Endocrine Deck 4 Flashcards
(55 cards)
Thyroid Hormones ADR
Symptoms of hyperthyroidism
Cardiovascular (CV): angina, blood pressure increase, flushing, palpitations
Central nervous system: anxiety, headache, insomnia
Long-term thyroid replacement associated with decreased bone density in hip/spine in postmenopausal women
Thyroid hormone drug interactinos
Bile-acid sequestrants, iron salts, and antacids decrease absorption; estrogens may decrease response.
Drugs may decrease action of warfarin, digoxin, and beta blockers
hypothyroidism
Treatment is indicated
in patients with TSH levels greater than 10 μIU/mL or in patients with TSH levels between 5 and 10 μIU/mL in conjunction with goiter or positive antithyroid peroxidase antibodies (or both).
Thyroxine replacement is typically
lifelong
Consult with pediatric endocrinologist before
treating a pediatric patient with thyroid hormone
subclinical hypothyroidism
is controversial on whether or treat it or not
T4 Dosing
For patients with no known CV disease
Initial dose can be started at 50 mcg/day for 2 to 4 weeks and may be increased in increments of 25 mcg/day.
Average full replacement of T4
100 to 125 mcg/day
what are you monitoring regarding t4
lab work and patient response
T4 Dosing
For patients 50+ years with CV disease or with long-standing hypothyroidism
Initial dosage of T4 is 12.5 to 25 mcg/day.
T4 Dosing
For patients 50+ years with CV disease or with long-standing hypothyroidism – an increase of
An increase of 12.5 to 25 mcg increments at approximately 1-month intervals avoids rapid increases in cardiac workload and symptoms of ischemic heart disease.
T4 if exacerbations of angina
pectoris occurs, the previous dosage regimen should be administered and titrated up in smaller increments.
start low and increase slowly
t4 rational drug selection
T4 is drug of choice for thyroid replacement and suppression therapy.
In older adults with no cardiac disease, consider consulting with endocrinologist regarding using T3 and T4 or liotrix.
TSH level should be measured
in 6 to 8 weeks, and the T4 dose should be adjusted as necessary.
The target tsh level should be between
0.3 and 3.0 μIU/mL
Once a stable TSH level is achieved
annual examination is appropriate (or if they have symptoms)
T4 monitor for
for osteoporosis in high-risk populations.
Many drugs affect TSH levels.
If you are on a natural version of t4 like naturethroid or armourthroid you need monitor
T3 and T4 because the t3 is unpredictable
t4 patient education
Take medication each day in the morning, preferably before breakfast because absorption is increased on an empty stomach.
T4 ADR
ADRs: Learn how to measure heart rate.
Lifestyle management is important
one of the biggest treatments for subclinical hypothyroidism
diet and exercise.
Antithyroid Agents
Propylthiouracil (PTU), methimazole (Tapazole)
Antithryroid agent block
Both block synthesis of T4 and T3.
Neither drug treats the underlying pathology in hyperthyroidism.
Antithryroid relapse rate
exist but are less likely if treated for 18 to 24 months
