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NAPLEX Review > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

What 2 thyroid hormones are produced by the thyroid gland?

A

triiodothyronine (T3)

thyroxine (T4)

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2
Q

The thyroid gland is the only organ that can absorb what molecule?

A

Iodine

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3
Q

Which is more potent T3 or T4?

A

T3

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4
Q

Which has a shorter half-life T3 or T4?

A

T3

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5
Q

What is thyroid hormone production regulated by?

A

thyroid-stimulating hormone (TSH)

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6
Q

Which is the active form T3 or T4?

A

T4

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7
Q

When the level of (T3/T4) increases, it inhibits the secretion of TSH

A

T4

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8
Q

In hypothyroidism T4 is (high/low) and TSH is (high/low)

A

T4: low
TSH: high

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9
Q

What is Hashimoto’s disease

A

Autoimmune condition in which antibodies attack the thyroid gland causing hypothyroidism

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10
Q

What is Myxxedema coma?

A

Life-threatening emergency characterized by poor circulation, hypothermia, and hypometabolism
Cause by chronically untreated hypothyroidism
Initial treatment: IV levothyroixine

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11
Q

S/Sx hypothyroidism

A 
Cold intolerance
Dry skin
Fatigue
Muscle cramps
Constipation
Weight gain
Goiter
Depression
Bradycardia
Menorrhagia
Memory and mental impairment
Coarse hair or loss of hair
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12
Q

What drugs can cause hypothyroidism?

A 
I TALC
Interferons
Tyrosine kinase inhibitors (e.g. sunitinib)
Amiodarone
Lithium
Carbamazepine
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13
Q

What is normal free T4? TSH?

A

T4: 0.9-2.3 ng/L

TSH 0.3-3 mIU/L

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14
Q

When initiating hypothyroidism treatment, how often should you monitor TSH?

A

every 4-6 weeks

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15
Q

What is DOC for hypothyroidism?

A

Levothyroxine (T4)

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16
Q

Why is iodine deficiency rare? How can you treat it if it does occur?

A

In US most salt is iodized

Can supplement with multivitamin

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17
Q

Levothyroxine initial dosing

A

1.6 mcg/kg/d (IBW)

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18
Q

Levothyroxine warnings, monitoring

A

Warnings: decrease dose in CV disease, can decrease BMD and lead to fractures
Monitoring: TSH levels and clinical symptoms every 4-6 weeks until levels are normal

19
Q

Levothyroxine IV to PO ratio

A

IV: PO

0.75:1

20
Q

Levothyroxine tablet colors

A 
Orangutans Will Vomit On You Right Before They Become Large, Proud Giants
Orange - 25
White - 50
Violet - 75
Olive - 88
Yellow - 100
Rose - 112
Brown - 125
Turquois - 137
Blue - 150
Lilac - 175
Pink - 200
Green - 300
21
Q

What drugs decrease levothyroxine absorption?

A

Separate by 4 hours: Antacids and polyvalent cations containing iron, calcium, aluminum, or magnesium, multivitamins (ADEK, folate, iron), cholestyramine, sevelamer, and sucralfate

22
Q

Thyroid hormone replacement can increase effects of ___ and decrease effects of ___

A 
Increase warfarin (Increased INR)
Decrease theophylline (asthma/COPD)
23
Q

Levothyroxine PO administration counseling notes

A

Take 60 minutes before breakfast or at bedtime at least 3 hours after a meal
Take with water

24
Q

What is thyrotoxicosis?

A

Hyperthyroidism

25
Q

TSH and T4 values in hyperthyroidism

A

TSH: low

free T4: high

26
Q

S/sx of hyperthyroidism

A 
Heat intolerance or increased sweating
Weight loss
Agitation, nervousness
Palpitations or tachycardia
Frequent bowel movements
Insomnia
Thinning hair
Exophthalmos (protrusion of eyeballs)
Light or absent menstrual period
27
Q

Most common cause of hyperthyroidism

A

Grave’s disease

28
Q

What is Grave’s disease

A

Autoimmune disease where antibodies stimulate thyroid to produce too much T4

29
Q

What drugs can cause hyperthyroidism?

A

Iodine
Amiodarone
Interferons

30
Q

How is hyperthyroidism treated?

A

Destroying part of the thyroid via radioactive iodine (RAI-131) or surgery
Patient is managed with Propylthiouracil (PTU) or methimazole while waiting for surgery
Need to treat at high dose for 1-3 months before symptoms control is complete

31
Q

What medications are thionamides

A

Propylthiouracil (PTU)

Methimazole

32
Q

Thionamide MOA

A

Inhibit synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland
PTU also inhibits peripheral conversion of T4 to T3

33
Q

Thionamide BBW, warnings, SE, and notes

A

BBW: (PTU) severe liver injury and acute liver failure, pregnancy (PTU preferred in 1st trimester)
Warnings: hepatotoxicity, agranulocytosis, DILE
SE: GI upset
Notes: methimazole is usually DOC; PTU is preferred in thyroid storm and in 1st trimester of pregnancy

34
Q

Iodides MOA

A

temporarily inhibit secretion of thyroid hormones

35
Q

Levothyroxine (T4) brand names

A

Synthroid
Levoxyl
Unithroid

36
Q

Thyroid, Desiccated (T3 and T4) brand names

A

Armour Thyroid

37
Q

Liothyronine (T3) brand names

A

Cytomel

38
Q

Why is potassium iodide used after radiation exposure?

A

It blocks the accumulation of radioactive iodine in the thyroid gland, preventing thyroid cancer

39
Q

What is thyroid storm?

A

Life-threatening medical emergency
Decompensated hyperthyroidism that can be precipitated by infection, trauma, surgery, radioactive iodine treatment, or non-adherence to anti-thyroid medication

40
Q

S/sx of thyroid storm

A 
Fever >103 F
Tachycardia
Tachypnea
Dehydration
Profuse sweating
Agitation
Delirium
Psychosis
Coma
41
Q

How to treat thyroid storm?

A 
Anti-thyroid drug therapy (PTU)
Inorganic iodide therapy (SSKI) or Lugols' solution
Beta blockers (propranolol)
Systemic steroid (dexamethasone)
Aggressive cooling
42
Q

How to treat hypothyroidism in pregnancy - what adverse outcomes can occur if left untreated?

A

Levothyroxine is DOC - will require 30-50% dose increase

Untreated can lead to loss of pregnancy, low birth weight, premature birth, lower IQ

43
Q

How to treat hyperthyroidism in pregnancy - what adverse outcomes can occur if left untreated?

A

If treatment is necessary: antipthyroid drugs (PTU first trimester, methimazole in 2nd and 3rd)
Untreated can lead to loss of pregnancy, low birth weight, thyroid storm, maternal HTN and CHF, seizure disorder in baby

NAPLEX Review (79 decks)

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