treatment of thyroid disorders

Question 1

Clinical manifestations of hypothyroidism

Answer 1

“slow”

dry skin, cold intolerence, wt gain, constipation, weakness, lethargy, fatigue, depression, coarse hair, cold skin, periorbital puffiness, bradycardia, speech slow and hoarse

Question 2

Normal ranges for thyroid tests

Answer 2

TSH 0.4-4.8
FT4 0.8-1.7
anti TPOAb-present in AI hypothyroidism
TSHR-SAb- confirms Graves disease

Question 3

Tx of hypothyroidism

Answer 3

Levothyroxine

Thyroid USP

Question 4

Levothyroxine (Synthroid)

Answer 4

MOA: synthetic T4
AE: HTN, tachycardia, insomnia, diarrhea, excessive dose may lead to heart failure, angina pectoris, MI, reduced bone density
Dosing: 1.7 mcg/kg/day (around 100-125 mcg/day_
take first thing in the am on an empty stomach and wait 30 min before eating and 4 hours to take calcium, iron, Mg, Al, sucralfate, cholestyramine, and orlistat

Question 5

Levothyroxine (Synthroid)

Answer 5

MOA: synthetic T4
AE: HTN, tachycardia, insomnia, diarrhea, excessive dose may lead to heart failure, angina pectoris, MI, reduced bone density
Dosing: 1.7 mcg/kg/day (around 100-125 mcg/day_
take first thing in the am on an empty stomach and wait 30 min before eating and 4 hours to take calcium, iron, Mg, Al, sucralfate, cholestyramine, and orlistat

Question 6

clinical presentations of thyrotoxicosis

Answer 6

“fast”

nervousness, emotional lability, easy fatiguability, heat intolerence, prox muscle weakness, wt loss with increased appetite, anorexia, increased fx of bowel movement, palpitations, irregular menses, warm, smooth moist skin, unusually fine hair, onycholysis, lid lag

Question 7

Antithyroid agents

Answer 7

Propylthiouracil and Methimazole

MOA: inhibit the synthesis of thryoi hormone

Question 8

Antithyroid agents

Answer 8

Propylthiouracil and Methimazole
MOA: inhibit the synthesis of thryoid hormone by blocking the oxidation of iodine in the thyroid gland,block synthesis T4 and T3 BUT do not inactivate circulating T3 and T4
AE: (minor) pruritic maculopapular rash, arthralgias, fevers, benign transient leucopenia
(major) agranulocytosis (first 3 mo), arthralgias and lupus like syndrome (6 mo), GI intolerence,
hepatotoxicity
-MMI usually within 3mo
-PTU any time on the drug therefore should be reserved for patients who can’t tolerate other tx, females trying to get pregnant or during first tri, tx of thryoid storm

Question 9

Antithyroid agents

Answer 9

Propylthiouracil and Methimazole
MOA: inhibit the synthesis of thryoid hormone by blocking the oxidation of iodine in the thyroid gland,block synthesis T4 and T3 BUT do not inactivate circulating T3 and T4
AE: (minor) pruritic maculopapular rash, arthralgias, fevers, benign transient leucopenia
(major) agranulocytosis (first 3 mo), arthralgias and lupus like syndrome (6 mo), GI intolerence,
hepatotoxicity
-MMI usually within 3mo
-PTU any time on the drug therefore should be reserved for patients who can’t tolerate other tx, females trying to get pregnant or during first tri, tx of thryoid storm

Question 10

Other tx for hyperthryoidism

Answer 10

Beta blockers
Iodides
radioactive iodine
surgery

Question 11

Other tx for hyperthryoidism

Answer 11

Beta blockers
Iodides
radioactive iodine
surgery

Question 12

Tx of hyperthyroidism caused by graves disease

Answer 12

antithyroid drugs (MMI and PTU)
radioactive iodine
surgery

Question 13

Thyroid storm s/s

Answer 13

high fever, tachycardia, tachypnea, dehydration, delirium, GI disturbances
precipitated by infection, trauma, surgery, radioactive iodine tx, and sudden withdrawal of antithyroid meds

Question 14

Tx of thyroid storm

Answer 14

short acting Beta blocker
IV or oral iodide
large doses of PTU
supportive care
IV hyrocortisone d/t the potential presence of adrenal insufficiency