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Endocrine 2 > Thyroid Drugs - Kruse > Flashcards

Thyroid Drugs - Kruse Flashcards

1
Q

Levothyroxine

A

T4

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2
Q

Liothyronine

A

T3

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3
Q

Liotrix

A

4:1 T4:T3

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4
Q

4 antithyroid agents

A

Radioactive iodine sodium
Methimazole
Potassium iodide
Propylthiouracil [PTU]

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5
Q

Levothyroxine - use

A

Hypothyroidism (thyroid hormone replacement), myxedema

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6
Q

Levothyroxine, Liothyronine - toxicities

A

Tachycardia, heat intolerance, tremors, arrhythmias

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7
Q

Liothyronine - use

A

Short-term suppression of TSH

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8
Q

Propylthiouracil, Methimazole - MoA

What else does PTU do?

A

Inhibits thyroid hormone synthesis - Inhibits thyroid peroxidase, blocking oxidation of iodide. Also inhibits coupling of DIT and MIT to form T3 and T4.

PTU - also blocks 5’-deiodinase, inhibiting peripheral conversion of T4 to T3

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9
Q

A patient is given PTU. What is different on labs afterwards than if he was given Methimazole?

A

PTU = significant decrease in T3 concentration compared to T4

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10
Q

PTU, Methimazole - most common toxicity

Most serious toxicity?

A

Maculopapular pruritic rash (+ systemic signs)

Agranulocytosis (rare)

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11
Q

Methimazole - unique toxicity

A

Aplasia cutis (TERATOGEN)

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12
Q

Perchlorate (ClO4-), Pertechnetate (TcO4-), Thiocyanate (SCN-) – MoA

A

Inhibit iodide uptake via competitive inhibition

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13
Q

A patient tries to OD on her anion inhibitor thyroid medications. How to fix?

A

Give lots of iodide

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14
Q

Grave’s disease, young, small/mild disease…treatment?

If pregnant?

A

Methimazole

PTU if pregnant

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15
Q

Grave’s disease, very large gland and severe disease…treatment?

A

Thyroidectomy

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16
Q

Grave’s disease, over 21 y/o…treatment?

Side effect?

A

Radioactive iodide

Hypothyroidism (requires hormone replacement)

17
Q

Grave’s disease, being treated w/ Methimazole or PTU. Still struggling w/ tachycardia, HTN, A. fib. Additional treatment?

A

Non-sympathomimetic beta-blocker (Metoprolol, Propranolol, Atenolol)

18
Q

Grave’s disease, being treated w/ Methimazole or PTU. Still struggling w/ tachycardia, HTN, A. fib. Also has Asthma/COPD. Additional treatment?

Why?

A

Diltiazem (Ca-channel blocker)

Asthma/COPD = contraindication for beta blocker

19
Q

Patient has hyperthyroidism and acutely starts experiencing fever, tachycardia, HTN, diarrhea, and neuro abnormalities. Diagnosis?

Treatment?

A

Thyroid storm

Tx = Beta blockers + Potassium iodide + PTU/methimazole + IV hydrocortisone

Endocrine 2 (12 decks)

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