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Specialized Pharmacology MN650 > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

a condition of excess secretion of thyroxine (T4) and triiodothyronine (T3)?

A

Hyperthyroidism

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2
Q

What are causes of hyperthyroidism?

A
  • Graves’ disease (most common cause)
  • subacute thyroiditis
  • Pituitary tumor (inc TSH)
  • Toxic nodular goiter or thyroid cancer
  • other autoimmune causes (pernicious anemia, diabetes mellitus, myasthenia gravis)
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3
Q

hyperthyroidism is most commonly seen at what age?

A

20 – 40 y/o

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4
Q

What are the signs and symptoms of hyperthyroidism?

A
  • hypermetabolism (weight loss)
  • heat intolerance
  • fatigue
  • anxiety, nervousness
  • manic behavior, confusion, restlessness
  • find tremors
  • diaphoresis
  • hyperreflexia of deep tendon reflexes
  • tachycardia, palpitations, a-fib
  • increased appetite
  • fine thin hair
  • exophthalmos (eye bulging)
  • hypomenorrhea or irregular menstruation
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5
Q

What is the most sensitive test for diagnosing hyperthyroidism?

A

TSH assay, low in most cases

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6
Q

Which labs are elevated in patients with hyperthyroidism?

A

T3, erythrocyte sedimentation rate, serum antinuclear antibody, calcium

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7
Q

Which labs are decreased in patients with hyperthyroidism?

A

RBCs (anemia), granulocytes

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8
Q

Are T4 levels increased, decreased, or normal in hyperthyroidism?

A

Maybe normal

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9
Q

High iodine uptake during a radioactive iodine uptake test is indicative of?

A

Graves’ disease

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10
Q

low iodine uptake during a radioactive iodine uptake test is indicative of?

A

Subacute thyroiditis

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11
Q

11) Assess the following systems in a patient with hyperthyroidism?

A

• Cardiac, ophthalmology, neurological, thermal regulation, GI

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12
Q

12) What drug is used to manage or provide symptomatic relief for resting heart rate > 90 BPM ?

A
  • beta blocker
  • Propranolol (Inderal): 10 - 40 mg PO 3-4 x day (may increase to 80)
  • Metoprolol (Lopressor): 25 mg PO q6-8 hrs (may increase to 50)
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13
Q

13) Methimazole (Tapzole) Is what category of drug?

A
  • Anti-thyroid medication used for mild cases of hyperthyroidism
  • initial dose: 30 - 60 mg QD in 3 divided doses
  • maintenance dose: 5 – 15 mg PO QD
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14
Q

14) What drug is used for patient’s intolerant of methimazole and/or in whom radioactive iodine or surgery is not appropriate?

A

Propylthiouracil

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15
Q

15) Propylthiouracil Is used for which type of patients?

A

• Pts Intolerant of methimazole and/or in whom radioactive iodine or surgery is not appropriate

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16
Q

16) What is the initial and maintenance dosing for propylthiouracil?

A
  • 300 - 600 mg/day in 4 divided doses

* 100 -150 mg/day in 3 divided doses

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17
Q

17) Propylthiouracil is what category of drug?

A

• anti-thyroid medication

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18
Q

What is radioactive iodine used for and time frame of treatment?

A
  • used to shrink goiters
  • usually takes 3-4 months for pt to become euthyroid
  • may need to repeat in six months if persistent hyperthyroidism is noted
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19
Q

Thyroid surgery is recommended for which patients?

A

Pregnant patients, suspected cancer

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20
Q

What is the best treatment for subacute thyroiditis?

A

Propranolol

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21
Q

What is the thyroid storm (thyrotoxic crisis)?

A

A deadly hyper metabolic state caused by inadequately controlled hyperthyroidism

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22
Q

What are symptoms of thyroid storm?

A
  • fever (100 - 106F)
  • flushing (d/t dilated vessels)
  • profuse diaphoresis (fluid loss up to 4L/24hr)
  • tachycardia , palpitations , SVT
  • mental status changes
    • agitation, delirium, psychosis, stupor, coma
  • hyperdefecation
  • hyperglycemia
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23
Q

23) Causes hyperthyroidism?

A
  • trauma
  • major stress
  • infection
  • subtotal thyroidectomy or other thyroid surgery
  • uncontrolled diabetes
  • pregnancy
  • thyroid drug OD
24
Q

What is the Burch-Warsofsky point scale used for?

