Pharmtx - Final - Thyroid Disorders

Front 1

Three major goals in the treatment of hypothyroidism:

Back 1

replace the missing hormones, relieve symptoms, and achieve a stable biochemical euthyroid state

Front 2

Treatment of choice for almost all pts with HYPOthyroidism?

Back 2

LT4. Mimics the normal physiology of the thyroid gland, which secretes mostly T4 as a prohormone.

Front 3

What is one of the most serious adverse effects of antithyroid drug therapy?

Back 3

Agranulocytosis

Front 4

The growth and spread of thyroid carcinoma are stimulated by __. RCTs show that suppressive __ therapy reduces tumor growth and improves survival

Back 4

TSH
LT4

Front 5

Baseline measurements of serum TSH, FT4, fT3, antithyroid peroxidase antibody(Anti-TPOAb( and TSH receptor-stimulating antibodies(TSHR-SAb) should be perfomed when starting this medication. TSH, FT3, and FT4 should be checked __ months after initiation and then every __ to __ months.

Back 5

Amiodarone
3 months
3-6months

Front 6

In patients with primary thyroid disease. What is the relationship b/w TSH level and thyroid function?

Back 6

There is an inverse relationship b/w the TSH level and thyroid funnction.

Front 7

Thyroid status:
Increased TSH
Increased FT4

Back 7

Pituitary hyperthyroidism

Front 8

Thyroid status:
Increased TSH
FT4 WNL but TSH increases with TRH Stimulation

Back 8

Incipient hypothyroidism

Front 9

Thyroid status:
Increased TSH
Decreased FT4

Back 9

Primary hypothyroidism

Front 10

Thyroid status:
TSH WNL

Decreased FT4 with increased TSH on TRH stimulation

Back 10

Pituitary-hypothalamic

Front 11

Thyroid status:
Decreased TSH
Increased FT4

Back 11

Primary Hyperthyroidism

Front 12

Thyroid status:
Decreased TSH
Decreased FT4

Back 12

Pituitary-hypothalamic

Front 13

Thyroid status:
Decreased TSH with blunted TSH upon TRH stimulation?

Back 13

Incipient hyperthyroidism

Front 14

TRH stimulation test determines if __ still responds, or measures it's function.

Back 14

Pituitary

Front 15

What test measures intrinsic thyroid function?

Back 15

Radioactive iodide uptake

Front 16

This test helps distinguish etiology of thyroid function.

Back 16

Thyroid scan

Front 17

A certain type of hyperthyroidism more prevalent in females.
It has elevated __, depressed ___ and _(inc/dec)__ RAIU.

Back 17

Grave's disease
Elevated T4, depressed TSH, increased RAIU.

*Goiter usually present(2-4x normal size)

Front 18

What are symptoms of hyperthyroidism?(6)
-Weight
-skin
-heart
-Regularity
-muscles

Back 18

-Nervousness
-Weight loos despite increased appetite
-Excessive sweating and heat intolerance
-Palpitations
-Frequent bowel movements
-Muscular weakness of the proximal type and tremor

Front 19

What are sings of hyperthyroidism?(5)
-skin
-eyes
-systolic and diastolic mmHG
-cardiac
-muscles

Back 19

-Warm, smooth, moist skin

-With Grave's disease, eye signs such as stare, lid lag, and exopthalmos

-Increased systolic and decreased diastolic blood pressures

-Tachycardia or artrial fibrillation. Hyperdynamic cardiac pulsations witha accentuated S1.

-Tremor and proximal muscle weakness

Front 20

Hyperthyroidism:
1. Toxic diffuse goiter(disease)
2. Solitary toxic nodule(disease)
3. VIral infections could be main trigger, self-limiting

Back 20

1. Graves disease
2. Plummer's disease
3. Thyroiditis

Front 21

Hyperthyroidism:

Thyroid storm can be a life-treatening medical emergency. What are S/S?
-Typically follow...
Lasts __to__ days
-Tx: ?

Back 21

S/S: high fever, tachycardia, tachypnea, dehydration, delirium, coma, NVD
typically follow surgery or infection
Lasts 3-8 days
Tx: PTU, iodides, propranolol, IV corticosteroids

Front 22

Treated with a short-acting Beata blocker such as IV esmolol, IV or PO iodide, large doses of propylthiouracil(PTU)

Back 22

Thyroid storm

Front 23

Hyperthyroidism:
What is MOA of Thioamide?(interferes with biosynthesis and conversion)
Efficacy:

Back 23

-Interfere with Biosynthesis of thyroid hormones
-PTU interferes with peripheral conversion of T4 to T3.
Efficacy: permanent remission in 30-50%. relapse upon D/c

Front 24

Name one of the two thioamides used in pregnacy.

Back 24

PTU

Front 25

ADEs of PTU? (name major one)
What is half-life of PTU?

