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Pharma S1Y2 > treatment of thyroid diseases > Flashcards

treatment of thyroid diseases Flashcards

1
Q

describe the process of regulation thyroid hormone

A

hypothalamus release TRH

TRH will stimulate pituitary to release TSH

TSH will release THYROID HORMONE

thyroid hormone will negatively inhibit TSH and TRH

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2
Q

what are the stuff we can inhibit in case of hyperthyroidism ?

A

peroxidase enzyme which is responsible coupling and iodination

inhibit the release of thyroid

inhibit the uptake of iodine

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3
Q

what drugs inhibit the peroxidase enzyme?

A

thioamides

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4
Q

what drugs inhibit the uptake of iodine?

A

potassium iodide

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5
Q

how do we inhibit the release of thyroid hormone?

A

lithium

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6
Q

what is the normal level of TSH?

A

0.4 - 4.0 mIU/L

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7
Q

what are some drugs that inhibit the release of TSH?

A

D2 receptor agonist

GHIH analogs –> octreotide

glucocorticoids

metformin

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8
Q

what are some dopamine agonists ?

A

dopamine
dobutamine
levodopa
cabergoline
bromocriptine

these inhibit prolactin and GH ( in acromegaly ) and TSH

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9
Q

what are some stuff that increases TSH secretion?

A

dopamine receptor antagonist ( D2 receptors )

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10
Q

what are some dopamine receptor antagonists?

A

metoclopramide

domperidone

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11
Q

what are the manifestation of hyperthyroidism ?

A

nervousness
emotional
disturbance
weight loss
heat intolerance
palpitations
proximal muscle weakness
increase frequency of bowel movements
irregular menses

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12
Q

what is grave disease?

A

autoimmune disease where antibodies that are similar to TSH bind to the TSH receptor and stimulate more production thyroid hormone and the release of it

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13
Q

what are the characteristics of graves disease?

A

thyroid enlargement

exophthalmos

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14
Q

what are the none pharmacological therapy for hyperthyroidism?

A

surgery

thyroidectomy

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15
Q

when do you consider surgery?

A

large thyroid gland

severe ophthalmopathy

lack of remission on antithyroid drug

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16
Q

what are the drugs used for preparation of thyroidectomy?

A

thionamides –> inhibit production of T3,T4

beta blockers/ propranolol –? relief symptoms and inhibit T3 production

supersaturated iodine–> reduces gland vascularity

lethium carbonate –> block thyroid release

dexamethasone/corticosteroid —-> reduces TSH levels and inhibit T4 to T3 conversion

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17
Q

what is wolff chaikoff effect?

A

when the body gets a large amount of iodine at once this will temporarily inhibit the thyroid synthesis due to inhibition of thyroid peroxidase

this will reduce the vascularity temporarily as well

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18
Q

what are the pharmacological treatments for hyperthyroidism?

A

antithyroid medications

iodides

adrenergic blockers

radioactive iodine

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19
Q

what are some antithyroid medications?

A

thionamides :

methimazole

propylthiouracil

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20
Q

what is the MOA of methimazole?

A

inhibit coupling of MIT AND DIT to form T3 AND T4

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21
Q

what is the MOA of propythiouracil ?

A

inhibit coupling

INHIBIT PERIPHERAL CONVERSION OF T4 to T3

more effective compared to methimazole because it works peripherally as well

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22
Q

which antithyroid drug is the choice for pregnant women?

A

propylthiouracil

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23
Q

what are the side effects of antithyroid medications ?

A

pruritic maculopapular rashes

arthralgias

fever

benign transient leukopenia

AGRANULOCYTOSIS –> LOW AMOUNT OF AGRANULOCYTES –> INFECTION –> major side effect

congenital malformation –> ONLY WITH METHIOMAZOLE

hepatoxicity

24
Q

what is the MOA of iodides?

A

temporarily block thyroid hormone release

inhibit thyroid hormone biosynthesis

decrease size of the gland

25
Q

what could happen if we give large doses of iodide ?

