Thyroid Disorders (Chen)

Question 1

what laboratory values determine hyperthyroidism?

Answer 1

1. DEC. TSH
2. INC. FT4
3. INC. FT3I

Question 2

what laboratory values determine hypothyroidism?

Answer 2

1. INC. TSH
2. DEC. FT4
3. DEC. FT3I

Question 3

what are some drugs that can cause hyperthyroidism?

Answer 3

1. iodinated compounds
2. amiodarone
3. interderons a and b
4. lithium

Question 4

what are treatments options for hyperthyroidism?

Answer 4

1. thioamides
   –> methimazole & propylthiouracil
2. RAI
3. Surgery

Question 5

tell me about the thioaimide comparison and what is used for pregnancy?

Answer 5

1. 20 mg of PTU per 1 mg Methimazole
2. Pregnancy
   –> methimazole (after 16 weeks)
   –> PTU (preferred; 1st trimester)
3. PTU can have hepatic failure

Question 6

what are some adverse reactions to thioamides?

Answer 6

1. Gi upset –> TWM
2. rash
   –> maculopapular, no systemic symptoms
   –> wheals, hives, SOB

Question 7

what is a severe adverse effect of thioamides and the warning signs?

Answer 7

1. agranulocystosis
2. warning signs
   –> fever > 101
   –> mouth sores
   –> sore throat
   –> flu-like symptoms >2 days

Question 8

how do you monitor thioamides?

Answer 8

1. Q4-6 weeks
2. use minimal dose of medication

Question 9

when is radioactive iodine contraindicated?

Answer 9

pregnancy, lactation, planing to be pregnant <6 months

Question 10

when is radioactive iodine not recommended for graces’ orbitopathy?

Answer 10

when it is moderate to severe

Question 11

when do you use a beta blocker for hyperthyroidism ?

Answer 11

1. HR >90 bpm
2. short term therapy to alleviate symptoms

Question 12

what beta blocker is best to use for pregnancy and overall?

Answer 12

1. atenolol can not be used in pregnancy
2. metoprolol is preferred in pregnancy and is more selective at the heart

Question 13

what drugs can induce hypothyroidism?

Answer 13

1. amiodarone
2. lithium
3. interferons

Question 14

what medication is mostly used in hypothyroidism?

Answer 14

levothyroxine

Question 15

what is a black box warning for levothyroxine?

Answer 15

weight loss and has negative effect on the heart

Question 16

when taking a medications that decrease T4 absorption what do you do?

Answer 16

give levothyroxine early in the morning, spaced away from other meds at least by 4 hours

Question 17

When do you use desiccated thyroid USP?

Answer 17

never

Question 18

why does T3 (liothyronine) have cardiac toxicities?

Answer 18

rapid absorption of T3 to cause hyperthyroid symtpoms

Question 19

How do you dose a uncomplicated adult?

Answer 19

1.6 mcg/kg/day
–> use IBW in obese patients

Question 20

how do you dose a elderly patient > 60)

Answer 20

25-50 mcg/day

Question 21

how do you dose someone with CAG or angina?

Answer 21

12.5-25 mcg/day

Question 22

what do you do when you reassess TSh levels and it is normal?

Answer 22

nothing; continue same dose

Question 23

what do you do when you reassess TSh levels and it is >upper limit: normal?

Answer 23

inc. levo by 12-25 mcg/day

Question 24

what do you do when you reassess TSh levels and it is below lower limit?

Answer 24

dec. levo by 12-25 mcg/day