Back 25

Rash, arthralgias, fever, AGRANULOCYTOSIS, hepatotoxicity

Front 26

Methimazole&Hyperthyroidism)
Well absorbed, actively concentrated in ___.
Half-life?
Same ADEs as PTU

Back 26

thyroid gland
5 hours

Front 27

Hyperthyroidism:
This therapy destroys thyroid tissue over period of ___ to ___.
ADEs:

Back 27

Radioactive therapy
-ADEs: mild pain, tenderness, dyspagia, hair thinning, HYPOthyroidism

Front 28

Mechanism of Iodide Tx for Hyperthyroidism:
Effect:
Uses:(pre-surgery and post-RAI)

Back 28

Mechanism: acutely blocks thyroid hormone release, inhibits thyroid hormone biosynthesis
Effect: reduces size and vascularity of thyroid
Uses: pre-surgery: to decrease size and vascularity
Post-RAI: prevents transient hyperthyroidism

Front 29

In the treatment of hyperthyroidism. BBlockers are used to decrease sx of palpitations, anxiety, tremor, heat intolerance. What is BB are contraindicated?

Back 29

Use CCB

Front 30

Lugols solution has __% Iodine and __% NaI

Back 30

5% iodine
10% NaI

Front 31

If TSHRAbs is positive what does that indicate?

Back 31

Positive antibodies indicates Grave's disease

Front 32

Hypothyroidism is more common in what sex over what age?

Back 32

females over 60

Front 33

Hypothyroidism:
Increased or decreased?
-T4
-TSH
-RAIU

Back 33

Decreased T4
Increased TSH
Decreased RAIU

Front 34

cornerstone of Hypothyroidism therapy?

Back 34

Replace T3/T4

Front 35

RFs for HYPOThyroidism:

Back 35

Personal History(Previous thyroid dysfunction, Goiter, Surgery or radiotherapy affecting thyroid, DM, Vitiligo, pernicious anemia)

Family History(Thyroid disease, Pernicious anemia, DM, Primary adrenal insufficiency)

Front 36

Diseases of Hypothyroidism:
1. Congenital Development defect aka __
2. ___ deficiency
Drug induced(what drugs)
3. Chronic Immune thyroidits aka __
4. Iatrogenic from...

*also can be primary idiopathic

Back 36

1. Cretinism
2. Iodine
3. Amiodarone, Li, TCAs, Sulfas
4. Radioblative, surgery

Front 37

Start therapy for HYPO at what TSH levels?

Back 37

TSH >10mU/mL

Front 38

A life-threatening sequelae of uncorrected hypothyroidism.
GIve symptoms
Tx?

Back 38

Myxedema coma
Symptoms: hypothermia, decreased DTRs, altered senosrium, hypercapnia, hypoglycemia, hyponatremia
Tx: IV L-thyroxine 400mcg x 1, the 5--200mcg/d
-also corticosteroids

Front 39

Drug of choice for HYPO.
Who needs lower doses

Back 39

Levothyroxine
-lower for IV or elderly with Cardiac disease
-try not to switch brand

Front 40

Graves’: most common thyrotoxicosis
• Hyperthyroid tx: PTU or MMI, RAI, surgery; initial tx
based on age, pregnancy, comorbidities, convenience
• PTU and MMI similar in efficacy and ADEs but dosing
differs
• Response to PTU and MMI x-x weeks, tx for x-x years
• Patients choose ablative tx
• Surgery large goiter patients
• Adjunctive tx
• Hypothyroidism:
• Monitor:

Back 40

Graves’: most common thyrotoxicosis
• Hyperthyroid tx: PTU or MMI, RAI, surgery; initial tx
based on age, pregnancy, comorbidities, convenience
• PTU and MMI similar in efficacy and ADEs but dosing
differs
• Response to PTU and MMI 4-6 weeks, tx x 1-2 years
• Patients choose ablative tx
• Surgery large goiter patients
• Adjunctive tx beta-blockers
• Hypothyroidism: Hashimoto’s, drug of choice: thyroxine
• Monitor: s/s, TSH, FT4

Front 41

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Front 43

Give primary secondary and tertiary thyroid disorders

Back 43

Primary-thyroid dysfunction
secondary-pituitary dysfunction
tertiary-hypothalamic dysfunction

Front 44

this hormone useful in assessing pituitary function

Back 44

TRH-thyrotropin releasing hormone

Front 45

Magnifies change in T4 by 10 fold.
Uses(3)

Back 45

TSH-thyroid stimulating hormone
Uses:
assess thyroid status
causes of thyroid disease
monitor treatment

Front 46

Free thyroxine (FT4) Normal x-x ng/dL
- __% of T4 made in thyroid is bound to TBG
__% plasma protein bound when in circulation
T1/2 =?

Back 46

Free thyroxine (FT4) Normal 0.7-1.9 ng/dL
- 80% of T4 made in thyroid is bound to TBG
99.97% plasma protein bound when in circulation
T1/2 = 7days

Front 47

__ is influenced by changes in TBG but __ is not.(FT4 and TT4)

Back 47

Total T4 (TT4) is influenced by changes in TBG but FT4 is not.

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