Thyroid disorders

Question 1

which has a longer half life ? t4 or t 3?

Answer 1

T4

Question 2

which can have a negative feedback w/ TSH to decrease its production? t4 or t3?

Answer 2

T4

Question 3

in hyperthyroidism, levels of T4 vs TSH? (diagnosis)

Answer 3

t4 is high, tsh is low due to negative feedback

Question 4

in hypothyroidism, levels of t4 vs tsh? (diagnosis)

Answer 4

t4 is low, tsh is high

Question 5

sx of hypothyroidism ?

Answer 5

fatigue
weight gain  (slow metabolism
dry skin
hoarsness
coarse or loss of hair 
memory and mental impairment 
myalgias
HLD
depression

Question 6

what is the most common type of hypothyroidism?

Answer 6

Hashimoto’s: autominue attack of the thyroid gland

Question 7

what are the two most common agents that can cause hypothyroidism?

Answer 7

lithium and amiodarone

Question 8

what is a typical dose for starting levothyroxine in an elderly patient?

Answer 8

12.5 to 25 mcg daily

Question 9

what are the consequences of overdosing the levothyroxine?

Answer 9

causes atrial fibrillation and fractures

Question 10

when you start levothyroxine, how often should you mx levels?

Answer 10

q 6-8 weeks until normal levels, then in 6 mod, then every year

Question 11

about how much should you increase the dose of levothyroxine if a women becomes pregnant?

Answer 11

30-50% throughout the pregnancy. Even several months after birth of the child

Question 12

cytomel

Answer 12

liothyronine

Question 13

triostat

Answer 13

liothyronine

Question 14

armour thyroid

Answer 14

t3 and t4

Question 15

how should patients take their thyroid hormone?

Answer 15

in the AM on an empty stomach 30 minutes before eating because its absorption is decrease w/ fiber, calcium , iron or other supplements

Question 16

synthorid

Answer 16

t4

Question 17

levothroid

Answer 17

t4

Question 18

levoxyl

Answer 18

t4

Question 19

what do you do if a patient switches brands of thyroid hormone?

Answer 19

make sure to tell about signs and symptoms and check levels in 6-8 weeks

Question 20

what dose to start patients for t4 <50 years old?

Answer 20

1.7 mcg/kg/day

Question 21

what dose to start in elderly adults > 50 years old for t4?

Answer 21

0.5 mcg/kg/day usually 12.5 or 25mcg

Question 22

pregnancy category for levothyroxine?

Answer 22

A!!!

Question 23

levothyroxine ratio IV to PO?

Answer 23

1: 2

Question 24

typical dose for armour thyroid?

Answer 24

60-120mg daily

Question 25

usual t3 dose

Answer 25

25-75 mcg

Question 26

liotrix

Answer 26

t3 and t 4

Question 27

how should you separate meds that interact w/ levothryoxine?

Answer 27

take the other medicines 2 hours before or 4 hours after the levothyroxine

Question 28

meds that interact w/ levo

Answer 28

``` calcium, mag, aluminum, iron sucralfate orlistat SPS cholestyramine --Beta blovkers, estrogen and hepatic inducers ```

Question 29

counseling for levothyroxine

Answer 29

- for energy and metabolism - take on empty stomach in the 30 minuts before BF - it can take up to 1 or two months for the full effect of the medicine to take effect - side effects of the medication

Question 30

symptoms of hyperthyroidism?

Answer 30

sudden wight loss, sweating , fast HR, nervous, irritable, diarrhea, insomnia

Question 31

most common cause of hyperthyroidism?

Answer 31

grave's disease: immune system stimulates the thyroid gland to produce too much T4

Question 32

most common medications that can cause hyperthyroidism?

Answer 32

iodide amiodarone interferons

Question 33

what is the DOC for Grave's disease?

Answer 33

RAI-131 : radicactive iodine

Question 34

what can you use only for symptomatic treatment of hyperthyroidism?

Answer 34

beta blockers

Question 35

two treatment medications for hyperthyroidism? med names?

Answer 35

PTU: propylthiouracil | Methimazole

Question 36

Propyl-thyracil

Answer 36

PTU

Question 37

Tapazole

Answer 37

methimazole

Question 38

typicl dose of PTU

Answer 38

50mg TID or higher (higher doses until euthyroid, then dose reduction)

Question 39

BBW PTU

Answer 39

can cause liver damage and acute liver failure

Question 40

typical dose for methimazole

Answer 40

5-15 mg daily (maintenance dose) : initial doses are higher

Question 41

two main side effects of PTU and methimzole

Answer 41

GI upset and hepatitis , agrunolocytosis (rare)

Question 42

how to toake both PTU and methimazole?

Answer 42

w/ food to decrease GI upset

Question 43

which put or methimazole is safe for pregnancy ?

Answer 43

methimzole, PTU is pregnancy category D. PTU ok for women trying to conceive or if they are still in the first trimester but should switch to methimazole in 2nd or 3rd trimester

Question 44

what is the DOC for thyroid storm?

Answer 44

PTU

Question 45

two iodide solutions for hyperthyroidism?

Answer 45

Lugol's solution ( potassium iodide and iodine solution) | Saturated solution of potassium iodide (SSKI)

Question 46

how should you take your iodide solutions?

Answer 46

w/ food to reduce GI upset

Question 47

can you use iodide solutions in pregnancy?

Answer 47

no = because category D. Nor in breastfeeding

Question 48

typical dose for the iodide solutions in hyperthyroidism?

Answer 48

4-8 drops po Q8h

Question 49

what are symptoms of thyroid storm?

Answer 49

``` fever > 103 F HR > 140 inc RR profuse sweating agitation psychosis coma ```

Question 50

Treatment for thyroid storm

Answer 50

``` PTU 900-1200 po daily divided q 4-6 hours (30 min before iodide) PLUS SSKI or lugos PLUS Propranolol PLUS dexamethasone Supportive care ```

Question 51

dose thyroid storpe SSKI and Lugols

Answer 51

sski 3-5 drops q 8h | luglos 5-10 dropps po q 8h