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40 Cards in this Set
- Front
- Back
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thyroid track
inhibition |
hypothalmus- TRH
Ant pituitary- TSH Thyroid- T3+T4 inhib- t3+t4 to Ant Pit |
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best lab for thyroid
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TSH
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TSH values
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.3-6
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T3 or T4 better?
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T3 for diagnosing hyper and monitering hypo drug therapy
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values for T3
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free 230-620 total 80-220
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T4 values
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free- .9-2 total- 4.5-12.5
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another name for hyper
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graves
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way to treat graves
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ectomy, radioactive iodine, antithyroid drugs
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biggest prob with hyper
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compliance
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what is toxic noduler giter called and signs
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plummers disease, like graves except eye problems
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thyroid storm caused by
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illness. infection, sepsis- not by rise in thyroid hormones, no lab test
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signs of storm
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fever >105, tachy, tremor
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treatment of storm
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high dose of iodide- suppress iodide release
PTU- suppresses synthesis and conversion BB- heart rate, steroids, IV fluids |
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antithyroid drug
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thionamides- PTU- propylthiouracil
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PTU mechanism and how long does it take for full effect?
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suppresses hormone synthesis takes 3-12 weeks to work b/c of existing thyroid however effect is fast
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adverse effects of PTU-3
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agranulocytosis dc in WBC- rare, sore throat and fever, will happen in first 2 months - CBC may not help
preferred for preg RASH |
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how often do you give PTU?
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q8h
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how long to effects for I131
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full effects 2-3 months
initial is days or weeks |
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good things about I131-4
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cheap, not sx, death is rare, only throid is damaged
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bad things about I131
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effect is delayed,
* causes hypo 90% |
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who should be treated with I131-4
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over 30 not good with sx or drugs, never in lactation or preg
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I131 used for
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diagnosis (small amounts),
thyroid cancer, graves's |
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example of nonradioactive
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strong iodine solution, lugol's
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how does excessive iodine help hyper
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suppresses synthesis and iodine uptake and inhibit release of hormone into blood
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uses of lugols
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before sx along with PTU, 10 days
onset is 24hrs |
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adverse effect of lugols
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iodism
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SxS of iodism adverse effect of lugols
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brassy taste, burning in mouth, teeth and gums hurt,coryza- nasalsneexing and inflammation, HA, Salivation
all goes away with DC |
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overdose of lugols sxs
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GI problems,glottis swelling, severe ab pain is emergency- call hcp
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treatment for overdose of lugols
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stomach lavage, sodium thiosulfate
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how should lugols be given
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with juice
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how is dosage effected in preg women who have hypo
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increased by 50% starting at 4-8 weeks levels at 16 weeks
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what is the prototype for hypo drugs
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synthroid or levothyroxine
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some facts about synthroid
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it converts to t3, bind to proteins 99%, plateau in 1 month
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SxS of thyrotoxcosis
chronic overdosages lead to |
tachy, angina, tremor, fever, nerousness, sweating, heat intolerance---- chronic overdosages can lead to afib
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drug interaction of synthroid absorption prevention and metabolism acceleration
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calcium supplemetns, sucralfate, aluminum antacids (maalox) and iron- all prevent absorbtion
zoloft and pheno can accelerate metabolism |
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effect with synthroid and warfarin and catecholamines, insulin and dig
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warfarin- you will need less b/c syn degrades clotting factors
cata- syn increases cardiac effect- cause dysythmias increase doses insulin and dig |
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takehome for levothyroxine meds
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do not change brands- naroow theraputic range, if switched test TSH 6 months later
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when should you take syn
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30 min before breakfast on empty stomach
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how to evaluate syn treatment
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check TSH but wait 6-8 weeks after, T3+T4 change first, use **T4 b/c some keep high TSH and decrease of symptoms,
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how long should you wait to reduce drug interactions with syn
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4 hours for chol, antacids sucralfate, iron, calcium
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