A

hyperthyroidism

or

wolff chaikoff effect

26
Q

when is iodide contraindicated?

A

multinodular goiter

27
Q

what is the clinical use of iodine ?

A

before thyroid surgery

28
Q

what is the example of iodine we give?

A

potassium iodide

29
Q

what is an adjuvant therapy we can use for iodide?

A

iodide + radioactive iodine

30
Q

what are the side effects of iodide?

A

hypersensitivity

salivary gland swelling/enlargement

iodism –> burning of the mouth and throat , headache, metallic taste

gynecomastia –> enlargement of breast tissue in males

31
Q

when is radioactive iodine given?

A

is the agent choice for :

grave disease

toxic autonomous nodules

toxic mngs

32
Q

when is radioactive iodine contraindicated

A

pregnancy

33
Q

what is given before Radioactive iodide in elderies?

A

thioamides

34
Q

what type of adrenergic blockers we use in hyperthyroidism?

A

beta blockers

NONE SELECTIVE bcz selectives dont work

propranolol

35
Q

why do we use beta blockers?

A

js to relief the symptoms

adjunctive therapy with antithyroid drugs, RAI, iodides

36
Q

what is the meaning QID?

A

4 times a day

37
Q

when is propranolol contraindicated?

A

decompensated heart failure

sinus bradycardia

38
Q

what are the side effects of beta blockers?

A

nausea

vomitting

anxiety

insomnia

light headedness

bradycardia

hematologic disturbance

asthma

39
Q

what is the first drug of choice in grave disease + pregnancy?

A

propylthiouracil

40
Q

what is the drug choice for neonatal and pediatric hyperthyroidism ?

A

methimazole first line

if no effect = propythiouracil

41
Q

what is the first drug of choice in thyroid storm?

A

propythiouracil

then antiadrenergic ( BB )

corticosteroids -> prednisone

palliative treatment

42
Q

what are the drugs used in cause of hyperthyroidism associated with ophthalmophaty
or Grave ophthalmopathy ?

A

Teprotumumab —> antibody for IGF1 RECEPTOR IN EYE

treat protrusion not hyperthyroidism

if it is too severe surgery

43
Q

what are the signs and symptoms of hypothyroidism?

A

lethargy

cold intolerance

weight gain

Constipation

myxedema

myxedema coma due to hypoglycemia

44
Q

what is the most common cause of hypothyroidism in adults?

A

hashimoto disease

other causes :
radioactive iodine
surgical removal
iodine deficiency

pituitary/hypothalamic dysfunction –> Secondary hypothyroidism

45
Q

what is the treatment in cause of hypothyroidism?

A

thyroid replacement therapy

46
Q

what are examples of synthetic thyroid hormones?

A

levothyroxine

liothyronine

liotrix

47
Q

what is the drug of choice out of the 3?

A

levothyroxine

48
Q

why is levothyroxine the drug of choice?

A

chemically stable

inexpensive

uniform potency

49
Q

what are the disadvantages of liothyronine?

A

higher incidence of cardiac adverse effects

higher cost

difficulty monitoring with labs

50
Q

what is liotrix?

A

4 :1 mixture of T3

Advantages : stable, predictable , potency

disadvantages : high cost

51
Q

what are the clinical features of myxedema coma?

A

hypothermia

advanced stage of hypothyroid symptoms

altered sensorium ranging from delirium to coma

52
Q

what is the initial treatment of myxedema coma?

A

IV bolus thyroxine

then maintenance treatment also given IV

IV hydrocortisone

53
Q

why is IV hydrocortisone given?

A

to rule out coexisting adrenal suppression

Cuz low TSH is usually has Low ACTH as well so low cortisol

54
Q

what is the treatment in congenital hypothyroidism?

A

maintenance therapy early

levothyroxine

55
Q

what is the treatment for hypothyroidism in pregnancy?

A

levothyroxine as well

Pharma S1Y2 (10 decks)

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