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Thyroid Disorders Zobeck Flashcards

1
Q

What is the purpose of the Thyroid hormone?

A

To regulate metabolism in every cell

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2
Q

Which thyroid hormone is more potent?

A

T3

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3
Q

Which thyroid hormone has a shorter half life?

A

T3

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4
Q

Which thyroid hormone is more protein bounded?

A

T4

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5
Q

What blocks NIS?

A

SCN, ClO4, low anions

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6
Q

What blocks TPO?

A

PTU, MMI, Carbimazole

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7
Q

If there is an excess of T4 and T3 in your body, how will that affect TSH and TRH?

A

negative feedback. Less TSH and TRH.

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8
Q

What are the proteins that TH bind to?

A

TBG, Albumin, Transthyretin

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9
Q

Is bound TH or unbound active?

A

UNbound is active because it is free TH

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10
Q

An increase in TBG …

A

decrease the free T4

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11
Q

What increases TBG

A
  1. Pregnancy
  2. New born state
  3. HIV infection
  4. Hepatitis
  5. Birth control
  6. Tamoxifen
  7. Perphenazine
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12
Q

What decreases TBG

A
  1. Steroids
  2. Glucocorticoids
  3. Salicylates
  4. Chronic liver disease
  5. systemic illness
  6. Nephrosis
  7. Phenytoin,
  8. carbamazepine
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13
Q

What is used to measure hormone levels?

A

Free T4

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14
Q

What are the symptoms of Hypothyroidism?

A
  1. Decrease BP, HR, CO
  2. Cold intolerance
  3. Constipation
  4. Lethargy, tired, depressed , mental fogginess
  5. dry skin, scaly, brittle nails, dry hair
  6. weight gain, hyperglycemia, hyperlipidemia, hypertriglyceridemia
  7. Goiter, myxedema
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15
Q

What are the symptoms of Hyperthyroidism?

A
  1. increase HR, BP, A. Fib, Myocardial hypertrophy
  2. Heat intolerance, flushing and sweating
  3. Anxiety, insomnia, tremor
  4. Warm/moist skin, hair loss
  5. Weight loss
  6. Osteoporosis
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16
Q

What is the most sensitive lab test for thyroid function?

A

TSH

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17
Q

What tests do you use to diagnose initial diagnosis

A
  1. TSH

2. FT4

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18
Q

What test do you use to test for abnormalities

A

FT3

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19
Q

What lab test is not useful

A

TT4

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20
Q

What are the FT4, TSH, T3 values for primary Hypothyroidism?

A
  1. FT4, low
  2. TSH, high
  3. T3 N/A
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21
Q

What are the FT4, TSH, T3 values for central Hypothyroidism?

A
  1. FT4, low
  2. TSH, low
  3. T3 N/A
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22
Q

What are the FT4, TSH, T3 values for Thyroid-mediated Hyperthyroidism?

A
  1. FT4, High
  2. TSH, low
  3. T3 High
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23
Q

What are the FT4, TSH, T3 values for TSH-mediated Hyperthyroidism?

A
  1. FT4, High
  2. TSH, High
  3. T3 High
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24
Q

What does Radioactive iodine uptake scan measure?

A
  1. Iodine utilization

2. Differentiates hyperthyroidism etiology

25
What does Radioactive iodine uptake NOT measure?
hormone synthesis
26
What does TSab test for?
Autoimmune disease | Test for thyroid stimulating antibodies. which can act like TSH to make hormones
27
What is Grave's Disease?
1. High FT4 2. Low TSH 3. Tsab + 4. goiter Autoimmune disease. Antibodies make a lot of TH. Hyperthyroidism
28
What is the first and second line defense for Grave's Disease?
1. Thioamides 2. Thyroidectomy 3. I radiation
29
What is a Toxic Thyroid Adenoma?
benign tumor that secretes T3 or T4
30
What are the treatments for hyperthyroidism?
``` 1. Beta blocker Propranolol 10-40 mg q6h 2. Calcium channel blockers -diltiazem, verapamil 3. MMI, PTU 4. Iodine ```
31
How should you adjust the dose of PTU, MMI once euthyroid?
Reduce by 30-75%.
32
What is the dose of Methimazole?
1. Initial dose: 15-60 mg/ TID | 2. Maintenance dose: 5-15 mg TID
33
What hyperthyroid drug is preferred?
MMI because they taste better, have a longer half life and is 10 times more potent than PTU
34
What hyperthyroid drug is preferred for pregnancy?
PTU
35
What is the dose of PTU?
1. Intial: 100-200mg TID q4-6 | 2. Maintenance: 50-100mg TID
36
What are the side effects of PTU and methimazole?
1. Liver damage 2. Leukopenia 3. Rash
37
What are the Iodine treatments available?
1. SSKI | 2. Lugol's solution
38
Which one of the Iodine solution is more concentrated?
SSKI | 50mg/drop TID
39
What are the side effects of Radioactive I and total thyroidectomy?
Hypothyroidism
40
If a pregnant women has hyperthyroidism, how often should you monitor her FT4?
Every four weeks
41
What medication for hyperthyroidism is preferred for a mother that is nursing?
MMI
42
What is Thyroid Storm?
Hyperthyroidism
43
What are the treatment for Thyroid Storm?
1. MMI 60-80 mg 2. PTU 500-100mg, 250mg q4 3. propranolol 60-80mg q 4h 4. SSKI 5. Steroid IV - hydrocortisone 300mg IV x1, then 100mg IV Q8hrs
44
What do the laboratory results for hypothyroidism show?
1. Low TT4 2. Low FT4 3. High TSH 4. High Cholesterol 5. Antibodies if Hoshimoto
45
What are the treatment for hypothyroidism?
1. Levothyroxine (T4) 2. Initial: 50-125 mcg/day then 12.5 to 25mcg/day
46
When do you want to use Liothyronine sodium (Cytomel) over levothyroxine?
1. can't absorb levothyroxine 2. Can't convert T4 to T3 3. quicker onset of action
47
What is Liotrix?
4:1, Levothyroxine:liothyronine
48
What is Armour Thyroid
``` For hypothyriodism Natural unstable allergic potential varaible potency ```
49
what happens if you over dose on liothyronine?
You cannot go back to T4
50
What's the difference between Liothyronine and levothyrioxine
Quicker onset on action and shorter duration
51
What should you dose an elderly patient if they are using levothyroxine?
12.5-25 mcg/day
52
Why do you want to monitor elderly patients who are taking Levothryoxine?
They have a slower CL of T4 so they are at risk for toxicity.
53
How often should you check TSH after a new treatment therapy?
6-8 weeks
54
What are should CP for Levothyroxine?
1. Monitor TSH 2. Monitor closely in elderly 3. Separate with food, medications and other drinks
55
What dose of Levothryoxine should elderly be put on?
25 mcg/day. Can be increased 12.5 to 25 mcg q 6-8 weeks
56
What dose of Levothyroxine should patients with pre-existing coronary artery disease be put on?
12.5 mcg/day can increase dose 12.5mcg q 6-8 weeks
57
In pregnancy, while taking Levothyroxine, how much should your dose be increased by?
50% because the fetus needs T4 to develop
58
What are the concealing points for pregnancy and levothyroxine
1. Monitor every 4 weeks FSH, FT4
59
what is Myxedema Coma?
Coma due to long standing hypothyroidism. Have to give T4 in IV because your body is shut down

Nonliner (Dose Dependent Pharmacokinetics) (4 decks)

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