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29 Cards in this Set
- Front
- Back
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Hypothyroidism
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deficient thyroid hormone production
results in slowing down of all body f(n)s more common in women |
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Hypothyroidism
Types |
primary-thyroid gland failure (common)
--Hashimoto's dz-90% of primary cases secondary-pituitary failure tertiary-hypothalamic failure iatrogenic-follows exposure to radiation other-thyroidectomy, iodine deficiency |
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Hypothyroidism
presentation |
SX include
- cold intolerance - fatigue, somnolence - constipation, menorrhagia, myalgias - hoarseness SIGNS include: - thyroid gland enlargement or atrophy - bradycardia - edema -dry skin - wt gain Myxedema coma is end stage |
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Hypothyroidism
Pathophys |
- T4 (thyroxine) secreted by thyroid
- T4 converted to more potent T3 (iodothyroxine) in tissue - T4 secretion stimulated by TSH - TSH secretion inhibited by T4 - negative feedback loop - Hashimoto's dz is autoimmune |
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Hypothyroidism
Diagnosis |
Plasma TSH levels are elevated in primary hypothyroidism
low plasma T4 confirms dx |
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Hypothyroidism
Treatment principles - doc |
synthetic thyroxine (levothyroxine)
- 100 to 125 mcg PO QD - 30 min before breakfast - dec in elderly 50mcg qd - goal is to maintain plasma TSH in normal range - change dose q6-8 weeks to optimize - overtreatment = subnormal TSH - leads to osteoporosis and a fib |
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Hypothyroidism
how long is one treated? |
Lifetime
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Levothyroxine drug interactions
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antacids, BASs, sucralfate, Calcium, iron, decrease absorption of levothyroxine
separte by at least 4 hours |
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hypothyroidism
drugs |
Levothyroxine (T4)
- Synthroid, Levothroid, Levoxyl, Unithroid Thyro-Tabs Desiccated thyroid USP - Armour Thyroid - Nature-Throid - Westhroid Liothyroine (T3) - Cytomel - Triostat Liotrix (T4 and T3 4:1) - Thyrolar |
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Hypothyroidism
monitoring |
TSH q6-8weeks until normalized
S&Sx improve in a few weeks TSH q 6 -12 months |
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desiccated thyroid USP
--use discouraged why synthetic T3 (liothyronine) --why not used often |
b/c less predictable potency and stability
b/c T3 has shorter t1/2, higher incidence of cardiac s/e, and more difficult to monitor |
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Hyperthyroidism (thyrotoxicosis)
Types |
Graves dz - most common cause
Toxic multinodular goiter (MNG) amiodarone idodine |
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Hyperthyroidism
Presentation |
SX
-heat intolerance -wt loss -weakness -palpitations -anxiety SIGNS -tremor, tachycardia, weakness -eyelid lag, warm, moist skin -afib, CHF |
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Hyperthyroidism
Pathophys |
Graves
-autoimmune dz that produces thyroid stimulating antibodies that mimic TSH MNGs -masses of thyroid tissue that secrete thyroid hormones independent of pituitary control |
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Hyperthyroidism
Diagnosis |
elevated t4 or t3 in presence of decreased TSH
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Hyperthyroidism
treatment |
3 methods:
1) surgery 2) radioactive iodide (RAI) -treatment of choice in Graves and MNG 3) antithyroid (thionamide) drugs -propylthiouracil (PTU) preferred in pregnancy -have no permanent effect on thyroid fn adjunctive tx BBs and CCBs to control tachycardia |
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Adrenals
Cushing's Syndrome |
chronic glucocorticoid (GCC) excess
Types - iatrogenic due to tx w/GCCs - endogenous due to overproductoin of adrenocorticotropic harmone (ACTH) by pituitary gland adenomas |
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Adrenals
Cushing's presenation |
*obesity - face, neck, trunk, abdomin
*HTN *hirutism *acne *amenorrhea *depression *thin skin *easy bruising, DM, osteopenia |
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Adrenals
Cushing's pathophys |
hypothalamus produces corticotropin -
releasing hormone (CRH) CRH stimulates anterior pituitary to release ACTH ACTH stimulates adrenal cortex to produce cortisol |
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Adrenals
Cushing's treatment principles |
iatrogenic
- minimization of corticsteroid exposure is essential Pharmacotherapy is aimed at dec ing cortisol production or act'y w/drug, radiation, or surgery |
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Cushing's Drugs
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ketoconazole (Nizoral)
aminoglutethimide (Cytadren) mitotane (Lysodren) metyraone (Metopirone) |
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Hyperthyroidism
thionamides a/e / monitoring |
may cause agranulocytosis and cirrosis so pts must see physician if have fever, sore throat, abdominal pain, jaundice
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Adrenals
adrenal insufficiency |
Addison's disease
-autoimmune mediated destruction of the adrenal cortex leads to glucocorticoid and mineralocorticoid deficiency |
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Addison's dz
presentation |
Glucocorticoid deficiency
-wt loss -malaise -abdominal pain -depression minearlocorticoud deficiency -dehydration hypotension hyperkalemia salt craving |
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Addison's
pathophys |
- adrenal cortex synthesizes cortisol (requires ACTH)
- adrenal cortex secretes aldosterone, cortisol, and androgenic hormones - mineralocorticoids (eg aldosterone) enhance reabsorption of na and water and increase urinary potassium excret glucocorticoids - affect glucose, CHO, and fat metab - produce anti-inflammatory effects - produce immunosuppresive effects chronic admin of corticosteroids inhibits pituitary ACTH and therefore cortisol (ie Hypothalamic-pituitary-adrenocortical (HPA) axis suppresion) |
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Treatment of Addison's
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lifelong glucocorticoid and mineralocorticoid replacement
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Addisons
DOC for acute adrenal crisis |
hydrocortisone 100mg IV q8h
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Corticsteroids
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cortisone (Cortone)
Hydrocortisone (Cortef, Hydrocortone) prednisone (Deltasone) prednisolone (Prelone, Delta-Cortef) methylprednisolone (Medrol) triamcinolone (Kenalog, Aristocort) dexamethasone (Decadron, Dexone) betamethasone (Celestone) fludrocortisone (Florinef) |
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Miscellaneous Endocrine Drugs
What are the following used for: 1. cosyntropin (Cortrosyn) and corticotropin (Acthar ie ACTH) 2. vasopressin (Pitressin) desmopressin (Stimate ie DDAVP) |
1. dx of adrenal indufficiency
2. Vasopressin: - diabetes insipidus, v fib, shock, variceal hemorrhage Desmopressin: - nocturnal enuresis, diabeter insipidus, hemophilia A, von Willebrand's dz |
