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thyroid medications Flashcards

1
Q

What is the largest endocrine gland in the body?

A

the thyroid

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2
Q

What 3 hormones does the thyroid produce?

A
  • thyroxine (T4) (converts to T3)
  • triidothyronine (T3)
  • calcitonin
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3
Q

What hormones are needed for metabolism?

A

T4 & T3

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4
Q

What does euthyroid mean?

A

normal thyroid gland function

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5
Q

What is a goiter?

A

visible enlargemtn of the thyroid gland

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6
Q

What is graves disease?

A

an antibody mediated autoimmune disease resulting in hyperthyroidism

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7
Q

What is hashimoto’s thyroiditis?

A

an autoimmune disorder often resulting in hypothyroidism

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8
Q

What is the function of thyroid hormones?

A
  • stimulates metabolic activity & oxygen consumption of cells
  • produces heat & thermogenesis
  • stimulates carb, fat, & protein metabolism
  • increases rate of glucose absorption
  • increases erythropoiesis
  • mood
  • works with growth hormone, insulin & sex steroids to promote growth
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9
Q

in what response is are thyroid hormones required?

A

normal respiratory response to hypoxia & hypercapnia respiratory drive

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10
Q

In what parts of fetal development are thyroid hormones critical?

A

neural & skeletal development

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11
Q

What is secretion of t3 & T4 controlled by?

A

TSH from the anterior pituitary

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12
Q

What does TSH control the rate of?

A

rate of thyroid hormone release

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13
Q

how does TSH control the rate of thyroid hormone release?

A

via a negative feedback mechanism

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14
Q

What do levels of thyroid hormone in the blood determine?

A

release of TSH

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15
Q

excess thyroid hormone in the blood leads to?

A

inhibition of TSH

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16
Q

low thyroid hormone in the blood leads to?

A

increase in production of TSH

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17
Q

What stimulates the pituitary to release TSH?

A

the hypothalamus releasing thyrotropin releasing hormone (TRH)

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18
Q

What are the normal ranges for TSH, T4 & T3?

A

TSH (0.4 to 4.5)
- less than .4 = hyper/overactive
- more than 4.5 = hypo
T4 (4-11)
T3 (80-180)

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19
Q

What are the sx of hypothyroidism?

A

fatigue
depression
dry skin
constipation
bradycardia
altered menstruation
weight gain
changes in hair
cold intolerance
cardiac enlargement(in long-standing cases)

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20
Q

Is thyroid hormone production decreased or increased in hypothyroidism?

A

decreased

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21
Q

What causes hypothyroidism?

A
  • can be primary problem
  • can be autoimmune (hashimoto’s)
  • can be result of medical tx (radiation; thyroidectomy)
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22
Q

What is the name for sever hypothyroidism?

A

myxedema

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23
Q

What are the two medications for hypothyroidism?

A
  • levothyroxine
  • armour thyroid (desiccated)
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24
Q

What are the 3 medications for hyperthyroidism?

