Thyroid Disorders Flashcards
An autoimmune disease resulting from cell and antibody mediated thyroid injury.
Hashimoto disease
Hyposecretion of the thyroid hormone causes what?
Myxedema, goiter and cretinism
Signs and symptoms of Hypothyroidism.
Sensitivity to cold, constipation, brady and weight gain.
Signs: dry flaky skin, coarse hair, slurred speech, puffyface, hands, feet and hearing loss. Dec libido, slow return of deep tendon reflexes
Diagnostic tests and results for Hypothyroidism.
Initial test is serum TSH assay and TSH levels are elevated in primary hypothyroidism and low serum free T4
Inc. serum TSH, dec. FT4 and TT4
Thyroid hormones increase what drug effect and how?
Warfarin effect. Increases catabolism of vitamin K dependent clotting factors= inc. warfarin effect.
What declines with initiation of levothyroxine?
Glycemic control. Antihyperglycemic agents may be required.
These drugs reduces absorption due to binding to levothyroxine.
Antiepileptics
cholestyramine, colestipol (separate 6)
Iron salts Ca, Mg and sucralfate (2h)
do not take Al
Levothyroxine dosing.
T4: 1.6mcg/kg/day
12.5-25mcg/day pts w Coronary Artery Disease or elderly
Pregnancy: Increase dose
Common form of hyperthyroidism, antibodies produced against autoantigens stimulates secretion of thyroid hormone.
Grave’s disease.
Complete opposite of Hashimoto= inhibits secretion of thyroid hormone
Hyperthyroidism may cause what and give symptoms.
Intolerance to heat, weight loss, weakness and anxiety.
Signs: heart palpitation, nervousness, diarrhea and tachycardia
Hyperthyroidism diagnosis
Decreased TSH (sensitive) Increased T4 and T3
What is the essential functional group for antithyroid activity?
Thiocarbamide (R-C=S)-NH-R)
Explain antithyroid drug mechanism of action Deiodination.
Inh. iodination of Tyrosine in thyroglobulins and thyroid peroxidase thus inh.T4 to T3.
Deiodination is activation of thyroxine T the degradation of thyroid horm. eliminated by feces and urine. T4 to actv triiodothyronine T3 in peri. and liver tissues.
Oral drops of Iodide, will stain.
Decreases gland size and blood supply therefore used for surgery preparation.
Inhibits uptake of I2 by what amino acid?
Lugol’s solution (KI + I)
10% KI and 5% I
Inhibits uptake of I2 by Tyrosine.
DOC for hyperthyroidism for pregnanct and lactating women.
Propylthiouracil
does not cross BBB
Side effects of MMI and PTU
Allergy, rash, agranulocytosis, hepatotoxicity and nephrotoxicity (rare)
Cholestic jaundice from MMI
For thyroid storm.
Thyrotoxicosis.
Lugol’s solution
Radioactive Iodine I^131
Which is more secreted in breast milk, PTU or MMI
MMI.
PTU is more strongly protein bound.
What are the factors that affect breast milk excretion?
Inc: lipid solubility and basicity
Dec: protein binding and acidity
PTU is excreted in the kidneys as what?
Glucuronide (inactive)
Use to ablate thyroid tissue in patients with Grave’s disease, toxic autonomous nodules and toxic multi-nodular goiters.
And dose.
Radioactive Iodine
Sodium iodide I^131 (Iodotope)
As single oral dose only.
Structurally related to thyroxine and how does this affect T4.
Amiodarone. Interferes with peripheral conversion of T4 to T3
Whereas Dronedarone has NO Iodides
Methimazole MOA
Inhibit I oxidation
Catalyze the incorpz of I into tyrosine
Inhibit the syn. of thyroid horm.
What Beta blocker is used for hyperthyroidism?
However propanolol is also used in the short-term preoperative management of thyrotoxic crises.
What are the following lab test increase indicate myopathies? A. Creatinin kinase (CK-MM) B. Creatinin kinase (CK-BB) C. Creatinin kinase (CK-MB) D. ADH, AST, ALT, ALP E. ALP, ALT
A.
MM indicator of skeletal muscles
BB brain
MB cardio
Which of the following laboratory investigations help to determine, myocardial infarction? A) Troponin-I and CK-MB B) CK-MB, Troponin C and ECG C) ECG, Troponin I, CK-MM D) Troponin I, CK-MB, ECG E) Troponin C, CK-MB, ECG
E.
What are the following lab test increase indicate MI: Troponin I
??
A patient using warfarin should be monitored for?
I. INR
II. Prothrombin time
III. activated Prothrombin time (aPTT)
Only I and II
A patient has dark urine, and muscle pains. SE of what statin
Atorvastatin
*Statins and Benzfibrate can inc. CK-MM
A patient creatinine clearance is 300 ml/hr, it is a? A. chronic renal disease B. normal renal function C. excessive renal function D. severe renal disease E. Acute renal disease
D
normal: 80-120 mL/min
Most sensitive test for liver cirrhosis
-cholestasis jaundice
-Acetaminophen toxicity
AST ALT ALP CK
- AST
- ALP
- AST
Which of the following is the major ketone increase in blood diabetic ketoacidosis? A) Acetone B) Beta hydroxy butyric acid C) Ethyl and methyl ketone D) Long change ketones E) Acetyl acetic acid
B
What phils are increased to pts with asthma and allergies
Baso and Eisinophils
