Treatment of Thyroid Disease

Question 1

Hypothyroidism

Answer 1

Causes: hashimoto’s thyroiditis, surgery, RAI

• failure of thyroid gland to secrete adequate amts of thyroid hormone
• placid appearance, pale, depressed, fatigue, hypothermia, dry skin, bradycardia

Question 2

Hyperthyroidism

Answer 2

Graves, toxic nodules, thyroiditis

tachycardia, tremor, thyroid enlargement, increase deep tendon reflex
proximal muscle weakness
dermopathy- thickened skin
ophthalmopathy

Question 3

Hashimoto’s

Answer 3

Chronic autoimmune thyroiditis

• hypothyroidism
• ab to thyroid peroxidase and thyroglobulin
• suppression of free T3 (more potent) and T4
• elevation of TSH

Question 4

primary hypothyroidism

Answer 4

decreased free T4 and elevated TSH

Question 5

secondary hypothyroidism

Answer 5

secondary to hypothalamic or pituitary conditions

-decreased free t4, normal or decreased TSH

Question 6

Subclinical hypothyroidism

Answer 6

characterized by absence of symptoms, normal free t4 and elevated tsh

Question 7

levothyroxine

Answer 7

LT4
-needs to be taken on empty stomach
-one hour away from food
-initial therapy for individuals w/ no functioning thyroid or severe secondary hypothyroidism 
half life 7 days

-beware of advanced age and heart disease because polypharmacy may cause calcium and iron binding

Question 8

Triiodothyronine/ liothyronine

Answer 8

T3

• most acive form
• not commonly prescribed drug due to peripheral metabolism

Question 9

what increases thyroid binding globulin

Answer 9

estrogen, tamoxifen, methadone

Question 10

What decreases thyroid binding globulin

Answer 10

androgen

glucocorticoids

Question 11

What displaces thyroid hormone from thyroid binding globulin

Answer 11

salicylates and furosemide

Question 12

what decreases absorption of thyroid hormone or t4

Answer 12

cholestyramine, colestipol, ppi, raloxifene, iron, calcium

Question 13

what decreases in absorption of thyroid hormone or T4 non prescribed meds

Answer 13

bran, soy, coffee

Question 14

Oral estrogen does what to thyroid

Answer 14

raises circulating levels of thyroxine binding globulin, increasing bound fraction and decreasing free fraction of t4

• may increase t4 dosage requirements
• increase by 25% for pts who are pregnant

Question 15

graves disease

Answer 15

autoimmune disorder characterized by IgG ab to thyroid stimulating hormone receptors on thyroid cells

-enlarged thyroid, homogenous, thyroid bruit

Question 16

diagnostics for graves disease

Answer 16

decreased tsh
increased t4/t3
increased RAIU
presence of thyroid stimulating antibodies

Question 17

graves disease tx

Answer 17

beta blockers, ccb, radioactive iodine
thioamides- inhibit thyroid hormone synthesis
thyroidectomy

Question 18

Thioamides

Answer 18

Propylthiouracil shorter half life
Methimazole longer half life
Block iodination process for tyrosyl groups and coupling of iodotyrosines to form
-may lead to rash and urticaria

may cause significant bone marrow depression, agranulocytosis,

Question 19

toxic nodular goiter

Answer 19

more common in elderly than graves
-hyperfunctioning thyroid nodule
-enlarged, nodular thyroid
ophthalmopathy and dermopathy usually absent

Question 20

diagnostics for toxic nodular goiter

Answer 20

dec TSH, increased free T4/3
RAIU and scintiscan will have hot nodule
-TSI absent

Question 21

tx for toxic nodular goiter

Answer 21

radioactive iodine ablation
-thiomides (inh thyroid hormone synthesis)
surgery as last resort

Question 22

thyroiditis

Answer 22

inflammation of thyroid gland may result in release excessive release of thyroid hormone, resulting in thyrotoxicosis

-decreased RAIU study
decreased TSH, inc free T4/t3
inc ESR

Question 23

tx for thyroiditis

Answer 23

beta blockers, aspirin, nsaids, steroids

NO anti-thyroid meds

Question 24

iodides

Answer 24

inhibit organification and hormone release

reduce size and vascularity of gland

Question 25

beta blockers

Answer 25

propranolol
inhibit b adrenoreceptors
inhibit T4 to T3 conversion