Thyroid Modulation

Question 1

Propranolol

Answer 1

• Beta Blocker

- Modify tissue response in Grave’s

Question 2

Hydrocortisone

Answer 2

• Cortisol Agonist

- Modify tissue response in Grave’s

Question 3

Levothyroxine

Answer 3

• T4 Replacement
• Be more aggressive in correcting kids
• Lower doses in oldsters
• Caution in cardiac disease
• Absorbed in ileum/colon, best taken on empty stomach
• Lots of DDIs, recommend spacing other drugs 2 hours

Question 4

Liothyronine

Answer 4

• Synthetic T3
• Quick uptake, quick action, short duration
• Not recommended for routine replacement
• Can be used as an adjunct for T4 therapy
• Avoid in cardiac disease
• Used in T3 suppression

Question 5

Liotrix

Answer 5

T4/T3 mix at 4:1

-Expensive and no advantage

Question 6

Thyroid USP

Answer 6

• Dried pig thyroid
• Variable ratios of T4/T3
• Protein antigenicity
• Less stable protein

Question 7

Methimazole

Answer 7

-Interferes with thyroid hormone synthesis
-Best in mild disease
-Caution in pregnancy
-Side Effects
1-Rash, GI probs, joint pain
2-Can cause agranulocytosis

Question 8

Propylthiouracil (PTU)

Answer 8

-Interferes with thyroid hormone synthesis
-Best in mild disease
-Caution in pregnancy but better than methimazole
-Side Effects
1-Rash, GI probs, joint pain
2-Can cause agranulocytosis
3-RARE- Hepatotoxicity

Question 9

SSKI

Answer 9

• High dose Iodide
• Inhibits hormone synthesis and release
• Rapid effect, but variable and rapidly reversible also

Question 10

Lugol’s Solution

Answer 10

• High dose Iodide
• Inhibits hormone synthesis and release
• Rapid effect, but variable and rapidly reversible also

Question 11

Radioactive Iodine

Answer 11

• I-131
• Take orally, wait for beta-radiation to destroy thyroid
• Easy, cheap, effective
• But also slow, not always effective first time
• Can cause thyroiditis
• Can worsen ophthalmic problems