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What is the first line treatment for hypothyroidism?
Levothyroxine 1.6 ug per kilogram per day
start at 12.5 - 25 ug per day in those at risk of angina
What are the side effects of levothyroxine?
Hyperthyroidism if over treated
possible exacerbation of angina
* can be used in benign nodule
What is the treatment of hyperthyroidism?
Consider thyroid surgery, radioactive iodine, propylthyiouracil
Acute management of severe:
Iodine
Symptom relief:
Atenolol 25-50mg QD po may increase to 200mgs QD po
Propylthyiouracil ptu
Initially 50-100 milligrams tid
reduce the dose in renal failure
in a thyroid storm use up to 1200 milligrams daily and divide doses.
Graves disease treatment using radioactive iodine. What is the dose for radioactive iodine?
Approximately 370 MBQ or 10 MCi
more might be used for toxic nodule or nodular goiter or less if uptake is very high.
can be used in renal failure or hot nodule
What are the side effects of PTU?
Skin rash,
allergic reaction,
agranulocytosis,
rarely hepatotoxicity,
interactions with Warfarin response
Warn patient to stop medication if rash, fever, sore throat or jaundice appears!
What is the acute management of severe hyperthyroidism?
Iodine lugol's solution
3-5 drops every 6 hours.
one hour after anti thyroid drug prior to thyroidectomy
if hyperthyroidism is reasonably controlled use the solution to 2-6 drops TID X 7 Days preceding the operation.
What are the side effects of using iodine for severe hyperthyroidism?
Allergy hypersensitivity
administering one hour after PTU blocks radioactive iodine absorption.
For symptomatic relief use Atenolol 25 to 50 milligrams everyday.
you can increase to 200 milligrams everyday.
What are the side effects of radioactive iodine?
Side effects of radioactive iodine are high risk of hypothyroidism
and possible worsening of graves ophthalmopathy
and risk of radiation thyroiditis.
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