00 Thyroid Disorders

Question 1

Which hormone is Triiodothyronine?

Answer 1

T3

Question 2

Which hormone is Thyroxine?

Answer 2

T4

Question 3

What is the most common cause of Hypothyroidism?

Answer 3

Hashimoto’s Disease (autoimmune thyroiditis, a condition that destroys the thyroid gland)

Question 4

What are some drugs that can induce hypothyroidism?

Answer 4

Octreotide, Amiodarone, Interferon, Lithium

Question 5

What are the most common symptoms of Hypothyroidism?

Answer 5

Cold intolerance, Dry skin, Fatigue, Weight gain, Depression, Constipation

Question 6

What are the hormone levels like in someone with Clinical Hypothyroidism?

Answer 6

High TSH, low T4 & T3

Question 7

What is the generic name of Levothyroid?

Answer 7

Levothyroxine (T4 only)

Question 8

What is the generic name of Synthroid?

Answer 8

Levothyroxine (T4 only)

Question 9

What is the generic name of Levoxyl?

Answer 9

Levothyroxine (T4 only)

Question 10

What is the generic name of Unithroid?

Answer 10

Levothyroxine (T4 only)

Question 11

What is the generic name of Tirosint?

Answer 11

Levothyroxine (T4 only)

Question 12

What is the generic name of Cytomel?

Answer 12

Liothyronine (T3 only)

Question 13

What is the generic name of Armour Thyroid?

Answer 13

Desiccated Thyroid (T3 and T4)

Question 14

What is the generic name of Nature Thyroid?

Answer 14

Desiccated Thyroid (T3 and T4)

Question 15

Which thyroid medication is the DOC for pregnancy?

Answer 15

Levothyroxine

Question 16

Which thyroid medication needs to be protected from light and moisture?

Answer 16

Levothyroxine

Question 17

What are the dose equivalencies like between IV and PO levothyroxine?

Answer 17

IV = 50% of PO dose

Question 18

When would you want to start with a lower dose of Levothyroxine?

Answer 18

Heart disease. Elderly > 50 years

Question 19

What common medications can Levothyroxine effect?

Answer 19

Can Decrease: Digoxin, Theophylline, Antidiabetic agents. Can Increase: Effect of warfarin

Question 20

What is the BBW with Levothyroxine?

Answer 20

In euthyroid patients, thyroid supplements are ineffective and potentially toxic for weight reduction. High doses may produce serious or even life-threatening toxic effects, particularly when used with some anorectic drugs

Question 21

What is monitoring like for Levothyroxine?

Answer 21

Initial therapy or w/ dose changes: TSH Q1-2 months until euthyroid. Maintenance: TSH Q6-12 months or as clinically indicated

Question 22

When do you not want to use Levothyroxine?

Answer 22

Acute MI, Thyrotoxicosis, Uncorrected adrenal insufficiency

Question 23

What is the most common cause of Hypothyroidism?

Answer 23

Grave’s Disease (autoimmune disorder leading to over production and secretion of thyroid hormones)

Question 24

What medications could cause Hyperthyroidism?

Answer 24

Amiodarone. Interferon. Thyroid hormone supplements

Question 25

What are some symptoms of Hyperthyroidism?

Answer 25

Irritability, Insomnia, Heat intolerance, Sweating, Tachycardia, Tremor, Diarrhea

Question 26

What are the thyroid hormone levels like in someone with Clinical Hyperthyroidism?

Answer 26

Low TSH. High T4 & T3

Question 27

Usually subclinical hyperthyroidism isn't treated, but when might you consider it?

Answer 27

> 65 years w/ heart disease. Pregnant. Symptoms of hyperthyroidism present

Question 28

What is the generic name of Propyl-Thyracil?

Answer 28

Propylthiouracil (PTU)

Question 29

What is the generic name of Tapazole?

Answer 29

Methimazole (MMI)

Question 30

What is different about PTU compared to Methimazole?

Answer 30

Both inhibit synthesis of thyroid hormones, but PTU also blocks CONVERSION of T4 to T3 at higher doses

Question 31

Which hyperthyroid treatment option is preferred in pregnancy?

Answer 31

PTU

Question 32

What is the BBW with PTU?

Answer 32

Hepatotoxicity

Question 33

What is the treatment of choice for Grave's and Plummer's Diseases?

Answer 33

Radioactive Iodine (RAI)

Question 34

When is Radioactive Iodine (RAI) contraindicated?

Answer 34

Pregnancy, Lactation, Thyroid cancer

Question 35

What are the Iodide therapy options?

Answer 35

Lugol's Solution (Potassium iodide and iodine solution). SSKI (saturated solution of potassium iodide)

Question 36

Which beta-blockers can be used in Hyperthyroidism to help block symptoms?

Answer 36

Propranolol, Nadolol, Metoprolol, Atenolol, Esmolol

Question 37

Which beta-blockers may actually block the conversion of T4 to T3 at higher doses?

Answer 37

Propranolol and Nadolol

Question 38

What are some precipitating factors of thyroid storm (medical emergency)?

Answer 38

Infection, MI, diabetes, trauma

Question 39

What are the symptoms caused by Thyroid Storm?

Answer 39

Fever > 103. Tachycardia > 140. Tachypnea. Sweating. Agitation, psychosis, coma

Question 40

What is used to treat thyroid storm?

Answer 40

All used together: PTU (or Methimazole), Propranolol (or esmolol), SSKI (only start 1 hour after antithyroid medications), Hydrocortisone (or dexamethasone)

Question 41

What is hyperthyroidism treatment like in pregnancy?

Answer 41

PTU is preferred during 1st trimester. Switch to MMI during 2nd and 3rd trimester. If unable to tolerate these, consider surgery (2nd trimester is ideal for thyroidectomy)

Question 42

Which thyroid medication should be avoided in someone allergic to pigs?

Answer 42

Armour Thyroid