Thyroid

Front 1

What are the s/sx of hyperthyroid?

Back 1

Weight loss, heat intolerance, heart palpitations, nervousness

Front 2

What are the s/sx of hypothyroid?

Back 2

Cold interolance, fatigue, weakness, weight gain, bradycardia

Front 3

How do you treat hyperthyroidism?

Back 3

1) Thioureas (PTU, methimazole)
Works by inhibiting iodination and synthesis of thyroid hormones

ADE: hepatotoxicity (BBW) with PTU
Leukopenia
rash
arthralgias

slow onset, may need to wait 4-6 months

2) Beta blockers
blocks hyperthyroid effects, may block T4 to T3 manifestation

3) Iodines (Lugol's, potassium iodide)
Inhibits the release of hormone

ADE: hypersensitivity, metallic taste

Primarily used temporarily before surgery

Front 4

How do you treat hypothyroidism

Back 4

1) levothyroxine (synthetic T4)

ADE: hyperthyroidism, cardiac abnormalities

Most clinicians recommend brand name only

2) Liothyronine (synthetic T3)

ADE: May have higher incidence of ADE to T4. Has shorter half life

3) Liotrix (4:1 ratio of T4 t T3)
Seldom used

Front 5

What is thyroid storm and how do you treat it

Back 5

Severe life threatening thyrotoxicosis. Fever, tachycardia, vomiting, dehydration, coma, tachypnea, delirium

Treatment
PTU 300mg tid
iodide therapy after PTU
beta blocker therapy (esmolol)
APAP, NSAIDS for therapy
Corticosteroid therapy 25-100mg/d

Front 6

What is myxedema coma and how do you treat it

Back 6

Life threatening decompensated hypothyroidism

Coma is not required, altered mental status, hypertension, hypothermia

Treatment:
IV T4 LD and then maintenance until oral therapy is tolerated

Some advocate T3 use

Corticosteroid therapy hydrocortisone 100mg q8h unless cortisol therapy is ok