Thyroid

Question 1

T4 is converted to T3 to be activated - true or false?

Answer 1

TRUE

Question 2

Oestrogens combined with levothyroxine can cause increase in the amount of iodine thyroglobulin binding? True or false?

Answer 2

TRUE

This is how the thyroid is stored

Question 3

Hypothyroidism is…?

Answer 3

When there are low amounts of the thyroid hormone.

LOW TSH and LOW T3

Question 4

Levothyroxine is a synthetic form of T3? True or false?

Answer 4

TRUE

Question 5

When should monitoring with levothyroxine be done?

Answer 5

In the first 4-6 weeks

Too high levo = low TSH

Too low levo = Hight TSH

Question 6

Levothyroxine doses should be tittered up slowly true of false?

Answer 6

true

Prevents thyroid storm or severe side effects of too much thyroid hormone I.e. sweating/increased HR

Question 7

Once levothyroxine dose has been established, how often should levels be monitored?

Answer 7

Levels should be monitored annually once stable dose is found

Question 8

What things can affect levothyroxine absorption?

Answer 8

• Taking levothyroxine with food
• Enzyme inducers will increase metabolism
• Taking with other medications = May form salts in the gut I.e. calcium/ferrous sulfate
• Oestrogens can cause increase in TBG levels (contraceptives/HRT)

Question 9

Counselling for patient taking levo?

Answer 9

Take on an empty stomach 30-60 minutes before food

Question 10

Liothyronine is a synthetic version of T3 or T4?

Answer 10

T3.

Is therefore more potent than levo

Question 11

What is the conversion between liothyronine and levo?

Answer 11

20 mcg = 100 mcg

Lio = levo

Question 12

Caution in what types of patients with liothyronine ?

Answer 12

Cardiovascular patients

Elderly

Question 13

Licensed beta-blockers for beta-adrenergic symptoms associated with hyperthyroidism?

Answer 13

Nadolol
Metoprolol
Propranolol

Question 14

Examples of thionamides?

Answer 14

Carbimazole

Propylthiouracil

Question 15

What can carbimazole be used for?

Answer 15

Treatment of:

• Long term hyperthyroidism
• Hyperthyroidism in pregnancy
• Graves’ disease remission and treatment
• Non toxic goitre (multi nodular)

Question 16

Thionamides MOA?

Answer 16

Impair the formation of iodine TBG

And propylthiouracil stops conversion of T4 to T3

Question 17

Is there a small chance of birth defects with thionamides?

Answer 17

Yes

Question 18

Alternative treatment to hyperthyroidism in pregnancy

Answer 18

Radioactive iodine treatment for at least 6 months before conception

Question 19

Side effects of thionamides/carbimazole

Answer 19

Agranulocytosis and neutropenia

Question 20

When are the blood side effects of carbimazole likely to show?

Answer 20

Firs three months of use

Need for FBC and monitoring during this time

Question 21

History of blood disorders mean that carbimazole is contra-indicated. True/false

Answer 21

True

Question 22

Alongside blood disorders what should be recognised as potential side effect with carbizmazole?

Answer 22

Liver disease

Patients should be able to spot jaundice and so on

Question 23

IV hydrocortisone and oral prednisolone can help to do what?

Answer 23

Bring down levels of T3