Thyroid Diseases

Question 1

Methimazole initial tx dose for mild ____thyroidism

Answer 1

15 mg/day

Hyper

Question 2

Methimazole initial tx dose for moderate ____thyroidism

Answer 2

30-40 mg/day

Hyper

Question 3

Methimazole initial tx dose for severe ____thyroidism

Answer 3

60 mg/day

Hyper

Question 4

Length of tx on Initial methimazole tx, end at _____

Answer 4

6-8 weeks

Euthyroid

Question 5

Euthyroid

Answer 5

normal thyroid levels

Question 6

Methimazole is preferred in what trimesters of pregnancy?

Answer 6

2nd and 3rd ONLY

Question 7

Methimazole dose for breastfeeding

Answer 7

20-30 mg/day (1st line)

Question 8

Methmazole maintenance dose for _____thyroidism

Answer 8

5-15 mg/day

Question 9

PTU Propylthiouracil 1st line for

Answer 9

thyroid storm

1st trimester of pregnancy

Question 10

MOA Methimazole

Answer 10

• Inhibits thyroid hmone synthesis

- depletes stored hmone

Question 11

MOA Propylthiouracil

Answer 11

-Inhibits peripheral T4 to T3 conversion within hours

Question 12

Thioamide Monitoring: Reassess pt every

Answer 12

4 weeks

until Euthyroid

Question 13

Remission is

Answer 13

Euthyroid for 12 mo

Question 14

Thioamide Monitoring: low dose every 2-3 mo check

Answer 14

T4, TSH and s/sx

keep tapering

Question 15

Thioamide adverse effects

Answer 15

GI upset
Arthralgia
Rash, uticarua, pruritis

Question 16

Thioamide severe adverse effect

Answer 16

Agranulocytosis
(granulocyte count <250, give em ABX!!)
Hepatotoxicity
(higher risk PTU)

Question 17

How soon should TSH be tested after a pt achieves remission?

Answer 17

2-3 mo

Question 18

Iodine MOA

Answer 18

bombard the body with iodine so it inhibits hmone release and dec. hmone syntheses

Question 19

Iodine tx lasts for

Answer 19

D/C after 1-2 weeks! short tx

Question 20

Iodism s/s (adverse effect!)

Answer 20

(iodine OD) burn in mouth, metallic taste, sore teeth/gums, cold s/s

Question 21

Iodine Adverse effects (other)

Answer 21

rash, GI upset, salivary gland swelling, immune hypersensitivity rxn, paresthesia

Question 22

Iodine initial dose to tx _____thyroidism

Answer 22

120-400mg orally in H20 or juice

Hyper

Question 23

Lithium dose to tx _____thyroidism

Answer 23

300 mg Q8hrs

Hyper

Question 24

Lithium MOA

Answer 24

block T3/T4 release

Question 25

Lithium: Monitor

Answer 25

serum level < 1 mEq/L

Question 26

Beta Blockers MOA to tx ____thyroidism

Answer 26

Hyper

block B adrenergic receptors

Question 27

B Blocker- Esmolol use in ___ via ___ dose____

Answer 27

ICU- thyroid storm
IV
50-100 mcg/kg/min

Question 28

Propanolol dose

Answer 28

10-40 mg PO 3-4x/day

may dec T4 to t3 conversion

Question 29

Nadolol dose

Answer 29

40-60 mg PO 1 x day
may dev T4 to T3 conversion
don’t use in pt with COPD

Question 30

Atenolol dose

Answer 30

25-100 mg PO 1-2 x day

Question 31

Metoprolol dose

Answer 31

25-50 mg PO 4x day

Question 32

Preferred tx in Thyroid Storm

Answer 32

high dose PTU

Question 33

Radioactive Iodine is a tx cure for ____

goal:

Answer 33

Hyperthyroidism

goal: induce hypothyroidism

Question 34

Radioactive Iodine MOA:

Answer 34

taken into thyroid by TSH-R Ab
incorporated into thyroid hmone and stored in colloid
emit B particle to irreversibly damage thyrocytes

Question 35

RAI Contrindications

Answer 35

Pregnancy (hold 6-12 mo)
Lactation
Thyroid Cancer

Question 36

RAI Monitor

Answer 36

T3/T4 2-4 weeks post tx

Question 37

RAI adverse effects

Answer 37

dysphagia, thyroid tenderness

Question 38

Pt in Thyroid Storm, what meds to initiate?

Answer 38

1. PTU
2. B Blocker (propranolol)
3. cool blankets
4. Tylenol
5. Hydrocortisone

Question 39

1st Line Med for hypothyroidism

Answer 39

Levothyroxine!

Question 40

Initiate Treatment when TSH >

and pregnancy

Answer 40

TSH > 10 mlU/L

TSH 2.5-4.5 mlU/L (pregnancy)

Question 41

Levothyroxine full replacement dose

Answer 41

1.6 mcg/kg/day

multiply x kg body weight

Question 42

IV Levothyroxine

Answer 42

75% of oral dose

Question 43

Monitor Levothyroxine @normal level

Answer 43

TSH and FT4 1x ever 6-12 mo

Question 44

Levothyroxine is a _____

Answer 44

synthetic thyroid supplement, mimics T4

Question 45

Liothyronine dose

Answer 45

relative dose = 15-37.5 mcg

Question 46

Liothyronine acts as

Answer 46

Synthetic T3

Question 47

Liotrix dose

Answer 47

50-60mcg T4 and 12.5-15mcg T3 in 1 tablet

Question 48

Liotrix is a ratio of

Answer 48

T4:T3
4:1

Question 49

ADE Synthetics

Answer 49

uncommon at appropriate doses

if overt treat then hyperthyroid s/sx

Question 50

Natural Thyroid Hmone from

Answer 50

hog, beef and sheep

Question 51

Contraindications Natural Hmone

Answer 51

Religious beliefs- no pork

DIs

Question 52

Natural Hmone Dose

Answer 52

1 grain= about 60mg T4 but variable

Question 53

PTU initial dose

Answer 53

100-150mg every 6-8 hrs

Question 54

PTU maintenance

Answer 54

50-150mg/day

Question 55

Lithium Adverse Rxn

Answer 55

Tremor, polyuria, renal failure, seizure, arythemia, bradycardia, suicide, toxicity

Question 56

Decrease Absorption Levothyroxine

Answer 56

Aluminum hydroxidie
Cholestyramine
Calcium Carbonate
Dietary Fiber
Ferrous Sulfate
FOOD
Soybean formula
Sucralfate

Question 57

Amiodarone

Answer 57

inc or dec thyroid levels

monitor TSH and FT4 every 6mo + baseline

Question 58

Digoxin

Answer 58

inc digoxin levels

dec dose thyroid meds

Question 59

Warfarin

Answer 59

inc or dec anticoagulation

monitor INR

Question 60

hyperthyroid + warfarin

Answer 60

more likely for pt to bleed bc inc metab of clotting factors

Question 61

insulin

Answer 61

inc risk hyperglycemia

inc insulin, pt monitor blood glucose