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PHARM 3 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What are the 3 treatment goals for Hypothyroidism?

A
  1. Provide exogenous thyroid hormone
  2. Normalize TSH and FT4 level
    TSH - 0.4–4.2 microIU/dL
    FT4 - 0.8 – 2.3 ng/dl
    FT3 - 1.4 – 4.2 ng/dL
  3. Minimize symptoms and long term consequences
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2
Q

In general, what is the drug of choice for a hypothyroid patient?

A

Levothyroxine

Syntheric T4

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3
Q

List 3 dosing facts for Thyroid replacement medication.

What do we monitor with these?

A

Dose : Adjust q 6 Weeks. Take in AM or bedtime. Take on EMPTY STOMACH

Monitor- TSH and FT4 @ baseline and q6-8 weeks until normal… then Q 6-12 months.

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4
Q

Describe some of the adverse effects of Thyroid Replacement medications

A

Excessive thyroid S/Sx:

Worsening CARDIAC function and decreased BONE Density

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5
Q

Describe the four thyroid replacement drugs and associate them with their type

A

Liothyronine – Synthetic T3

Levothyroxine – Synthetic T4

Liotrix – Synth T3:T4 @ 4:1 ratio

Dessiccated thyroid – Animal sources

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6
Q

Give bolded information for each of the four Thyroid Replacement drugs from the slideshow

A

Liothryonine – Requires MULTIPLE daily doses, nich for pts who cant convert t4 to t3.

Levothyroxine – drug of choice, long half life (7 days)

Liotrix – no clinical advantage

Dessicated thyroid AKA Thyroid USP – Highest risk of hypersensitivity, concentration varies.

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7
Q

What is a Myxedema coma? How do we treat this?

A

Myxedema coma = acute complication/end state of untreated hypothyroidism. Loss of brain function presented as weakness, stupor, hypothermia, hypoventilation, hypoglycemia, hyponatremia, shock and death.

Tx: 1. Levothyroxine daily and 2. Hydrocortisone Q8hrs until coexisting adrenal suppression ruled out.

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8
Q

What causes Thyrotoxic crisis (Thyrotoxicosis)

A

Excessive quantities of thyroid hormone

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9
Q

What is a Thyroid Storm?

A

Life threat emergency - Decompensated THYROTOXICOSIS, fever, tachycardia/pnea, dehydration, delirum, coma, n/v, diarrhea

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10
Q

Exopthalmos is commonly associated with what disorder?

A

Graves (50% of graves patients)

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11
Q

What is the treatment of choice for a NON-PREGNANT, patient over 21 with Grave’s, multinodular goiter or toxic adenoma?

A

Radioactive Iodine (ablation), most cost effective… Try pharmacology first

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12
Q

Who should not get Radioactive Iodine?

A

Graves patient with MODERATE or SEVERE EXOPTHALMOS

Pregnant or nursing female

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13
Q

If somebody has SEVERE hyperthyroid (>80gms), Is unwilling to take meds, or is pregnant, what is the treatment of choice?

A

Partial or total THYROIDECTOMY

Almost all (80-90%) will become hypothyroid

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14
Q

What patients should get Anti-thyroid pharmacotherapy for hyperthyroid?

A
  1. Pts with significant symptoms of mild disease/small goiters… likely to achieve remission after 1 year
  2. Pts who refuse ablative or surgical therapy
  3. Ablative or surgical therapy fails
  4. Limited life expectancy or MOD-SEVERE exopthalmos
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15
Q

What are some general timeline and relapse characteristics of Anti-Thyroid Pharmacotherapy?

A

Requires 12-18 months of tx

50% chance of relapse

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16
Q

Describe our four classes of Anti Thyroid medications (including ablative therapy)

A
  1. Thionamides - PTU/Methimazole block synth
  2. Iodides - Potassium Iodide blocks release
  3. Radioactive isotope - Sodium Iodide ablates gland
  4. Adrenergic blockers - B blockers control symptoms
17
Q

Describe the thioamide/thionamide class of drugs including specific meds, and MOA

A

Meds : Propythiouracil and Methimazole

MOA - inhibits THYROID PEROXIDASE = blocks iodination and synth of thyroid hormones (can also blcok t4-t3 conversion)

18
Q

Methimazole is the preferred agent in _________ disease unless in the _______ trimester of pregnancy

A

Grave’s disease

First

19
Q

Propythiouracil (A thioamide) is use for what patients?

