Thyroid disorder

Question 1

Counselling point of thyroxine

Answer 1

Take in the morning, empty stomach (30mins before food)
Take 4hrs apart from Antacid (Al, Mg, Ca), Iron & Ca supplement
Improvement of sx may take several weeks
SE: Hyperthyroidism (heat intolerance, sweating, tremors, palpitations)
Advise against sudden DC of drug

Question 2

SE of carbimazole & propylthiouracil?

Answer 2

Carbimazole: rash, pruritis, hepatitis, agranulocytosis
Propylthiouracil: rash, fever, hepatocellular dysfunction, agranulocytosis, bitter taste, arthralgia

Question 3

What premed is needed before thyroidectomy?

Answer 3

Inorganic iodine 7-10 days before surgery to ↓ vascularity of thyroid gland

Question 4

How to manage thyroid storm?

Answer 4

Propranolol IV or Esmolol IV → control HR
Hydrocortisone IV or Methylprednisolone IV → antipyretic
High-dose propylthiouracil or carbimazole
Tx precipitating factors