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58 Cards in this Set
- Front
- Back
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What are the symptoms of hyperthyroidism due to?
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Overactivation of the sympathetic NS
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What are the 3 most common causes of Hyperthyroidism?
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1. Grave's disease
2. Toxic nodular goiter 3. Transient things - subacute thyroiditis, hashimoto's thyroiditis |
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Which is the MOST common?
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Grave's disease
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What happens in Grave's disease?
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TSI - thyroid stimulating Ig's - develop and stimulate the TSH receptor
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What other antibody in addition to TSI develops in Grave's disease?
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Anti-TSH
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What is another term for TSI's?
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LATS - long acting thyroid stimulating antibodies
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What accounts for 10-40% of hyperthyroid cases?
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Toxic nodular goiter
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What is multinodular toxic goiter also referred to as?
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Plummer's disease
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What is a uninodular toxic goiter referred to as?
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Toxic adenoma
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What are the 4 basic types of treatment for hyperthyroidism?
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-Surgery
-Medicine -Iodinated contrast media -Propanolol |
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When is surgery NOT the tx of choice?
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For pregnant women
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When is surgery indicated?
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If a patient refuses radioactive iodine or has a very large gland/goiter
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What are 3 advantages of surgical txmt for hyperthyroidism?
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-Effective
-Safe generally -No usual recurrance |
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What are the bad things about surgery?
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Complications/Anesthesia
-Hypothyroid/parathyroid as a result |
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How do Monovalent hydrated anions treat hyperthyroidism?
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By blocking the Na/I symporter so there is less iodine uptake by the gland.
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What are the 3 more common types of medical therapy for hyperthyroidism?
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-Thiourea derivatives/Thionamides
-Radioactive iodine -Iodide |
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What are the 2 thiourea derivatives / thionamides?
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-Propylthiouracil
-Methimazole |
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What is the mechanism of Propylthiouracil (PTU) and Methimazole?
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They inhibit the enzyme Thyroperoxidase so inhibit iodide organification
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What are 4 indications for giving PTU/Methimazole?
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-Young patients w/ small glands and mild disease
-Pregnancy -Initial tx of patients that don't want radioiodine -Thyroid storm |
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Is inhibition of Iodide organification the only thing PTU and methimazole do?
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No, but it's their primary mechanism.
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What is the treatment of choice for MOST adult patients with Hyperthyroidism?
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Radioactive Iodine
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What is the mechanism of Radioactive Iodine?
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Radioactive ablation of the thyroid gland!
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What are the side effects of radioactive iodine like in general?
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Few and rare!
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What is Radioactive iodine contraindicated for?
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Children
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What do you ALWAYS have to do before giving Radioactive iodine to a woman?
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A pregnancy test!
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Is radioactive iodine only used for treating hyperthyroidism?
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No it's also used for diagnosing thyroid function disorders
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How does Radioactive iodine work?
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It gets incorporated into thyroglobulin like normal iodine, and then deposited in colloid which it destroys.
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What are the 3 main disadvantages of Radioactive iodine therapy?
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-40-70% of patients develop HYPOthyroidism in 10 years
-The decrease in function takes a long time; 1st doses may not be effective |
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And why is Radioactive Iodine contraindicated in children?
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It can cause neoplasms in them
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How is Iodine given for Hyperthyroidism?
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in HIGH doses
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What are 3 indications for Iodide treatment of hyperthyroidism?
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-During the immediate pre-op period to manage symptoms
-In conjunction with antithyroid drugs like TPU/Methimazole -To manage hyperthyroidism that occurs with radioactive iodine treatments |
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What is the mechanism of Iodide in treating hyperthyroidism?
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It inhibits all aspects of iodine metabolism by the thyroid!
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Are we giving Iodine or Iodide here?
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IODIDE!!!! dont forget it
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Is it radioactive iodine or iodide?
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iodine
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So what are 4 aspects of iodine metabolism that Iodide inhibits?
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-Thyroid hormone release
-Its own Na/I symport uptake -Iodination of thyroglobulin -TSH stimulation of colloid endocytosis/proteolysis.. |
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How does the onset of effects of Iodide compare to that for Radioactive iodine?
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Iodide's effects occur in 24 hours instead of taking several months!
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What adverse reaction to Iodide can occur at the thyroid if doses are too LOW?
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Thyrotoxicosis - low doses STIMULATE the thyroid
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What adverse reaction to Iodide can occur at the thyroid if doses are too HIGH?
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iodide goiter or hypothyroidism
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What are 3 extrathyroidal adverse reactions to Iodide?
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Sore mouth/throat, hypersalivation
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What can Iodide precipitate in developing fetuses due to crossing the placenta?
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Goiters
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How can iodide therapy interact with TPU/methimazole therapy?
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By increasing iodide stores, this may delay the onset of thioamide therapy by preventing its inhibition of peroxidase.
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What else can the increased iodide stores delay?
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Onset of radioactive iodine treatment
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But what can occur if iodide therapy is used alone?
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The gland will 'escape' and severe thyrotoxicosis can occur.
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When is iodide given orally?
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Prior to thyroidectomy
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When is iodide given by IV?
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For thyrotoxic crisis, after antithyroid drugs, or after propanolol.
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What is the name of the drug that is iodinated contrast media?
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Ipodate
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What are the 2 indications for giving Ipodate for hyperthyroidism?
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-Thyroid storm
-When other agents are contraindicated |
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What is Ipodate's mechanism? (2 things, it does)
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-It rapidly inhibits the conversion of T4->T3
-IT inhibits the release of thyroid hormones |
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Does ipodate have side effects?
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nope, it's relatively non-toxic!
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What drug is used as an adjuvant therapy and preoperatively before subtotal thyroidectomy?
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Propanolol
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What is thyroid STORM?
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An acute exacerbation of thyrotoxicosis
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What are 5 drugs given for Thyroid Storm?
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Propylthiouracil
Acetominophen Propanolol Sodium iodide Ipodate |
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What does PTU do for thyroid storm?
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Inhibits hormonal synthesis
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What does NaI do?
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Inhibits stored hormone release
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What does Propanolol do for thyroid storm?
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Suppresses peripheral effects of thyroid hormone
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What does Ipodate do?
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Inhibits T4-T3 conversion
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Whats the way to diagnose Thyroid carcinoma?
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Fine needle aspirate biopsy
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What is required for thyroid carcinoma management? (3 steps)
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1. Thyroidectomy
2. Post-op radioiodine tx 3. Lifetime replacement with Levothyroxine |
