ch 49 highlights Flashcards
(47 cards)
in adults mild thyroid hormone deficiency is called
hypothyroidism
Severe thyroid deficiency is called
myxedema
When hypothyroidism occurs in infants its called
congenital hypothyroidism
if someone is pale, puffy, expressionless face with cold and dry skin. The hair is brittle and hair loss occurs. Heart rate and temp are lowered. Pt complains of lethargy, fatigue and intolerance to cold. Mentation may be impaired. What disease process do these symptoms most correlate to?
Hypothyroidism
maternal hypothyroidism can result in
permanent neurophysiological deficits in the child
At what trimester does the fetus have a thyroid gland that is fully functional and able to supply his/her own hormones
2 nd trimester
a pt with hypothyroid becomes pregnant
dosage requirements usually increase often by as much as 50% . The need for increased dosage begins at 4-8 weeks gestation and levels off at approximately week 16 then remains steady
In children with congenital hypothyroidism therapy should continue for
3 years then d/c for 4 weeks. Blood work to see if the TSH rises.
the more TSH the more
hypothyroid the pt is
the less TSH the less
hypothyroid the pt is
which form of hyperthyroidism has exophthalmos
Graves
Which form of hyperthyroidism does not have exopthalmos
Plummer Disease
Graves disease is most common in what gender
women
nervousness, insomnia, rapid speech, weakened muscles, increased body temp, intolerance to heat and skin that is warm and moist, increased appetite, weight loss
thyrotoxicosis
Treatment for Graves disease
1) Surgical removal of thyroid tissue
2) destruction of thyroid tissue with radioactive iodine
3) suppression of thyroid hormone synthesis with an anti-thyroid drug (methimazole or propyolthiouracil)
radiation is preferred treatment for adults
antithyroid drugs is preferred for younger ptatients
improvement of exophthalmos
will not improve with lowered thyroid levels
if severe, it can be treated with surgery and radiation
symptoms profound hyperthermia (105 or higher) severe tachycardia restlessness agitation tremor
unconsciousness coma hypotension heart failure may ensue
thyrotoxic crisis (thyroid storm)
what is given for thyroid storm
high doses of potassium iodine solution to suppress the hormone synthesis
B blocker is given to reduce heart rate additional measures include sedation cooling glucocorticoids IV fluids
first line for hypothyroid
Levothyroxine (Synthroid) - used in all types and for all causes of hypothyroid
what time of day should synthroid be taken?
30 min before breakfast on an empty stomach
overdose on synthroid
causes thyrotoxicosis - tachycardia angina tremor nervousness insomnia hyperthermia heat intolerance sweating
chronic overdose - accelerated bone loss
increased risk of a-fib (esp older adults)
loss of bone increases r/o fractures
drugs that reduce levothyroxine (synthroid) absorbtion
H2 receptor blockers (cimetidine (tagamet)) PPI (Prevacid) Sulcralfate (Carafate) Cholestyramine (Questran) Colestipol (Colestid) Aluminum containing antacids (maalox, mylanta) Calcium supplements (Tums, Os-cal) Iron supplements (ferrous sulfate) mag salts Orlistat (Xenical)
separate administration of synthroid and these drugs by 4 hours
drugs that accelerate levothyroxine metabolism
phenytoin (Dilantin) Carbamazepine (Tegretol, Carbatrol) Rifampin (Rifadin) Sertraline (zoloft) phenobarbitol
if a pt on warfarin begins levothyroxine
synthroid accelerates the degradation of vit k-dependent clotting factors. Effects of Warfarin are enhanced and dosage of warfarin may need to be reduced
