Thyroid Disorders: Pharmacotherapy (Al-Jammali) Flashcards
TRH from hypothalamus increases the secretion of _____ from anterior pituitary gland.
TSH stimulates the synthesis and secretion of ___ and ___ by the thyroid gland.
T3 and T4 inhibit secretion of ____ by suppressing the release of ____.
T4 is converted to T3 in the liver by the action of ____________
TSH
T3,T4
TSH, TRH
T4 monodeiodinases
In hyperthyroidism, T4 is ________, T3 is _______, and TSH is ________.
In hypothyroidism, T4 is ________, T3 is _______, and TSH is ________.
increased, increased, decreased
decreased, decreased, increased
What are symptoms of hyperthyroidism?
-tachycardia
-weight loss
-lid retraction or lag
what is the most common cause of hyperthyroidism?
other causes?
grave’s disease
goiter, iodine excess, thyroiditis
what is Grave’s disease?
is it more common in men or women?
what are special symptoms only seen in this disease?
what type of treatment can worsen graves ophthalmopathy?
if this treatment method is used, what drug is prescribed to prevent ophthalmopathy and how long is it used for?
an autoimmune disorder with intrinsic activity against the TSH receptor
women
exophthalmos (proptosis… bulging of eyes), and lid lag
use of Radioactive iodine ablation (RIA)
prednisone, 4-6 months
Thyroid enlargement with a bruit frequently audible over the thyroid is a potential cause of what disease?
Grave’s disease
How is Grave’s disease diagnosed?
decrease in TSH and an increase in T4 or having thyroid auto antibodies (TRAb)
How do we treat Grave’s disease?
what drugs can be used to manage the symptoms?
first-line: anti-thyroid drugs to reduce thyroid size and hormone production for 6-12 months
second-line: RIA, subtotal thyroidectomy, or long-term anti-thyroid meds (if can’t have surgery or RIA)
beta blockers. Or CCBs if BBs contraindicated
what is the drug class/MOA of propylthiouracil and methimazole?
Thionamides
blocks iodine from binding to thyroglobulin and tyrosine to inhibit thyroid hormone synthesis. large doses of PTU blocks conversion of T4 to T3
SEs of thionamides?
A fever may be a sign of?
itching rash, arthritis, fever, N/V
neutropenia
Which thionamide is preferred during pregnancy?
propylthiouracil
what is MOA of Iodide solutions?
when do we use them?
block thyroid synthesis and release
10-14 days pre-thyroidectomy to decrease thyroid bulkiness and vascularity
or 7 days after RIA to decrease risk of thyroiditis
symptoms of hypothyroidism?
fatigue, hair loss, and weight gain
causes of hypothyroidism?
iodine excess, antithyroid drugs, iodine deficiency
what could be causing hypothyroid-like symptoms in pts with normal-range TSH lvls?
liver disease, adrenal insufficiency, anemia, viral infections, chronic kidney disease, vitamin D deficiency, depression/anxiety, or meds : lithium and amiodarone
