Thyroid Parathyroid

Question 1

Hypothyroid
Hyperthyroid
TSH levels

Answer 1

Hypo- High TSH
Hyper- Low to no TSH

Question 2

congenital hypothyroidism (cretinism)

Answer 2

hypothyroidism in newborns, measure TSH 5 days after birth.
Tx: Levothyroxine

Question 3

Hypothyroidism adult

Answer 3

Severe: myxedema coma if untreated. rare
Tx: T4 IV therapy

Mild: common, weight gain, weak, lethargy

Tx: levothyroxine

Question 4

Causes of Hypothyroidism

Answer 4

Most common in US: Hashimoto thyroiditis-autoimmune disease

-post partum thyroiditis, hyper, then hypo

Rare in US: low iodine diet
- goitrogens: prevent Iodine usage/absorption in thyroid

Question 5

Levothyroxine

Answer 5

synthetic T4, daily, monitor TSH and free thyroxine, increase dose for pregnant

Question 6

Hyperthyroidism

Answer 6

weight loss, nervousness, restlessness, hot moist, heat intolerance, cramps

-exophthalmos: periorbital inflammation or extraocular muscle hypertrophy

-Low TSH, normal T4/T3

atrial arrhythmias in older pt

Tx: 131 I

Question 7

Graves disease

Answer 7

causes hyperthyroidism
-autoimmune
-IgG antibodies mimic TSH
-TSH suppressed to 0

hypothyroid if gland burns out later

Question 8

131 I

Answer 8

high Iodine dose that kills thyroid gland tissue.
-Tx for hyperthyroid

Question 9

Bisphosphonates

Answer 9

Alendronate**
Zoledronate**
Risedronate
Ibandronate

Treat Osteoporosis
inhibit osteoclast
-analog of pyrophosphate,
slows bone turnover
- may induce apoptosis in osteoclast

Question 10

Osteoporosis

Answer 10

low bone mineral density
-bone fractures (vertebral)

Question 11

Estrogen (Calcitonin similar effect)

Answer 11

Decreases osteoclast activity, increase osteoblast activity, maintains bone density.

decrease in estrogen cause for osteoporosis

Question 12

Alendronate

Answer 12

Bisphosphate
more potent

Tx: osteoporosis
- also Pagets disease

AE: esophageal erosion (high doses for pagets disease)
-Femur fractures, diaphysial/ subtochanteric
-Jaw fractures

-GI distress for all bisphosphonates

Question 13

Risendronate

Answer 13

Chemically diff than all others
binds hydroxyapetite
decrease turnover
-same Adverse Effects as other bisphosphonates

Question 14

Zoledronate (reclast/Zometa)

Answer 14

Reclast: IV once a year
GI adverse
Tx for osteoperosis

Zometa: Injection weekly
-Hypercalcemia
AE: osteonecrosis of jaw

Question 15

Ibandronate

Answer 15

Bisphosphate
once monthly
Tx: osteoperosis
AE: GI
Long term-bilateral simultaneous femoral diaphyseal fracture

Question 16

Estrogen therapy

Answer 16

post menopausal osteoporosis.
risk outweigh benefits(cancer)
Raloxifene:
Osteoporosis
-agonist on bone
AE: thromboembol

Question 17

Denosumab

Answer 17

2nd line osteoporosis
M=Binds RANK, inhibits osteoclast activation
Only if bisphosphonates not tolerated

Question 18

Calcitriol

Answer 18

aka Vit D
increase Ca absorption
decrease Ca excretion
promotes osteoblast

Tx: osteoporosis
-hypoparathyroidism

Question 19

Non drug therapy for osteoporosis

Answer 19

resistance training with Ca supplement

Question 20

hypercalcemia

Answer 20

Caused by hyperparathyroidism
-(primarily) also lung an breast tumors

-polyuria

Question 21

PTH

Answer 21

increases blood calcium

Question 22

Hypercalcemia Tx (PCZ)

Answer 22

Pamidronate
IV only
AE: nausea, osteonecrosis of jaw fracture

Zoledronate(Zometa)

Calcitonin: lowers Ca ,inhibits osteoclast,
Tx for Pagets disease

Question 23

Pagets disease ( CAZ)

Answer 23

excessive bone turnover

Tx:
Calcitonin

Alendronate

Zoledronate(Reclast)