Clinical Questions Flashcards
What is the role of the thyroid gland?
Regulate body temp
Cardiac and nervous system functions
Metabolism
Muscle strength
Skin Dryness
Menstrual Cycles
Weight
Cholesterol Levels
What is the role of iodine in the thyroid?
The thyroid is the ONLY organ that can absorb iodine and it is necessary for both T3 and T4 throid hormones
What is the Negative feedback loop oof thyroid hormones?
Hypothalamus releases TSH which stimulates the pituatary gland to release TSH. This signals the thyroid to produce MORE T3 and T4. When there is A LOT of T3 and T4 this shuts off the release from the hypothalamus.
Which drugs might cause HYPOthyroidism?
ITALIC
Interferons
TKI
Amiodarone
Lithium
Carbamazepine
Condition: Hashimoto’s Disease
What are the symptoms of hypothyroidism?
Cold intolerance
Dry skin
Weight GAIN
Fatigue
Muscle cramps
Constipation
Myalgias
Bradycardia
Goiter (low iodine)
Menorrhagia (HEAVY)
Hair loss or Coarse hair
A patient presents with 10 lb weight gain in the past 2 weeks. She also has chronic constipation and overall muscle weakness.
Her vitals:
BP 110/74
HR 62 bpm
Temp 36
Her labs:
T4 0.7 ng/dL
TSH 7.6 mIU/L
What is her diagnosis? What is a good treatment for her?
HYPOthyroidism
T4 is low (0.9 - 2.3)
TSH is HIGH (0.3 - 3)
Levothyroxine (Synthroid)
A patient was just diagnosed with hypothyroidism and is being starting on Levoxyl. She is 43 years old. Her height is 5’5” and weight is 180 lbs. Her past medication history includes obesity. What would be a good dose to start with?
IBW = 45.5 + 2.3(5) = 57 kg
1.6 mcg x 57 kg = 91.2 mcg
start with 88 mcg daily
A patient was just diagnosed with hypothyroidism and is being starting on Unithroid. She is 42 years old. Her height is 5’2” and weight is 160 lbs. Her pasthistory includes obesity, CAD, HTN, and HLD. What would be a good dose to start with?
25 mcg daily (because of known CAD
A patient is complaining of poor temperature regulation and is intolerable of cold. She has a history of depression, arrhymias menorrhagia, and GERD. She is currently on Pacerone, Prozac, Levora, and Prilosec. If she were to start Synthroid for her hypothyroidism which of these medications would have an effect on her disease state?
All of them!
Pacerone (Amiodarone) decreases effectiveness of levothyroxine
Prozac (Fluoxetine) SSRI decrease thyroid hormones
Levora an estrogen product birth control will decrease thyroid hormones
Prilosec (Omeprazole) will decrease levothyroxine absorption
How does levothyroxine effect warfarin and theophylline?
increases effect of warfarin
decrease levels of theophylline
A patient’s at home dose of levothyroxine is 112 mcg (rose colored tablet). She was admitted to a hospital and needs to be converted to IV. What would her dose be?
IV:PO 0.75:1
84 mcg IV of levothyroxine
A Jehovah’s Witness is just diagnosed with hypothyroidism. What treatment would you absolutely avoid for this patient?
Thyroid Desiccated USP (T3 and T4) made from porcine
(Armour Throid)
What are the symptoms of hyperthyroidism?
Weight loss
heat intolerance
agitation, anxiety
Palpations/Tachycardia
Diarrhea
Insomnia
Tremor
Thinning of hair
Goiter
Ammenorrhea
Diplopia
What are common causes of hyperthyroidism?
Grave’s disease
Drugs: iodine, amiodarone, interferons
A 36 yo male patient presents with unexplained weight loss within past 3 months, hair thinning, diarrhea, and heat intolerance. His past medical history includes: anxiety and insomnia.
His vitals:
BP 134/78
HR 122
RR 21
His labs:
T4 4.5 ng/dL
TSH 0.1 mIU/L
What is his diagnosis and treatment options?
HYPERthyroidism
TSH is Low (0.3 - 3 mIU/L)
T4 is high (0.9 - 2.3 ng/dL)
Treatment options include:
- Radioactive Iodine
- Propylthiouracil (PTU)
- Methimazole
- Surgery
