34 - Thyroid Disorders Flashcards Preview

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Flashcards in 34 - Thyroid Disorders Deck (48):
1

more common in what gender

women

2

Hypothyroidism is an ______ TSH level

elevated

3

What is subclinical hypothyroidism?

defined by an elevated TSH with normal thyroid hormone levels

4

Symptoms of hypothyroidism

fatigue, impaired memory, bradycardia, dry skin and hair, constipation, cold intolerance

5

What does dessicated thyroid contain?

both t4 and t3

6

Hypothyroidism:
What is the treatment of choice?

Levothyroxine (L-T4) to normalize TSH level

7

Hypothyroidism:
Dose adjust for levothyroxine every ____ weeks as needed

4-6

8

Hypothyroidism:
Dose of levothyroxine in adults

1.6 mcg/kg/day

9

Hypothyroidism:
Dose of levothyroxine in newborns

10-16 mcg/kg/day

10

Hypothyroidism:
When do you give liothyronine (T3) ?

short term management of patients with thyroid cancer undergoing withdrawal of L-T4 when recombinant TSH is not an option or in order to prepare for radioactive iodine therapy

11

Hypothyroidism in Pregnancy:
How do you manage women who are already taking thyroid hormone replacement therapy?

-increase the dose by 2 extra tabs/week immediately after a positive pregnancy test
-further dose adjustments based on TSH levels

12

Hypothyroidism in Pregnancy:
When do you get TSH levels drawn?

-have TSH levels q 6 weeks or 4 weeks after dose adjustment

13

Hypothyroidism in Pregnancy:
For those not on therapy, what is the target TSH?

TSH should be maintained at < 4 mU/L

14

Hypothyroidism in Pregnancy:
When would you initiate therapy if they're not on it already?

if the TSH > 10 mU/L or if the patient has TSH > 4 mU/L and is positive for anti-TPO antibodies then you want to initiate thyroid replacement therapy

15

Hypothyroidism:
How do you explain the safety of thyroid replacement in pregnancy and breastfeeding?

thyroid replacement is completely safe in pregnancy and breastfeeding and is important to ensure a healthy pregnancy and normal fetal development

16

Hypothyroidism in Breastfeeding:
How do you treat it?

same as non-breastfeeding women

17

Thyrotoxicosis is also caused ______

hyperthyroidism

18

Hyperthyroidism is when TSH is ____

low

19

Define subclinical hyperthyroidism

TSH is low but thyroid hormone levels are normal

20

Symptoms of hyperthyroidism

weight loss, palpitations, diarrhea, heat intolerance, anxiety

21

What drugs can suppress TSH

corticosteroids, domperidone, metoclopramide, dopamine

22

Hyperthyroidism:
What can radioactive iodine cause as a side effect?

hypothyroidism

23

Hyperthyroidism:
Radioactive iodine is CI in ____

pregnancy

24

Hyperthyroidism:
What are the 2 antithyroid drugs?

-methimazole
-PTU

25

Hyperthyroidism:
How do antithyroid drugs work?

decrease production of thyroid hormone

26

Hyperthyroidism:
What can PTU also do?

block conversion of L-T4 to T3

27

Hyperthyroidism:
When do antithyroid drugs need to be stopped?

Need to be stopped 5 days prior to a thyroid scan or treatment with iodine

28

Hyperthyroidism:
Which antithyroid drugs is preferred? Why?

MTZ is preferred due to lower incidence of hepatotoxicity

29

Hyperthyroidism:
In what situation is PTU preferred over MTZ?

1st trimester of pregnancy

30

Hyperthyroidism:
How do beta blockers work?

ameliorate the symptoms of adrenergic excess and are usually used adjunctively in the management of Graves disease or toxic nodules

31

Hyperthyroidism:
Which beta blockers can decrease conversion of L-T4 to T3

propranolol and nadolol

32

Hyperthyroidism:
How does iodine (Lugol solution) work?

blocks thyroid hormone production

33

Hyperthyroidism:
When should iodine (Lugol solution) be given in relation to antithyroid drugs?

1 hour after administration of an antithyroid drug

34

Hyperthyroidism:
What can methimazole and PTU cause?

neutropenia

35

Hyperthyroidism:
How can corticosteroids help?

they lower the level of free T3

36

Hyperthyroidism:
Place of selenium in therapy?

Selenium 100mcg BId may prevent worsening of mild Graves orbitopathy and can be considered as supplemental therapy

37

How do you treat thyroid storm?

-antithyroid meds, BB and corticosteroids

-use acetaminophen for hyperthermia

-plasmapheresis can be considered in unresponsive cases

38

Hyperthyroidism and Pregnancy:
Wait how long after radioactive iodine before conceiving ?

6 months

39

Hyperthyroidism and Pregnancy:
____ is preferred antithyroid for 1st trimester of pregnancy

PTU

40

Hyperthyroidism and Pregnancy:
Can you give MTZ?

if PTU is CI

41

Hyperthyroidism and Pregnancy:
What is the treatment for 2nd and 3rd trimester?

MTZ

42

Hyperthyroidism and Pregnancy:
What are some other options?

BBs or iodine in 1st trimester with careful monitoring

43

Hyperthyroidism and Pregnancy:
What do you monitor and how often?

TSH, fT3, fT4 q6-8 weeks

44

Hyperthyroidism and Pregnancy:
What do you need to measure at 22 weeks gestation

TRAb titre should be measured

-if positive, repeat at 30-34 weeks

45

Hyperthyroidism and Pregnancy:
A high titre of TRAb means what?

increased risk of hyperthyroidism for the baby

46

When on antithyroid drugs, when will neutropenia be seen if it happens?

1st 90 days

47

When on antithyroid drugs, when will hepatic effects be seen if it happens?

1st 120 days

48

Hyperthyroidism and Breastfeeding:
What antithyroid drug is preferred?

-MTZ preferred but can use PTU
-can use BBs

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