Thyroid Disease Diagnostics

Front 1

What are HyperT therapies?

Back 1

thyroidectomy
RAI-ablation
percutaneous ethanol injection into nodule
iodides
antithyriod drugs (thionamides)
BB/CCB--treat Beta symptoms--adj
CS--adj
Nsaids--adj

Front 2

When would you do surgery for hyperT?

Back 2

thyroidcancer
ectopic thyroi
pit adenoma
toxic nodule
toxic multinodular goiter
graves disease

Front 3

When would you do RAI-ablation for HyperT?

Back 3

Ectopic
toxic nodule
toxic multinodular goiter
Graves--preferred!

Front 4

why do you pre treat RAI-ablation with iodides and thionamides?

(BB/CS)

Back 4

RAI-ablation destorys the gland causing TH to dump into blood, if pre-treated, then there is less TH to dump

must stop wk before treatmetn becasue iodine blocks the pump and RAI wont be able to get in!

Front 5

When would you do percutanous ethanol injection for HyperT?

Back 5

toxic nodule
toxic multinodular goiter

Front 6

When would you do iodides for HyperT?

when would you not use iodides?

Back 6

Graves--pretreat/posttreat for RAI to decrease TH syn

Neonatal Hyperthyroidism--materanl graves--use wiht ATDs

dont use iodides for toxic nodules or transient thyroid (autonomous!)

Front 7

When would you do use ATDs (thionamides) for HyperT?

When do you not use ATDs?

Back 7

Graves disease
Neonatal hyperthyroid (maternal graves--use PTU + iodides)
Thyroid storm

Dont use ATDs for toxic nodules or transient thyroiditis

Front 8

What is the wolff chaikoff effect and when is it seen?

Back 8

increased levels of iodine turn off the pump and decrease TH synthesis

seen in pretreatmetn of RAI wiht iodines

Front 9

Why use BB during therapy with ATDs?

Back 9

BB are adjuntive therapy

BB block TH adrenergic effect--propranolol is recommended (non-selective) use a RACEMIC mixture

Front 10

What would you use to treat thyroid storm?

Back 10

High dose PTU
BB
CS
treat the cause

Front 11

When do you give BB?

Back 11

for adrenergic patholgy of hyperT like thyroid storm

only therapy needed for transient thyroiditis

Front 12

When do you give CS?

Back 12

pain and inflammation associated with thyroiditis, thyroid storm

Front 13

When do you give NSAIDs?

Back 13

pain and inflammation of thyroiditis

thyrotoxicosis

Front 14

What are treatment options for graves?

Back 14

RAI-ablation (pre/post treat with iodides, thionamides, BB, CS)

Thyroidectomy

Antithyroid drugs--PTU and MMI

Front 15

What are risks associated with thyroidectomy?

Back 15

-lose PT and PTH
-lose parafollicular cells and calcitonin
-must replace with levothyroxine
-altered Ca levels

Front 16

Why cant you give iodides for chronic treatment of hyperT?

Back 16

only reduces TH for a few weeks, is eventaully overcome

Front 17

which thionamide can have immediate onset?

Back 17

PTU--because it also blocks the peripheral conversion of T4-->T3

MMI doesnt do this--slow onset because it only inhibits TPO and decreases concentration of TSH-rec abs

Front 18

Which thionamide has slower onset?

Back 18

MMI--does not prevent T4-->T3 lke PTU

Front 19

Which thionamide is smaller and more potetent?

Back 19

MMI

Front 20

Which thionamide has better WS?

Back 20

MMI

Front 21

Which thionamide has longer half-life?

Back 21

MMI

Front 22

Which thionamide has lower PPB?

Back 22

MMI

Front 23

Which thionamide diffuses into milk and across placenta?

Back 23

MMI

Front 24

Which thionamide should be given to pregnant woman?

Back 24

PTU--doesnt cross placenta, milk

Front 25

Which thionamide has a larger dose?

Back 25

PTU--take up to three itimes a day

MMI--more potent, smaller dose

Front 26

Which thionamide could be given in a once daily dose?

Back 26

MMI

Front 27

how long does it take to see resolutino of S/S with thionamides?

when should T4 levels resolve?

Back 27

can take up to a year--compliance is often bad

T4 levesl increase in 16 weeks

Front 28

What should be monitored with thionamides?

how often should you run TFT?

How often should you run TFT once euthyroid?

Back 28

-base T4, TSH, WBC

-every 4-6 weeks

- 3-6m

Front 29

what are mild thionamide ADR?

Back 29

GI--altered taste, NV--depends on dose

Skin--itch, hives,rash--use AH and topical CS

transiet elevation of Transaminases--mainly PTU

joint pain, swelling, fever

-Hypoprothrombinemia--TH will increase biosyn and degrade clotting facots

-benign transiet leukopenia--children, doesnt predict agran

Front 30

What are major thionamide ADR?

Back 30

- agranulocytosis (elderly on PTU)--flu-like symptoms

-overt heptaotoxicity (mainly PTU)

HSR rxn: aplastic anemia, vasculitis, glomerulonephritis, lupus like syndrome, polyarthritis

Front 31

Which thionamide is assocated with hepatoxicity?

Back 31

PTU

Front 32

Thionamide + pregnancy

Back 32

MMI--scalp problems with baby
PTU less likely to cross

PTU and MMI can cause goiter and hypothyroid in baby

Front 33

Which thionamide is safer for liver toxicity?

Back 33

MMI

Front 34

What is the half-life of Levothyroxine (T4)

Liothyronine? (T3)

Back 34

6-7 days

2 days

Front 35

What would you use to treat hypoT pt with CVS disease?

Back 35

Levothyroxine--T4

giving T3 could cause overdose and conduction disorder may result

Front 36

How long does hypoT pt take thyroxine?

Back 36

forever

Front 37

how do you measure pt compliance with drugs for hypoT?

Back 37

T4 levels

Front 38

If taking levothyroxine, how long does it take for TSH levels to decrease?

Back 38

decrease within hours--noramlize in 2-6 weeks