Thyroid

Question 1

Medications that cause hypothyroidism

Answer 1

Lithium, amiodarone, interferon, and others

Question 2

Hypothyroidism symptoms

Answer 2

Memory loss
Obesity
Menorrhagia
Slowness
Skin and hair dryness
Onset gradual
Tiredness
Intolerance to cold
Energy levels fall
Depression/delayed relation phase of all reflexes (especially patellar, Achilles)

Question 3

Signs and symptoms of hyperthyroidism

Answer 3

Sweating, weight loss, emotional liability, mind racing, memory alteration, appetite increased but losing weight, tremors/tachycardia, intolerance of heat, irregular menstruation, irritability, nervousness, goiter, G.I. problems

• goiter non specific to hyper or hypo

Question 4

Most common hyperthyroid etiology

Answer 4

Graves’ disease

Autoimmune in nature. Also presents with exophthalmus and goiter

Question 5

Toxic adenine

Answer 5

Benign non-malignant, metabolically active thyroid nodule. Typically hyperthyroid presentation with palpable unilateral thyroid mass but without exophthalmus.

Causes sym of hyperthyroidism

For ex: US, biopsy or thyroid scan.

Question 6

Thyroiditis

Answer 6

Ideology viral or autoimmune, postpartum, drug-induced origin. Usually transient and reversible. Will have tenderness to thyroid. Typically mild hyperthyroidism presentation without exophthalmus.

Question 7

Medications that cause hyperthyroidism

Answer 7

Amiodarone (also causes hypo), interferon (also causes hypo)

Also mild symptoms without exophthalmus

Question 8

Prescribing levothyroxine or Synthroid.

Answer 8

Using IDEAL body weight in obesity, actual body weight and healthy or under weight.

1. 6 mcg per kilogram per day in adults
2. 0 mcg per kilogram per day in elderly
3. 6 mcg per kilogram per day in children

Check tsh after 8 weeks of therapy

Take with empty stomach, at the same time every day.

Should not be taken within two hours of cat ions such as calcium iron aluminum magnesium or others due to chelation (binding) effect with reduce drug absorption.

Question 9

Hyperthyroidism treatment

Answer 9

Symptomatic treatment at time of diagnosis. Non specific beta blocker (Propanolol, nadolol) - counteract tachycardia and tremor.

Hyperthyroidism tx:

PO methimazole (Tapazole) or PTU to reduce thyroxine production to become euthyroid.

Once you thyroid from anti-thyroid medications, radioactive iodine is used. Therapeutic goal is thyroid ablation with resulting in hypothyroidism.

Pt will need to be on levothyroxine for life.

Question 10

Most common cause of asymptomatic hypercalcemia

Answer 10

Primary hyperparathyroidism