A

First trimester
Thyroid storm
or adverse reactions to Methimazole

20
Q

Describe the efficacy and onset for thioamide drugs

A 
Slow onset (weeks) 3-8 for euthyroid... max effect 4-6 months. 
Remission rates of 20-30% (norm for 1 year after discontinue)
21
Q

What labs should be monitored with thioamide drugs? Why?

A

Baseline CBC w/ diff and LFTs with bili.

Watch for agranulocytosis and Jaundice

22
Q

Should a radioactive iodide and thioamide be given together?

A

No, discontinue thioamide at least 3-5 days before admin of radioactive iodide.

23
Q

Iodine therapy can ______ onset of thioamide therapy

A

delay

24
Q

What is the black box warning for Thioamides? What are other adverse effects?

A

Sever liver injury and acute liver failule.

Also causes jaundice, agranulocytosis (stop), leukopenia (OK), lupus like symtpoms (stop), rash (OK)

25
Q

Iodides acutely ______ hormonal secretion of thyroid within _________

A

Inhibit

Hours

26
Q

Is iodine a permanent solution to hyperthyroid?

A

No, it is temportary. It prevents the usage of iodine by THYROID PERIOXIDASE

27
Q

When the thyroid escapes iodide inhibition and has a surge of t3 and t4 release, what do we call this?

A

Escape from the Wolff-Chaikoff effect.

28
Q

Iodides ______ the thyroid gland’s vasculatiry, Increase ________, and decrease ______ prior to thyroidectomy

A

decrease

Firmness

size

29
Q

Why and when would we give a patient an Iodide?

A
  1. PREOP prep for thyrodectomy in graves
  2. Thyroid blocking to protect gland before RADIATION exposure
  3. Hyperthyroid pts w/ Toxic Adenoma or Toxic Nodular goiter
  4. Severe Hyperthyroidism or THYROID STORM
  5. Patient w/ Graves in region w/ IODINE Deficiency
30
Q

Discontinue all ____________ medications at least 3-4 days prior to sodium iodide admission

A

Anti-thyroid medication

Also, watch out for lithium

31
Q

How does a radioactive iodine work to ablate the thyroid?

A

Accumulates in the thyroid and emits beta and gamma rads. This destroys thyroid tissue. Takes 2-6 months. May need 2 doses

32
Q

What monitoring must we do with Radioactive iodine?

A

Neg preg test 48 hours prior

TSH and FT4 q 4-6 weeks

33
Q

What adverse effects are we worried about with radioactive iodine?

A

Hypothyroidism (permanent in 80% patients)

Hurts fetus/baby

Thyroid pain

34
Q

Do we like selective or non-selective Beta blockers for hyperthyroidism?

A

Non selective. Think Propranolol

35
Q

If Beta blockers are contraindicated but we need to relieve tachycardia from a hyperthyroid patient, what should we give?

A

Non-DHP calcium channel blockers –> Verapamil or Diltiazem

36
Q

Amioderone can cause what thyroid side effect?

A

Amiodarone induced Thyrotoxicosis.

37
Q

What is the fever cutoff for a thyroid storm?

A

103+

38
Q

Describe our 6 step management of thyroid storm

A
  1. Suppress NEW HORMONE synth*** - PTU or methimazole
  2. Block release of thyroid hormone - after 1 hour from step 1, give potassium iodide drops
  3. Antiadrenergic therapy - Propranolol or esmolol for asthma/diltiazem
  4. Acetaminophen - fever and bp stable
  5. Corticosteroid - hydrocortisone
  6. Bile acid sequestrant - no recycle TRH - Cholestyramine

PHARM 3 (4 decks)

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