44
Q

Thioamides (PTU and methimazole) - Black box warning?

A

Severe liver injury and acute liver failure

45
Q

Thioamides - AE’s?

A 
Jaundice
Agranulocytosis
Leukopenia
Arthralgia (lupus-like symptoms)
Rash
46
Q

Which thioamide uses once daily dosing?

A

Methimazole

47
Q

Which thioamide must be dosed three times a day?

A

Propylthiouracil (PTU)

48
Q

Iodides - MOA?

A

Temporary inhibition of thyroid hormone synthesis (acute) by flooding the thyroid with iodide

Reduces thyroid gland’s vascularity and size

49
Q

Iodides - clinical use?

A

Pre-op thyroidectomy

Toxic adenoma or toxic nodular goiter

50
Q

Iodide - drug interactions?

A

Must discontinue anti-thyroid meds (methimazole, PTU) at least 3-4 days prior to administration of iodide

51
Q

Radioactive iodine - what must you check before administration?

A

If the patient is pregnant

52
Q

Which procedure results in a 25-yr 80% incidence of permanent hypothyroidism?

A

Administration of Radioactive iodine

53
Q

Effects of lithium with respect to radioiodine?

A

Lithium may prolong the retention of radioiodine and increase its efficacy

54
Q

Non-selective beta blockers - use in hyperthyroidism?

A

Control the sympathetic symptoms of thyroiditis or thyroid storm

55
Q

What medicine has the most evidence of use in treatment of thyrotoxicosis?

A

Propranolol

56
Q

Which medicine is given in the ICU for thyroid storm?

A

Esmolol (IV)

57
Q

Which two beta blockers also inhibit the peripheral conversion of T4 to T3?

A

Propranolol and Nadolol

58
Q

Metoprolol - use in hyperthyroidism?

A

Not as common because it is specific to B1 (non-specific beta blockers are preferred)

59
Q

If B-blockers are contraindicated in your hyperthyroid patient, what could you use to control tachycardia?

A

Verapamil or diltiazem

60
Q

What is thyrotoxicosis factitia?

A

Refers to any state characterized by thyroid hormone excess, including ingestion of excess thyroid hormone and THYROIDITIS

61
Q

Precipitating causes of thyroid storm?

A

Trauma, infection, antithyroid agent withdrawal

62
Q

Thyroid storm - presentation?

A

Tachycardia, tachypnea, N/V, dehydration, delirium

63
Q

Therapeutic management of thyroid storm - how many therapies involved?

A

6

64
Q

First step of thyroid storm treatment?

A

Suppress new hormone synthesis (PTU, methimazole)

65
Q

Second step in thyroid storm treatment?

A

Block the release of thyroid hormone (iodide solution - rapidly blocks release of pre-formed thyroid hormone)

66
Q

Third step in thyroid storm treatment?

A

Antiadrenergic therapy (symptom control)

Propranolol (most common) or Esmolol

67
Q

Fourth step of thyroid storm management?

A

Administration of Acetaminophen

Lowers fever and stabilizes BP

68
Q

Fifth step in thyroid storm management

A

Corticosteroid therapy

Reduces T4 to T3 conversion

69
Q

Sixth step in thyroid storm management?

A

Bile acid sequestrants

Decrease recycling of existing thyroid hormone

Sophomore - Pharm test 3 (7 decks)

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