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Pharmacotherapy 4271 > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

____a____(endocrine/exocrine) glands release hormones directly into the bloodstream, whereas ___b___ (endocrine/exocrine) glands release chemical substances through ducts, releasing outside the body.

A

a) endocrine (e.g. hypothalamus, pituitary, thyroid, adrenal, gonads, pancreas, parathyroid)

b) exocrine

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2
Q

this is the most common thyroid hormone

A

T4

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3
Q

what is the function of the thyroid gland in children

A

critical for normal growth and development

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4
Q

what is the function of the thyroid gland in adults

A
  • controls metabolism (affects lipolysis/lipid synthesis, metabolism of carbs and proteins)
  • increases expression of beta receptors in heart
  • increases development of type II muscle fibres (fast twitch fibres)
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5
Q

this hormone secreted by the thyroid is 4x more potent

A

T3

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6
Q

this hormone secreted by the thyroid is the major circulating hormone

A

T4

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7
Q

what do the TSH, FT3 & FT4 look like in hypothyroidism

A

TSH = increased
FT3 = low
FT4 = low
(Low levels of thyroid hormones, TSH increases due to -ve feedback)

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8
Q

what do the TSH, FT3 & FT4 look like in hyperthyroidism

A

TSH = decreased
FT3 = increased
FT4 = increased
(thyroid hormones increased, TSH decreased b/c of -ve feedback)

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9
Q

what do the TSH, FT3 & FT4 look like in subclinical hypothyroidism

A

TSH = increased
FT3 = normal
FT4 = normal

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10
Q

what do the TSH, FT3 & FT4 look like in subclinical hyperthyroidism

A

TSH = decreased
FT3 = normal
FT4 = normal

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11
Q

what is the best screening test for hyper/hypothyroidism?

A

TSH

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12
Q

give examples of high risk patients who should be screened for thyroid disease

A
  • females > 45
  • pregnancy/post-partum
  • family history
  • goiter
  • other autoimmune disease (T1DM)
  • neck radiation
  • history of thyroid surgery
  • psychiatric disease (MDD, mania, bipolar)
  • medications (lithium, amiodarone)
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13
Q

what are some signs and symptoms of hypothyroidism

A
  • decreased HR
  • fatigue
  • weight gain
  • cold intolerance
  • dry skin/hair & hair loss
  • constipation
  • menorrhagia
  • poor concentration
  • increased cholesterol
    (hypo => think everything slows down)
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14
Q

list examples of Primary Hypothyroidism

A
  • Hashimoto’s Thyroiditis
  • Iatrogenic )medications, removal of thyroid)
  • Congenital
  • decreased iodine intake (rare)
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15
Q
  • synthetic T4 First Line for hypothyroidism
  • Wait 6-8 weeks before dosage increase b/c long half life therefore drug needs to be at steady state before we can see whether or not dose needs to be increased
  • Take dose same time every day
  • Side effects: symptoms are usually due to over-tx thus present as hyperthyroidism; palpitations, increased HR, tremors, anxiety, diarrhea (*may aggravate existing CVD - thus start at low dose)
  • Pregnancy: will likely need increased dose because increased metabolic demands
  • Lactation: Compatible
  • Drug Interactions: Space from cations (multivitamins, calcium, potassium, iron) by 2-4hrs, space from coffee/tea by 1hr, space from meals by 30 mins (TAKE ON EMPTY STOMACH), space from PPI & H2 blocker
A

Levothyroxine (Synthroid, Eltroxin)

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16
Q

used for Tx of hypothyroidism
- synthetic T3
Short half life
Side effects: same as synthetic T4, may be worse since T3 is more potent

A

Liothyronine (Cytomel)

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17
Q

used for Tx of hypothyroidism
Animal protein derived (risk of allergic reaction)
Side effects: same as synthetic T3 & T4

A

Desiccated thyroid

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18
Q

when should the patient start to feel better after being started on levothyroxine for hypothyroidism

A

~ 2 weeks

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19
Q

how long after starting tx should TSH/FT4 be monitored in hypothyroidism

A

6-8 weeks -> FT4 more reliable indicator initially, but in the long run we want normal TSH

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20
Q

If a patient changes LT4 brands, or gains more than 10 pounds, when should they get their TSH checked

A

4-6 wks following these changes

21
Q

what are the signs and symptoms of hyperthyroidism

A
  • increased HR
  • tremor
  • heat intolerance
  • weight loss
  • menstrual changes
  • increased Ca++ levels
  • dairrhea
  • weakness
  • sweating
    (hyper = everyhting speeds up)

ophthalmology:
- dry eyes
- blurry vision
- lid lag

22
Q

this is a type of hyperthyroidism; most common; is an autoimmune disorder due to Thyroid Receptor Antibodies (TRAbs) which stimulate thyroid growth, hormone release

A

Grave’s Disease

23
Q

this is a type of hyperthyroidism; autonomous thyroid nodules that secrete excess thyroid hormone (increased radioactive iodine uptake (RAIU))
tx = RAI or removal of thyroid gland

A

solitary toxic nodules & toxic Multi Nodular Goiter

24
Q

this is a type of hyperthyroidism; inflammatory damage to the gland which increases release of hormones.
subacute = develops after a viral syndrome
painless = cause is unknown
tx = self-limiting, beta-blockers for HR, NSAIDs for pain control, steroids for severe cases

