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14 Cards in this Set

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Describe the signs, symptoms, and physiological effects of hyperthyroidism
Palpitations, nervousness, easy fatiguability, hyperkinesias, irritability, tremor, diarrhea, heat intolerance, sweating, weight loss, increased appetite, muscle weakness, eye exopthalmos
Characterize graves Dx in terms of age, sex, pathogenesis, gross and micro appearance
Age: 20-40, Females
Pathogenesis: TSH receptor ab's which bind and stimulate the thyroid.
Gross: Thyroid gland looks symmetrically enlarged
Micro: Dominant feature is too many cells. follicular cells are tall and more crowded. lymphoid infiltrates are present throughout the interstitium
Discuss the clinical use, pharmacokinetics, and adverse effects of the drugs levothyroxine and liothyronine
Both used to tx hypothyroidism. Levothyroxine has a long half life of 7days, liothyronine is short, 24hrs. Adverse effects: nervousness, heart palpitations, tachycardia, intolerance to heat, unexplained weight loss
Describe the steps in thyroid hormone synthesis and release
TSH action is mediated by cAMP and leads to stimulation of iodide uptake. Oxidation of iodine by a peroxidase is followed by iodination of tyrosines on thyroglobulin. Condensation of 2 diiodotyrosine residues gives rise to T4 or T3 still bound to protein.
Discuss the MOA, Pharmacokinetics, and adverse effects of: PTU, Methimazole, Iodide salts, and Radioiodine
Prophylthiouracil: Inhibits thyroid peroxidase, blocks iodine organification, coupling of iodotyrosines, inhibits peripheral deiodination of T4,T3.
Is rapidly absorbed, reaching peak levels after 1 hr. Renally excreted. Give every 6-8 hrs. Maculopapular pruritic rash as SE. Agranulocytosis.
Discuss the MOA, Pharmacokinetics, and adverse effects of: Methimazole
Same MOA as PTU except deiodination of T3 and T4 is less than that of PTU. Excretion slower than PTU. Single daily dose effective. Same SE as PTU
Discuss the MOA, Pharmacokinetics, and adverse effects of: Iodide salts
Inhibits organification, hormone release, decreases size and vascularity of hyperplastic glands. Crosses the placenta and causes fetal goiter. Causes Acneform rash, swollen salivary glands, ulcerations, conjunctivitis, metallic taste, bleeding dx
Discuss the MOA, Pharmacokinetics, and adverse effects of: Radioiodine
Only isotope used for tx of thyrotoxicosis. Destroys thyroid parenchyma. rapidly absorbed, concentrated into thyroid, incorporated into storage follicles. Crosses placenta and excreted in breast milk
Discuss the use of adrenoreceptor antagonists as adjunct therapy in the tx of hyperthyroidism
Beta blockers, without intrinsic sympathomimetic activity are effective therapeutic adjuncts in the mgmt of thyrotoxicosis since many of these symptoms mimic those associated with sympathetic stimulation.
Describe the effects of thyroid hormones as it relates to fetal development, oxygen consumption, heat production and free radical production, pulmonary fxn, the CV system, hematopoetic effects, GI, Sympathetic, neuromuscular, and endocrine effects, lipid and carb metabolism
Fetal: essential for development
Ox Consumption: increases
Heat/free radicals: increases
Pulmonary FXN: maintains normal hypoxic/hypercapnic drive in the respiratory center
CV:increases HR, increases inotropy
Hematopoetic effects: increases 2,3DAG in erythrocytes, allowing incresaed dissociation of O2
GI: increases motility
Sympa: incresaes
Neuromuscular: Increases
Endocrine: increases hormone turnover/fertility
INcreases lipid/carb metab.
List all the possible d/dx of a thyroid nodule and the type of pt most likely to have these
Benign: Thyroiditis, multinodular goiter, agenesis of a lobe, postsurgical/radioiodine hyperplasia, adenomas
Malignant: Papillary, follicular, medullary, and undifferentiated carcinomas
Describe the actions of TSH on thyroid cells:
Thyroid growth, transcription of Tg, Iodination of tyrosine by TPO stimulated H2O2, Deiodination of T4 to T3, T3/4 secretion, Thyroiodide trapping, Thyroperoxidase enzyme activity, thyroid metabolism
Describe how T3 is mediated by nuclear thyroid hormone receptors:
T3 enters and it binds to a nuclear receptor. TRalpha is associated with cardiac fxn, while Beta is associated with feedback regulation and cochlear development. T3 binds the TR, corepressor dissociates, coactivator binds, and a heterodimer is formed.
Describe the relationship between TSh and FT4 in normal, hypothyroid, hyperthyroid individuals
In normal people, TSH and FT4 is normal;
In hyperthyroid: TSH is decreased, but FT4 is increased
In Hypothyroid: TSH is increased, FT4 is decreased
In Levothyroxine suppressed: TSH is decreased, FT4 is Normal.