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47 Cards in this Set

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Labs results for hypothyroidism
> TSH
< T4 and T3
Lab results for hyperthyroidism
< TSH
> T4 and T3
A pt has normal TSH levels with slightly < T4, what do you do?
increase synthroid dose
Causes of hyperthyroidism
Graves disease
TSH like proteins(from IVIG)
Tumors
Goiter due to Iodine
Physical characteristics of Graves disease
Goiter
Exophthalmos
Pretibial edema
Clinical presentation of Graves
Loss of weight
Nervousness
Heat intolerance
Moist skin
Onycholysis
How do you treat hyperthyroidism?
Methimazole
Propothiouracil
Iodides
RAI-radioactive iodine
Sugery
What's the MOA of Thioamides?
inhibit coupling of MIT and DIT
inhibits oxydation of iodine

inhibits peripheral conversion of T4 and T3 (only PTU)
what's the dose of Methimazole?
30mg/d initial for 7 days then 5mg maintenance
what are the adverse drug reactions of methimazole?
LFT changes
Leukopenia
Agranulocytosis(stop drug)
Rash
GI
PTU is the DOC in which conditions
Pregnancy
Nursing mothers
Thryoid storm
what drug inhibits peripheral conversion of T4 to T3
PTU
What is the dose of PTU?
75 mg QID initial then
100mg/day in divided doses
What are the S.E of PTU?
LFT changes
Leukopenia
Agranulocytosis
Rash
GI
Hepatitis
A pt in the ER comes in with a thyroid storm, what do you order?
PTU and Lugol's solution

Has better progression to euthyroid state
what are 2 Iodine treatments
SSKI- 40mg of iodine/drop
Lugol's- 8mg iodine/drop
what are the S.E of iodides
Metallic taste
Rash
what is the MOA of RAI?
Destroys thyroid follicles
How long does it take to see the effects of RAI?
3-6 months
what is the MOA of iodides?
prevents hormone release and hormone synthesis
what is the presentation of Acute thyrotoxicosis(thyroid storm)
Fever
Tachy
Tremor
Confusion
How do you treat thyroid storm?
BBs- control systemic and peripheral symptoms

PTU, Iodides- suppress hormones

Corticosteroids- suppress inflommatory process
MCC of hypothyroid
Hashimoto's - autoimmune
what are the S.E of Synthroid?
Sweating
Weight loss
(which are symptoms of hyperthyroid if you think about it)
What drugs interact with thyroid replacement?
Bile Acids
Oral Contraceptives
Warfarin
Lithium
How does Synthroid affect Warfarin?
There may be an increase in synthesis of clotting factors so the INR may decrease; you may need to increase the dose of warfarin
What does lithium do?
inhibits release of thyroid hormone
what does the adrenal cortex secrete?
Aldosterone
Androgens
Cortisol
Name some functions of cortisol
response to stress
maintains BP
breaks down sugar
metabolism of proteins,carbs,fats
slows inflammatory respone
name a mineralcorticoid produced in the cortex
Aldosterone
How do you Dx Cushing's syndrome?
Dexamethasone suppression test(overnight- give 1mg at 11pm, obtain cortisol level at 8 am)

24 hr free cortisol test
How do you treat Cushings?
If adenoma, carcinoma or pituitary dependent, do surgery
what is the effect of spironalactone on aldosterone?
Antagonist
S/Sx of hyperaldosteronism
HTN
< K- due to Na retention
Fatigue
Nocturia
Dose of spironalactone
200-400mg/day
Causes of secondary hyperaldosteronism
Diuretics
Pregnancy
Hemorrhage
which diurectic can cause hyperaldosteronism
Thiazides
spironalactone
Loops
A pt with HTN and hyperaldosteronism; what drug should you prescribe
Ace Inhibitor to decrease aldosterone production
what are the clinical presentations of Addison's disease?
Hypotension
Hypoglycemic
Wt loss
Dehydration
< NA
> K
How do you treat Addison's?
Lifetime Tx of corticosteroids
How do you treat chronic adrenal insufficiency?
Fludrocortisone: replaces aldosterone to control Na and K and keep BP normal
What is the dosing for Fludrocortisone?
0.10mg PO q24
How do you treat acute adrenal insuffieciency?
Hydrocortisone 100mg IV q6 for 24 hr then
50mg IM q6 hr

Once oral meds are tolerated:
40mg po q AM and 20mg q PM 24
which corticosteroids come in IV or oral formulations?
Hydrocortisone (Cortef)
Methylprednisone
Dezamethasone
what are the equivalent conversions of corticosteroids?
Cortison 25mg
Hydrocortisone 20mg
Prednison 5 mg
Methylprednisone 4mg
Dezamethazone 0.75mg
what are some uses of corticosteroids?
Replacement therapy
Anti-inflammatory
Immune suppression
Asthma/allergies
what happens if you stop steroids too quickly?
HPA axis suppression; so taper off slowly