Thyroid Disorders Flashcards
Hyperthyroidism
- Drugs induced
- S/S
- Onset of drug therapy
Drugs induced:
- L-thyroxine, Lithium, iodides, aminodarone, interferone, interleukin-2
Tapazole
- Indication
- MOA
- Preg Cat
- SEs
- Monitor
- Pt counseling
Methimazole
- Indication: hyperthyroidism
- MOA: block hormone synthesis.
- Preg Cat: D
In preg: start w/ PTU 1st then change to MMI
SEs:
- Hypothyroidism, rash, wt gain
- Agranulocytosis
- Hepatitis, jaundice
- Infection
Monitor:
- WBC, TST Q4-6W, LFT
Pt counseling
- s/s of agranulocytosis: fever, sore throat, signs of infection, HA, rash
- Hepatitis: yellowing of skin
PTU
- Indication
- MOA
- BBW
- Preg Cat
- SEs
- Monitor
- Pt counseling
Prophylthiouracil
- Indication: hyperthyroidsm use in pt who fail other therapy. Can also use for thyroid storm b/c it inhibits conversion of T4 to T3
- MOA: block hormone synthesis. PTU also inhibits peripheral conversion of T4 to T3.
- BBW: severe liver injury
- Preg Cat: D
In preg: start w/ PTU 1st then change to MMI
SEs:
- Hypothyroidism, rash, wt gain
- Agranulocytosis
- Hepatitis, jaundice
- Infection
Monitor:
- WBC, TST Q4-6W, LFT
Pt counseling
- s/s of agranulocytosis: fever, sore throat, signs of infection, HA, rash
- Hepatitis: yellowing of skin
Other treatment for hyperthyroidism
Radioactive: RAI (Iodotope)
- Destruction of thyroid gland. Slow onset
- Advantage: simplicity: drink it
Thyroidectomy: surgical removal of thyroid gland
Lugol’s sol’n:
- Block hormone release.
- Adv: rapid effect: symptomatic relief, thyroid storm, pre-op adjunct
Sodium ipodate (Oragafin): - Block T4 converts to T3
Propranolol (inderal)
- Blocker peripheral action of thyroid hormone. No effect on the disease state. Blocks conversion of T4 to T3
Diltiazem: alternative for beta blocker
Cholestyramine: increase fecal excretion of T4 by binding to T4 in the intestine.
Oragafin
Ipodate
Inderal
Propanolol
Thyroid replacement for hypothyroidism is preg cat?
Pre Cat A
Armour thyroid
- Came from/Content
- Adv
- Disadv
Desiccated thyroid
- Dried pig thyroid. Provides both T3 and T4.
- Adv: inexpensive
- Disadv: variable potency
Levoxyl
Synthroid
Levothyroid
- Content
- Adv
- Disavd
L-thyroxine
- Synthetic pure T3
- Adv: long half life = 7d
- Disadv: slow onset
Cytomel
Triostat
- Content
- Adv
- Disadv
Liothyronine
- Synthetic pure T3
- Adv: rapid abs, rapid onset
- Disavd: Multiple daily doses required. Short half life. High level of T3 can produce toxicity
Thyrolar
- Content
- Adv
- Disadv
Liotrex
- Synthetic T4:T3(4:1) ratio
- Adv: short and long acting effects
- Disadv: expensive
Pt counseling on thyroid hormones
Too much levothyroxine
Counseling:
- Should be taking in AM on empty stomach at least 30 min b/4 foods. Abs can be decreased by Ca, iron, fiber, coffee and other substances
- Wait at least 30 min b/4 eating and wait 4h to take supplements with Ca, Iron, Mg, Al, sucralfate, cholestyramine, orlistat
- Use brand name product
Too much levothyroxine causes atrial fibrillation => no need to adj dose for obesity or wt loss pt
During pregnancy
- TSH level increase 25-30%
- Check levels Q4W
- Increase thyroid hormone dose by 25%
- As soon as pt delivery, goes back to normal dose b/4. Check TSH in 6wks
- Lack of therapy causes impaired fetal brain development and lower IQ; increases the risk of miscarriage, preterm birth, and low birth weight.
Levothyroxine
- IV:PO conversion
- Dilution
- Shelf life
- IV:PO = 1:2
- Dilution: NS
- Shelf life: use immediately
