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15 Cards in this Set
- Front
- Back
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S/S of hyperthyroidism |
anxiety, insomnia, eyelid retractions (exophthalmus), hand tremors, diarrhea, wt loss, excessive sweating, goiter |
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Types of hyperthyroidism |
-Abnl stimulation of thyroid gland: Graves Disease, TSH mediated thyrotoxicosis -Thyroid gland autonomy: Toxic adenoma, Toxic multinodular goiter, Thyroid CA related thyrotoxicosis -Gland inflame with unregulated thyroid hormone disease: subacute thyroiditis, amiodarone-induced thyrotoxicosis |
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what is the antithyroid |
methimazole (Tapazole) propylthiouracil (PTU) |
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how do antithyroids work |
-prevent connection btw iodine and thyroglobin -doesn't get rid of thyroglobin you already have so it takes a while to work (3-8wks) |
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which antithyroid do you want to use in pregnant women |
PTU (Propylthiouracil) bc it doesn't cross the placenta
don't use really use in any other case bc black box warning for liver failure |
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ADR of antithyroid |
Agranulocytosis- get baseline WBC +diff; sore throat and fever rule of 40s
nausea, skin pigmentation, paresthesias, joint pain/stiffness, hepatitis, nephritis |
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what is the rule of 40s |
ADR of agranulocytosis RF: dose greater than 40mg/d AND pt age older 40yrs |
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dose for antithyroid |
Methimazole (Tapazole) 10mg TTT qd |
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when do you evaluate TSH level? |
start at 35 y/o q 5yrs |
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what are sx of hypothyroidism |
pale, cool, puffy skin dry and brittle hair brittle nails drooping eyelids decreased HR decreased appetite lethargy stiffness/muscle fatigue impaired water exception- decreased renal BF decreased basal metabolic rate |
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what are the thyroid supplements |
levothyroxine (T4) liothyronine (T3) desiccated thyroid |
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ADR of thyroid supplements |
unlikely any ADR! insomnia, tachycardia, nervousness |
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what are drug interactions with thyroid supplements |
impaired levothyroxine absorption: food, antacids, iron salts, phosphate binder, PPI
increased thyroxine metabolism: carbamazepine, phenytoin, rifampin, sertraline (zoloft)
impaired T4 to T3 conversion: amiodarone
also tyrosine kinase inhibitors, simvastatin |
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special cases of hypothyroidism |
subclinical hypothyroidism: mildly elevated TSH with nl T4, tx may not be needed
pregnancy: dosing requirement likely elevated
myxedema coma: life threatening, tx with corticosteroids then levothyroxine (probs IV) |
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dose for thyroid supplement |
levothyroxine 100mcg T qd |
