what laboratory values determine hyperthyroidism?
- DEC. TSH
- INC. FT4
- INC. FT3I
what laboratory values determine hypothyroidism?
- INC. TSH
- DEC. FT4
- DEC. FT3I
what are some drugs that can cause hyperthyroidism?
- iodinated compounds
- amiodarone
- interderons a and b
- lithium
what are treatments options for hyperthyroidism?
- thioamides
–> methimazole & propylthiouracil - RAI
- Surgery
tell me about the thioaimide comparison and what is used for pregnancy?
- 20 mg of PTU per 1 mg Methimazole
- Pregnancy
–> methimazole (after 16 weeks)
–> PTU (preferred; 1st trimester) - PTU can have hepatic failure
what are some adverse reactions to thioamides?
- Gi upset –> TWM
- rash
–> maculopapular, no systemic symptoms
–> wheals, hives, SOB
what is a severe adverse effect of thioamides and the warning signs?
- agranulocystosis
- warning signs
–> fever > 101
–> mouth sores
–> sore throat
–> flu-like symptoms >2 days
how do you monitor thioamides?
- Q4-6 weeks
- use minimal dose of medication
when is radioactive iodine contraindicated?
pregnancy, lactation, planing to be pregnant <6 months
when is radioactive iodine not recommended for graces’ orbitopathy?
when it is moderate to severe
when do you use a beta blocker for hyperthyroidism ?
- HR >90 bpm
- short term therapy to alleviate symptoms
what beta blocker is best to use for pregnancy and overall?
- atenolol can not be used in pregnancy
- metoprolol is preferred in pregnancy and is more selective at the heart
what drugs can induce hypothyroidism?
- amiodarone
- lithium
- interferons
what medication is mostly used in hypothyroidism?
levothyroxine
what is a black box warning for levothyroxine?
weight loss and has negative effect on the heart
when taking a medications that decrease T4 absorption what do you do?
give levothyroxine early in the morning, spaced away from other meds at least by 4 hours
When do you use desiccated thyroid USP?
never
why does T3 (liothyronine) have cardiac toxicities?
rapid absorption of T3 to cause hyperthyroid symtpoms
How do you dose a uncomplicated adult?
1.6 mcg/kg/day
–> use IBW in obese patients
how do you dose a elderly patient > 60)
25-50 mcg/day
how do you dose someone with CAG or angina?
12.5-25 mcg/day
what do you do when you reassess TSh levels and it is normal?
nothing; continue same dose
what do you do when you reassess TSh levels and it is >upper limit: normal?
inc. levo by 12-25 mcg/day
what do you do when you reassess TSh levels and it is below lower limit?
dec. levo by 12-25 mcg/day