A

To assist in diagnosing thyroid storm (≥ 45 thyroid storm, 25-44 impending storm, <25 unlikely)

25
Why should Aspirin an NSAIDs be avoided in patients with hyperthyroidism?
they interfere with the binding of T4 and thyroid binding globulin , potentially resulting in exacerbated hypermetabolism
26
Four classes of pharmacologic therapy used to treat hyperthyroidism?
- anti-thyroid drugs (inhibit synthesis of thyroid hormone) - iodine preparations (inhibit release of thyroid hormone) - agents that block the effects of thyroid hormone (beta blockers, CCB) - Drugs the prevent conversion of T4 to T3
27
What are the anti-thyroid drugs used to treat hyperthyroidism?
- propylthiouracil | - methimazole
28
What are the iodine preparations used to treat hyperthyroidism?
Lugol’s solution and Potassium iodide (SSKI)
29
What agents are used to block the effects of thyroid hormone in patient with hyperthyroidism?
Beta blockers and calcium channel blockers
30
What drugs are used to prevent the conversion of T4 to T3 in patients with hyperthyroidism?
Hydrocortisone and dexamethasone
31
What is the dosage of propylthiouracil in the treatment of hyperthyroidism?
500-1000 mg loading dose PO followed by 250 mg PO q4hr
32
What is the dosage of methimazole in the treatment of hyperthyroidism?
60 -80 mg/day PO
33
What are the actions of lugol solution and potassium iodide?
They inhibit the release of thyroid hormone, should be administered one hour after administration of anti-thyroid drugs
34
What is the dosage of Propranolol in the treatment of hyperthyroidism?
1-2 mg IV Bolus, may repeat q10-15 min PRN
35
What is the drug of choice for the treatment of hyperthyroidism when beta blockers are contraindicated?
Calcium channel blockers (verapamil or diltiazem)
36
What drugs can be used in the treatment of hyperthyroidism when beta blockers are contraindicated?
* Calcium channel blockers (verapamil /diltiazem) | * Reserpine
37
When is Reserpine and used in the treatment of hyperthyroidism?
when beta blockers are contraindicated
38
Why are hydrocortisone and dexamethasone used in the treatment of hyperthyroidism?
They inhibit the conversion of T4 to T3
39
What is the dosage of hydrocortisone in the treatment of hyperthyroidism?
300 mg IV followed by 100 mg q8hr until stable
40
What is the dosage of dexamethasone in the treatment of hyperthyroidism?
2-5 mg IV q6hr
41
A rare condition of greatly decreased metabolism resulting from a deficient amount of circulating thyroid hormone is called?
- Hypothyroidism
42
What is the most common thyroid disease?
- Hypothyroidism
43
What are risk factors for hypothyroidism?
- > 60 y/o - Women - iodine deficiency
44
What are causes of hypothyroidism?
- Iodine deficiency - autoimmune diseases (Hashimotos) - pituitary tumor (TSH) - Thyroidectomy - high dose amiodarone - medication noncompliance
45
What are the signs and symptoms of hypothyroidism ?
- fatigue - changes in LOC (confusion, depression, coma) - puffy face - decreased breathing - Brady cardia - hypothermia - hypoglycemia - anorexia - decreased bowel sounds - weight gain with poor appetite - Constipation - dry cracked skin - coarse brittle hair and nails - cold intolerance - decreased deep tendon reflexes - paresthesia - decreased diaphoresis - ataxia - hair loss - menorrhagia (abn Heavy or prolonged bleeding)
46
Lab findings for patient with hypothyroidism?
``` Increased: -TSH - LFT - cholesterol - triglycerides Decreased or normal T4 level Decreased - resin T3 uptake - hypoglycemia - hyponatremia - anemia (normochromic, normocytic) ```
47
The presence of thyroid peroxidase (TPO) antibody is indicative of?
Autoimmune disease such as Hashimotos or graves disease
48
Levothyroxine is also known as?
Synthroid or T4
49
What medication used to treat hypothyroidism?
Levothyroxine
50
What is the dosage of levothyroxine for pts < 60 y/o and w/o CAD?
50 -100 mcg QD, increase dosage 25 mcg every 1-2weeks until symptom stabilization
51
What lab is checked eight weeks after dose adjustments for patients taking levothyroxine?
TSH
52
Levothyroxine should be taken how long prior to breakfast?
30-60 mins
53
How long should a patient wait after they have eaten before taking their levothyroxine?
4 hours
54
What is the name for severe hypothyroidism leading to decreased mental status, and multisystem organ failure?
myxedema coma
55
What is the dosage of levothyroxine for pts > 60 y/o and w/ CAD?
25 -50 mcg QD, increase dosage by 25 mcg q 1-2wks until symptoms stabilization
56
TSH is checked how often in patients with hypothyroidism and receiving levothyroxine?
eight weeks after dose adjustments

Specialized Pharmacology MN650 (28 decks)

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