Endocrine pt 1 Tx Flashcards
(27 cards)
Tx:
What is one way to Tx Grave’s? What are the downsides?
1) Radioactive iodine can be used
Ablates thyroid in 6-18 weeks
2) Contraindicated in pregnant/lactating women
Can make exophthalmos worse
Eye symptoms treated with steroids and surgery
Tx: Thioamides for Grave’s:
1) Give 2 examples
2) What is their MOA?
3) What should you do in pregnancy?
4) What are some side effects?
1) Methimazole or propylthiouracil (PTU)
2) Prevents thyroid hormone synthesis
PTU also prevents peripheral conversion of T4
Methimazole has fewer side effects
3) PTU preferred in pregnancy; methimazole is teratogenic in 1st trimester
4) Agranulocytosis monitor WBC’s
Hepatitis monitor LFT’s
Txs for Graves’; describe: when to use
1) Beta blockers
2) Steroids
3) Iodine
1) Used in acute, emergent treatment
2) Used in acute, emergent treatment
Also used to treat the ophthalmopathy
3) Used with extreme caution in acute, emergent treatment
What Tx for Grave’s is teratogenic in the 1st trimester?
Methimazole
List some ways to Tx Grave’s
1) Radioactive iodine can be used
2) Thioamides (Methimazole or propylthiouracil (PTU))
3) Beta blockers
4) Steroids
5) Iodine
Toxic Multinodular Goiter / Toxic Adenoma:
What are 4 ways to Tx this? Which is most common?
1) Most common is Radioactive Iodine ablation
2) Surgery may be performed (esp if compressive symptoms from the mass)
3) Thionamides less preferred
4) +/- emergent therapy
Beta blockers, steroids
TSH Secreting Pituitary Adenoma: What are the TSH and T4 levels?
TSH is high AND T4 is high
How do you Tx TSH Secreting Pituitary Adenomas?
-For pituitary adenoma, “transsphenoidal” is always the type of surgery
-Prior to surgery, somatostatin analogs may be used
How do you Tx Factitious/Struma Ovarii?
Remove mass OR “stop doing that”
How do you Tx thyroid storm?
(seems important)
1) Nonselective beta blocker: propranolol IV
Helps slow HR and blocks the body’s response to T3/T4
2) Thioamides: methimazole or PTU (preferred)
3) Steroids (dexamethasone)
4) Antipyretic (Tylenol preferred)
5) Be careful with Iodine!
-ICU
Hashimotos: Describe the pathogenesis
Autoimmune thyroiditis
Antibodies against TPO, IG
Also, some TSH receptor blocking
Hashimoto’s: Describe the pt profile & Sx
More often female (age 30-50)
Hypothyroid sx
Goiter
May be mild or diffuse – up to 2-3 times normal size
May get hoarseness and dyspnea due to tracheal compression
May have galactorrhea
TSH stimulation of lactotrophs in ant. Pituitary
Hashimoto’s diagnosis: Describe what you’ll see on PE
Thyroid exam is nonspecific: may be large, small, or normal
Bradycardia
Decreased DTR
Loss of outer 1/3 of eyebrows
Myxedema: nonpitting, periorbital or peripheral
Hashimoto’s diagnosis: Describe the testing
1) Increased TSH, low T3/T4
May be normal or subclinical in early disease
2) Anti TPO or TG antibodies
What is the first line Tx for Hashimoto’s?
Levothyroxine
When do you need to increase levothyroxine doses for Hashimoto’s?
During pregnancy
Describe the Tx of Hashimoto’s
1) Levothyroxine is 1st line
-Indicated if TSH 10mlU/L or greater
-MOA: synthetic T4
-Monitor TSH q 6 weeks to titrate the dose
-Start low and go slow; will need to increase during pregnancy
2) Best taken in the morning
3) Don’t take with multivitamins, iron/calcium supplementation, or PPI
-All these decrease effectiveness
5) Caution against overshooting and causing hyperthyroid
*doses will need to increase during pregnancy
Hashimoto’s Tx:
What are the levothyroxine doses for:
1) Kids
2) Adults
3) Elderly
1) 4mcg / kg / day
2) 1.6mcg/ kg/ day
3) 1 mcg/ kg/ day
Describe follow-up with Hashimoto’s Tx
1) Begin follow up testing every 6 weeks
-Test patients on Thyroid replacement every 6 to 12 months once stable.
-Test patients more often with severe illness
2) Several meds can change absorption of thyroid hormones which may require more freq monitoring
coumadin, antidepressants, antidiabetics
Hashimoto’s: When should you f/u Q4-6 wks?
If TSH is not stable
Recent change in dose
Recent change in manufacturer
How do you Tx cretinism and myxedema coma?
Levothyroxine
What are the 2 options for the Tx of subclinical hypothyroid?
1) You can observe them and recheck
2) You can definitely give levothyroxine if the TSH is 10mU/L or higher
This has been shown to prevent cardiovascular side effects down the line
Why, this can stave off adverse cardiovascular effects of subclinical hypothyroidism
Subclinical hypothyroid: You can definitely give levothyroxine if the TSH is ________ or higher
10mU/L
Silent (lymphocytic) / Postpartum: How do you Tx?
NO thyroid meds will return to normal on its own
Aspirin or NSAID
20% chance of permanent hypothyroidism
