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P2 E3 Shea > Thyroid/Parathyroid 1 > Flashcards

Thyroid/Parathyroid 1 Flashcards

1
Q

The following are signs of what?

cold intolerance

fatigue

face/eyelid edema

brittle hair/nails

A

Hypothyroidism

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2
Q

The folllowing are signs of what?

heat intolerance

bulging eyes

Inc. HR

weight loss

A

Hyperthyroidism

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3
Q

Which structures release which hormones in relation to the thyroid and parathyroid?

A

hypothalamus –> TRH –> ant pit. –> TSH –> thyroid gland –> T3/T4

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4
Q

Affinity at the receptor for ____ is 10x lower than T3.

A

Affinity at the receptor for T4 is 10x lower than T3.

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5
Q

T/F: Starvation leads to decreased T3/T4 receptors.

A

True

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6
Q

Which drugs cause a decrease in T3/T4?

A

corticosteroids

diclofenac (T3)

Naproxen (T3)

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7
Q

Lab results for Primary hypothyroidism

A

Inc TSH, Dec. T4

This is a thyroid problem

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8
Q

lab results for secondary hypothyroidism

A

dec. free & total T3/T4

cannot trust TSHL it could be nml or decreased

This is a pituitary problem

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9
Q

lab results for autoimmune thyroiditis

A

elevated anti-thyroid peroxidase antibodies

anti-TG antibodies

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10
Q

lab results for subclinical TSH

A

inc. TSH, normal T4

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11
Q

When would you treat subclinical hypothyroidism?

A

if pt has:

  1. iron deficiency anemia
  2. TSH >10
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12
Q

What changes should you make to thyroid medications during pregnancy?

A

Increase thyroid meds dosage by 25-50%

Monitor TSH monthly in 1st trimester

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13
Q

What is the TSH goal in 1st trimester of pregnancy?

A

TSH: 2-2.5

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14
Q

Which drug can increase TSH?

A

amiodarone

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15
Q

What is the half-life of levothyroxine?

A

7 days

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16
Q

When should you recheck labs after giving levothyroxine?

A

4-6 weeks post initial dose or dose change

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17
Q

Levothyroxine mimics which Thyroid hormone?

18
Q

What does it mean that the relationship between Levothyroxine (T4) and TSH is not linear?

A

very small changes in T4 concentration can lead to substantial changes in TSH

19
Q

What can impair Levothyroxine (T4) absorption?

How should you take it then?

A

Food can impair absorption

Take in AM 1hr before food

20
Q

Meds that decrease levothyroxine(T4)

A

iron

Ca carbonate

espresso coffee

H2 blockers/PPIs

21
Q

What 2 things could block the conversion of T4 to T3?

A

selenium deficiency

amiodarone

22
Q

Liothyronine (cytomel)

A

synthetic T3

gives you a burst of energy and has rapid onset

23
Q

Dessicated Thyroid Extract

A

natural forms: dessicated pork thyroid gland

NOT RECOMMENDED AS TX

24
Q

Most pts require starting at _____mcg/kg/day of levothyroxine(T4) for full replacement

A

Most pts require starting at 1.6 mcg/kg/day of levothyroxine(T4) for full replacement

25
T/F: dose of Levothyroxine is **estimated on ideal Body weight**
True
26
What Levothyoxine (T4) dosage should you start patients **\>45y/old w/o CVD** on and what should you increase to after 1 month?
Initiate with **50mcg QD** and **increase to 100mcg QD after 1 mo**
27
Initial dose of Levothyroxine in older patients
25mcg QD: titrate up by 25mcg monthly
28
T/F: Give only 2/3rds of Levothyroxine dose in older patients because they have a greater clearance.
False: Give only 2/3rds of Levothyroxine dose in older patients because they have a **_lesser_** clearance.
29
**T/F:** Increase the levothyroxine dose when starting post-menopausal hormone replacement.
True
30
Excess doses of Levothyroxine has what 2 effects?
Increased serum digoxin levels decreases sensitivity to warfarin (need to increase warfarin dosage)
31
Excess doses of thyroid hormone cause
**heart failure** angina pectoris **MI**
32
least allergenic levothyroxine dosage?
50mcg tablet
33
when do you want to use levothyroxine tx?
1. nodular thyroid dz 2. diffuse goiter 3. H/o thyriod irradiation 4. thyroid CA **Levothyroxine suppresses TSH to keep thyroid from functioning**
34
ideal TSH levels of **high-risk** thyroid CA pts
suppress TSH **\< 0.1**
35
ideal TSH levels for **low-risk** thyroid CA pts
suppress TSH to lower limit nml: **(0.1-0.5)**
36
cardinal signs of hyperthyroidism
weight loss and increased appetite
37
antithyroid drugs are 1st line tx in which 3 populations?
kids adolescents preggos
38
pros of antithyroid drugs
1. **noninvasive** 2. reduced cost 3. decreased risk of permanent hypothyroid
39
cons of antithyroid drugs
1. **low cure rate** 2. ADEs 3. reduced compliance
40
MOA of thiourea drugs
serve as preferential **iodinating intermediate of thyroid peroxidase**--\> **_inhibit coupling of monoiodo tyrosine & diiodotyrosine_** to form T3 & T4
41

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