Thyroid Drugs

Question 1

Are you able to tell if someone is having symptoms of hypo/hyper thyroidism?

Answer 1

Good

Question 2

How do you treat myxedema coma?

Answer 2

You need to give Liothyronine sodium (Cytomel) immediately!!

(NOT levothyroxine)

Question 3

Why do you give liothyrhonine sodium (Cytomel) for myxedema coma and not Levothyroxine?

Answer 3

Because Liothyronine sodium is synthetic T3 (not T4) and will work FASTER since it acts right on the receptors and does not need to be converted

Question 4

Which thyroid drug do we use for long term treatment of hypothyroidism?

Answer 4

Levothyroxine, which is synthetic T4

Question 5

If your patient has been taking levothyroxine and their dose is too high and they’re now presenting with signs of hyperthyroidism, what do you need to do?

Answer 5

Reduce dose or stop drug for a few days and then resume at a lower dose

Question 6

which 2 drugs are Thioamides?

Answer 6

Propylthiouracil (PTU)

Methimazole (Tapazole)

Question 7

What is the MOA of thioamides?

Answer 7

Inhibits synthesis of T4

PTU will block conversion of T4 to T3 (methimazole won’t)

Question 8

What is the DOC for Graves?

Answer 8

Methimazole (Tapazole)

Question 9

When would you use Propylthiouracil (PTU) for Graves instead of methimazole (Tapazole)?

Answer 9

Pregnant

Can’t tolerate methimazole

Question 10

If someone is going to have a radioactive iodine ablation, what drug do you pretreat them with before the ablation?

Answer 10

Methimazole or PTU

Not iodide because it will block the uptake of the radioactive iodine

Question 11

If someone is going to have a thyroidectomy, what drug do you pretreat them with to reduce the likelihood of thyroid storm?

Answer 11

Iodide

Question 12

Why do we give iodide for 7-10 days before thyroid surgery?

Answer 12

Decreases vascularity and T4/T3 production= Lower Risk of thyroid storm

Question 13

How does radioactive iodine work?

Answer 13

Small doses- diagnostic scans

Large doses- destroys the gland

Question 14

If someone has Graves’ disease and it’s going to be a few days before their surgery or you’re waiting for the thioamides or radioactive iodine to kick in, what should you give them?

Answer 14

Propranolol- reduces the symptoms of hyperthyroidism

Question 15

Why do you specifically use propranolol to treat symptoms of hyperthyroidism?

Answer 15

It can inhibit the peripheral conversion of T4 to T3