Thyroid Disorders

Question 1

Normal Lab Values
TSH
Free T4
Free T3

Answer 1

TSH: 0.5 - 4.5 mIU/L

Free T4: 0.8 - 2.7 ng/dL

Free T3: 2.5 - 4 ng/dL

Question 2

Levothyroxine- when to take and what to monitor

Answer 2

• take 30-60 mins prior to breakfast or 4 hrs after last meal of the day
  -monitor TSH levels 6-8 weeks after initiation/titration

Question 3

Levothyroxine drug interactions

Answer 3

-iron
-calcium
-aluminum hydroxide
-cholestyramine
-PPI’s
-sevelamer
-sucralfate
-raloxifene

Question 4

Treatment options for hyperthyroidism

Answer 4

1. Surgery
2. Radioactive iodine
3. antithyroid medication

Question 5

Beta-blockade therapy

Answer 5

recommended as initial therapy in all patients with symptomatic thyrotoxicosis, pt with a resting heart rate > 90, or comorbid cardiovascular disease

Question 6

Beta-blockade medications

Answer 6

Propranolol- preferred for nursing mothers
Atenolol
Metoprolol
Nadolol

Question 7

Thiourea Meds

Answer 7

methimazole (Tapazole), propylthiouracil (PTU)

-inhibit organification and coupling of thyroid hormone

Question 8

Thioamides Adverse Effects

Answer 8

-Rash, GI, and arthralgias
-Agranulocytosis- fever, sore throat, or flu-like symptoms
-Hepatotoxicity

Question 9

Antithyroid medication monitoring

Answer 9

-CBC with diff
-Liver function
-Free T4 instead of TSH