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Pediatric Pharm Exam 3 > Hypothyroidism & Hyperthyroidism > Flashcards

Hypothyroidism & Hyperthyroidism Flashcards

1
Q

Congenital Hypothyroidism (CH)
Incidence
Most common preventable cause of…
Risk Factors (3)

A

1 in 2000
Mental retardation
Female, Asians/Hispanics, Low birth weight

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2
Q 
Congenital Hypothyroidism (CH)
Diagnosis (2)
A

No clinical manifestations in most newborns

Lethargy, hoarse cry, prolonged jaundice, hypothermia

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3
Q 
Congenital Hypothyroidism (CH)
Newborn Screening (2)
A

Most assays measure TSH directly

Others measure TSH in samples with low/normal T4 concentrations

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4
Q

Congenital Hypothyroidism (CH)
Must send screen after ___ hours
Recheck WHEN?

A

Must send screen after 48 hours of birth

  • Large TSH surge occurs at birth
  • Recheck at 2 weeks of life
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5
Q 
Congenital Hypothyroidism (CH)
Etiology (3 types)
A

Primary hypothyroidism

  • Sporadic (85%) – thyroid dysgenesis
  • Hereditary (15%) – inborn errors of thyroid hormone synthesis

Central hypothyroidism

Transient
- Iodine deficiency, transplacental transfer of TSH-receptor blocking antibodies, maternal antithyroid medications

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6
Q

Treatment (5)
CH

Interactions (2)
Absorption

A
  • Initiate once positive screening test confirmed
  • Oral levothyroxine – 10-15 mcg/kg/day
  • No commercial oral suspension available
  • Interactions = Iron/calcium
  • Absorption = Decreased by food
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7
Q

CH

Monitoring Initial Goal

A

T4 > 10 mcg/dL

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8
Q

CH Goal of Treatment

A

0-1 year: T4 10-16 mcg/dL, TSH < 5 mU/L

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9
Q

CH Monitoring (5)

A
  • 2 and 4 weeks after initiation of L-T4 treatment
  • Every 1-2 months during first 6 months of life
  • Every 3-4 months between 6 months and 3 years
  • Every 6-12 months until growth is complete
  • 2 weeks after any change in dose
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10
Q

Hyperthyroidism

Etiology (2)

A

Graves disease

TSH receptor-stimulating antibodies (TRS-Ab)

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11
Q 
Hyperthyroidism
Risk Factors (3)
A

Females
Older children
trisomy 21

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12
Q

Hyperthyroidism

Consequences

A

Graves’ ophthalmopathy

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13
Q

Hyperthyroidism

Presentation (9)

A 
Weight loss/increased appetite
Heat intolerance
Goiter
Fine hair
Tachycardia
Acceleration of growth
Nervousness
Sweating
Lid lag
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14
Q

Hyperthyroidism

Diagnosis

A 
T4/FT4  = increased
T3 = increased
TSH = decreased
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15
Q

Hyperthyroidism

Management (3)

A

o Antithyroid Medications
o Radioactive Iodine
o Surgery – Thyroidectomy

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16
Q

Hyperthyroidism

MOA

A

Inhibit synthesis of thyroid hormones by blocking oxidation of iodine in the thyroid gland

17
Q

Hyperthyroidism
Medication
Advantages (3) /Disadvantages (1)

A

o Typically 1st line in children, adolescents, pregnancy

ADV = Noninvasive, lower cost, low risk of permanent hypothyroidism
DADV = Low cure rate
18
Q

Hyperthyroidism
Medications (2)
Dosing for each

A

Methimazole (MMI)
- Dosed every 8-12 hours

Propylthiouracil (PTU)

  • Not used routinely due to increased rates of PTU induced liver failure
  • Dosed every 8-12 hours
19
Q

Hyperthyroidism

Medication Absorption, metabolized, excretion

A

Well absorbed in the GI tract
- Peak serum concentrations in 1-2 hours

Hepatically metabolized
Excreted in the urine

20
Q 
Hyperthyroidism
Monitoring meds (3)
A

Every 2-4 weeks
Administered at the same time each day
Consistently in relation to meals

21
Q

Hyperthyroidism

ADE (5)

A
  1. Cutaneous - pruritic rashes, self-limiting and respond to antihistamines
  2. Hematologic - Leukopenia
  3. Musculoskeletal - arthralgias
  4. GI Intolerances - nausea, abnormal taste
  5. Misc - agranulocytosis, vasculitis, hepatitis/liver failure
22
Q

Acquired Hypothyroidism

Etiology (5)

A

Most common disturbance in thyroid function in children

  • Autoimmune thyroiditis
  • Iodine deficiency
  • Thyroid damage
  • Hypothalamic-pituitary disease
23
Q 
Acquired Hypothyroidism
Risk Factors (4)
A

Females
down’s syndrome
T1DM
Celiac disease

24
Q

Acquired Hypothyroidism

Presentation (8)

A 
Weight gain
Cold intolerance
Coarse hair
Bradycardia
Fatigue
Dry skin
Periorbital swelling
Declining growth velocity
25
Q

Acquired Hypothyroidism

Diagnosis of Acquired hypothyroidism

A 
T4/FT4 = decreased
T3 = decreased
TSH = increased
26
Q

Management of Hypothyroidism

Monitoring

A

Levothyroxine (T4)

Monitoring
- T4 and TSH 2-4 weeks after initial treatment

Pediatric Pharm Exam 3 (11 decks)

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