A
  • methimazole
  • propylthiouracil
  • iodine solutions
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25
What are the brand names of levothyroxine?
- synthroid - levoxyl
26
What is levothyroxine?
a synthetic form of T4
27
levothyroxine has good _____________ & reliability
bioavailability
28
What is the half life of levothyroxine?
6-7 days
29
What is the goal of levothyroxine therapy?
to restore the TSH & T4 back to normal
30
When should levothyroxine be taken?
on an empty stomach before breakfast
31
Is levothyroxine protein bound?
yes; highly protein bound
32
What are the side effects of levothyroxine?
usually similar to hyperthyroidism if dose is too high
33
What is desiccated thyroid also known as?
amour thyroid
34
What is desiccated thyroid?
is a thyroid extract that comes from animal thyroid gland that have been dried & powdered
35
what does desiccated thryoid contain?
both T3 & T4
36
What is the bioavilability of desiccated thyroid?
variable
37
What are side effects of desiccated thyroid?
- changes in appetite - chest pain - diarrhea
38
What are nursing considerations for hypothyroid medication?
- doses are based on TSH results - avoid giving calcium containing medications, antacids, or iron supplements at same time - assess HR prior to giving; if tachycardic may want to consult - life long medication - safe for pregnancy
39
When should blood work be checked when taking hypothyroid medications?
should have TSH checked regulary until dose stabilizes - levels checked 6-8 weeks after starting & after dose changes - then anually - may need to check LFTs & WBCs
40
What is hyperthyroidism causes by?
increased circulating T3 & T4 which comes from overactive thyroid or excessive thyroid hormone production
41
hyperthyroidism can be mild or if not treated can lead to ______
death
42
What is caused by hyper functioning of the thyroid gland?
graves disease (autoimmune disorder)
43
What is the name for the bulging eyes found in hyperthyroidism?
exopthalmos
44
What is used to treat exopthalmos?
tepezza
45
What are the sx of hyperthyroidism?
- anxiety - restlessness - diaphoresis - diarrhea - N/V - tachycardia (check for a-fib) - weight loss - heat intolerance - exopthalmos - changes in menstrual cycle - insomnia
46
What does hyperthyroidism depend on?
underlying cause; directed at either - decreasing thyroid hyperactivity - preventing complications
47
What can hyperthyroid tx consist of?
single or combined therapy consisting of: - anti-thyroid agents - radioactive iodine - surgery
48
What is often the result of hyperthyroid tx?
recurrent hyperthyroidism or permanent hypothyroidism
49
How do thioamides work?
- lower levels by inhibiting formation of thyroid hormones in the cells - inhibit conversion of T4 to T3
50
What do you need to obtain before starting thioamides?
baseline CBC & liver profile
51
When should thiomides be taken?
should be taken on an empty stomach 30 minutes before eating
52
How long might it take to see effects of thioamide therapy?
several weeks
53
What two medications are thioamides?
- methimazole - propylthiouracil (PTU)
54
how often is methimazole given?
given once daily
55
methimazole is the drug of choice unless?
pt is pregnant
56
Where do side effect of methimazole come from?
thyroid suppression
57
methimazole causes ______ GI side effects
less
58
What can cause bone marrow suppression?
methimazole
59
What does propylthiouracil (PTU) do?
converts T4 to T3
60
Can PTU be used during pregnancy?
can be used during first trimester of pregnancy then should be stopped
61
Does PTU have any drug interactions?
yes; several (which ones not stated)
62
What do you need to monitor in pts taking PTU?
LFTs - increased risk of liver inj CBC- leukopenia
63
What are the two types of Iodine used for tx of hyperthyroidism?
- lugol's solution - I-131
64
How long is lugol's solution used?
used short term
65
How does Lugol's solution work?
inhibits release of T3 & T4
66
What can lugol's solution cause?
iodinism
67
What are the sx of iodinism?
- metallic taste - stomatitis - sore throat - hypersensitivity
68
What is I-131?
radioactive iodine
69
What is I-131 typically used for?
- thyroid cancer - thyrotoxicosis - special cases
70
Can you do I-131 therapy during pregnancy?
no; contraindicated
71
What should you avoid when on lugol's solution?
iodine rich foods (seafood, iodinated salt)
72
what are side effects of lugol's solution?
- bitter taste - tooth staining
73
What should a pt who is on I-131 therapy do?
increase fluid intake
74
What kind of precaution should a pt on I-131 therapy be on?
radiation precautions
75
What is the adjuvant therapy for hyperthyroidism?
beta blockers (propanolol or atenolol)
76
With what population are beta blockers used as adjuvant therapy for hyperthyroid?
used in older adults when the HR is greater than 90 or may have hx of arrhythmias, HTN or chest pain
77
When are beta blockers mainly used for hyperthyroid?
used to control sx while waiting for meds to take effect

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