A

thyroiditis painless/subacute

25
Q

this is a type of hyperthyroidism; life threatening thyrotoxicosis (presents as fever, tachycardia, dehydration, delirium, coma, N/Vm diarrhea). caused by: trauma, surgery, RAI, infection, withdrawal from antithyroid tx

A

thyroid storm

26
Q

what may be used to tx thyroid storm

A

beta blockers - for HR
propylthiouracil (PTU) - blocks conversion of T4 to T3
iodine solution - blocks release of hormones (administer after PTU)
hydrocortisone - antipyuretic & BP

27
Q

this medication is second line in thyroid storm and first line in the first trimester of pregnancy in hyperthyroidism - these are the only times we used this drug

A

propylthiouracil (PTU)

28
Q

this is used to treat hyperthyroidism; first line in adults and children
MOA: inhibits the conversion of T3 to T4 in the thyroid gland
Side effects: vasculitis, agranulocytosis, neutropenia, reversible cholestatic jaundice
Skin rash, abnormal taste/smell, GI upset
Get baseline WBC’s => if have symptoms (fever, sore throat, mouth ulcers) consult Dr and get repeat WBC
Pregnancy: category D, but maternal benefit outweighs fetal risk
Lactation: compatible but caution advised with high doses
Drug interactions: warfarin, TCA’s, digoxin, codeine, paroxetine

A

Methimazole (Tapazole)

29
Q

DOC in thyroid storm & first trimester pregnancy
MOA: inhibits the conversion of T3 to T4 in the thyroid gland; inhibits peripheral conversion of T4 to T3
Side effects: vasculitis, agranulocytosis, neutropenia, hepatocellular injury (if dark urine, jaundice, light stools, unexplained abdominal pain: stop drug + LFTs done)
Skin rash, GI upset
Get baseline WBC’s => if have symptoms (fever, sore throat, mouth ulcers) consult Dr and get repeat WBC
If jaundice, dark urine, light stools, unexplained abdominal pain: STOP DRUG & get LFTs done
Pregnancy: category D, but maternal benefit outweighs fetal risk (PTU = DOC for first trimester, then switch to MMI)
Lactation: compatible but caution advised with high doses

A

Prophylthiouracil (PTU)

30
Q

this class of medication can be used to treat symptoms of hyperthyroidism such as palpitations, anxiety, tremor, heat intolerance

A

beta-blockers

31
Q

this treatment for hyperthyroidism will destroy the thyroid. contraindications include pregnancy/lactaiton => defer 6 months before and after

A

radioactive iodine (RAI)

32
Q

this form of treatment for hyperthyroidism may be used if drug failure, large thyroid, nodules or severe eye disease

A

surgery

33
Q

when should a patient with hyperthyroidism start to feel better after starting tx

A

3-4 weeks

34
Q

how long after staring tx should TSH/FT3/FT4 be monitored in hyperthyroidism

A

q 4-6 weeks until stable

35
Q

this is the state of having normal thyroid function

A

euthyroid

36
Q

how long of a patient being euthyroid do you decrease the dose of MMI/PTU

A

4-12 weeks euthyroid

37
Q

once a patient is euthyroid and a stable dose of MMI/PTU is found, how often should TSH be monitored

A

q 3 months

38
Q

patients are often treated until euthyroid for _____

A

1 year

39
Q

this medication causes hypothyroidism. increased risk if pt has thyroid disease or family history, goitre or thyroid abs. if increased risk monitor TSH q 1 month x 3 months, then q 3 months x 4-8 then q 6-12 months

A

amiodarone

40
Q

what are some risks to the mother and fetus if hypo/hyperthyroidism is not treated

A

maternal: miscarriage, preterm labor, pre-ecamlpsia
fetus: stillbirth, low birth weight, delays in mental/motor development

41
Q

how is hypothyroidism treated in pregnancy

A

patients typically advised to increased levothyroxine dose by 2 extra tablets per week immediately after pos pregnancy test

42
Q

when should TSH/FT4 be monitored for hypothyroidism in pregnancy

A

check when pregnant and q 4 weeks

43
Q

how is hyperthyroidism treated in pregnancy

A

mild hyperthyroidism - monitor w/o tx (as long as mom and fetus are asymptomatic)

pt may consider radioactive iodine ablation or thyroidectomy for tx of hyperthyroidism over 6 months prior to actively trying to conceive

PTU is DOC in first trimester; consider switch to MMI in 2nd and 3rd trimester

44
Q

when should TSH/FT3/FT4 be measured in hyperthyroidism in pregnancy

A

q 6 to 8 weeks

45
Q

when should a TRAb titre be done in pregnancy patients with hyperthyroidism

A

done at 18-22 weeks - if positive repeat at 34 weeks

46
Q

what does it mean if TRAb titre is high in pregnant patients with hyperthyroidism

A

means increased risk of hyperthyroidism for the newborn; neonatologist monitoring rec

47
Q

what does it mean if TRAb titre is low in pregnant patients with hyperthyroidism

A

risk to the fetus is low

48
Q

what is the recommended tx for subclinical hypo/hyperthyroidism

A

treat if pt is symptomatic - don’t treat lab value if pt is not symptomatic

Pharmacotherapy 4271 (29 decks)

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