Thyroid disorders

Question 1

Treatment of subacute thyroiditis

Answer 1

Propranolol. begin dosing with 10mg PO up to 80 4x daily

Question 2

treatment of mild hyperthyroidism (small goiters or fear of isotopes)

Answer 2

Thiourea drugs
Methimazole (Tapazole) 300-600 mg daily in 4 doses
radioactive iodine used to destroy goiters
thyroid surgery (must be euthyroid)
Lugol’s solution to reduce vascularity of the gland

Question 3

Treatment of Hypothyroidism

Answer 3

Levothyroxine (synthroid) 50-100 mcg daily, increasing dosage by 25 mcg every 1-2 weeks until symptoms stabilize. > 60 years of age decrease dosage

Question 4

Treatment of Thyroid crisis

Answer 4

Propylthiouracil (TPU) 150-250 mg q 6 hours WITH the following in 1 hour:
lugol’s solution 10 gtts tid OR
sodium iodide 1 gm slow IV along WITH
propranolol 0.5-2gm IV every 4 hours or 20-120 mg Po every 6 hours
hydrocortisone 50 mg every 6 hours with rapid reduction as situation improves
avoid ASA

Question 5

In-Patient management of Myxedema Coma

Answer 5

Protect airway: mechanical ventilation as needed
fluid replacement as needed
levothyroxine 400 mcg IV x 1 then 100 mcg every day
support hypotension
slow rewarming with blankets (not hyperthermia blankets)
avoid circulatory collapse

Question 6

Hyperthyroidism

Answer 6

TSH low, T3 up

Question 7

Hyperthyroid work up

Answer 7

radioactive uptake scane (increased grave’s dz)

MRI to visualize problems that were created in grave’s dz

Question 8

Euthyroid sick syndrome is characterized by what?

Answer 8

Normal/lowered TSH, normal/lowered T3, normal/lowered T4

Question 9

what do you do when you are converting someone from IV levothyroxine to oral?

Answer 9

double the dose d/t GI absorption