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Pharma Tbilisi > Thyroid And Anti-thyroid > Flashcards

Thyroid And Anti-thyroid Flashcards

1
Q

Name the anti-thyroid medications

A

Propylthiouracil

Methimazole

Propranolol

Iodide (lugol solution)

Radioactive iodine

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2
Q

How does propylthiouracil work?

A

Inhibits TPO: less thyroid hormones produced by gland

Inhibits 5’-deiodinase: less T4 to T3 conversion peripherally

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3
Q

How does methimazole work?

A

Inhibits TPO: less thyroid hormones made by gland

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4
Q

How does propranolol work?

A

Blocks catecholamine action

Mildly inhibits 5’-deiodinase: less T4 to T3 conversion peripherally

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5
Q

Sise effect of amiodarone?

A

Can cause hypothyroidism via excess iodine (wolff-chaikoff effect)

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6
Q

How does amiodarone affect TSH?

A

Mimics T4 therefore inhibits 5’-deiodinase

Therefore less T3

Therefore TSH rises

Later it normalises

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7
Q

Effect of radioactive iodine?

A

In low doses it can be used for imaging but in high doses it destroys thyroid tissue

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8
Q

What happens if thyroid binding globulin is low?

A

Thyroid hormones are not very soluble so without thyroid binding globulin there will not be much T4 in circulation available to tissues

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9
Q

What can effect TBG levels?

A

Pregnancy raises it

Liver failure reduces it

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10
Q

How does the body respond when TBG increases?

A

More TBG

More bound T4

Less free T4

More TSH

More total T4

More free T4 (back to normal)

TSH back to normal

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11
Q

What are the ratios of thyroid hormones in the blood?

A

T4>T3

Total T4&raquo_space; Free T4

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12
Q

Drugs used in hypothyroidism?

A

Levothyroxine (T4)

Liothyronine (T3)

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13
Q

What causes myxedema?

A

Hypothyroidism

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14
Q

Effect of iodine deficiency?

A

Hypothyroidism

Goiter

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15
Q

Effect of excess iodine?

A

Hypothyroidism
Wolff-Chaikoff

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16
Q

Effect of iodine load?

A

Hyperthyroidism

17
Q

What is the Wolff-Chaikoff effect?

A

A protective mechanism for the gland

Excess iodine inhibits organification and therefore hormone production

Chronic excess iodine can cause goiter

18
Q

What is reverse T3?

A

Isomer of T3 also derived from T4

19
Q

Importance of reverse T3?

A

In euthyroid sick syndrome

In critically I’ll patients there is low TSH, T4 and T3

This resembles central hypothyroidism

However in this case rT3 is also high due to impaired clearance

This excludes central hypothyroidism

20
Q

Why is methimazole preferred over propylthiouracil to decrease thyroid hormones synthesis?

A

Longer half life

Less side effects

21
Q

How do we treat exophthalmos in hyperthyroidism?

A

Steroids

Radiation

Surgery

22
Q

What does it mean if the thyroid does not take up radioactive iodine much?

A

Chance of cancer

23
Q

How does oral lugol’s solution block thyroid hormones release?

A

Mechanism not yet understood

Pharma Tbilisi (12 decks)

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