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Endocrine: Thyroid Flashcards

(78 cards)

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1
Q

TRH

A

thyrotropin releasing hormone

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2
Q

TSH

A

thyroid stimulating hormone

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3
Q

T3, T4

A

circulating thyroid hormones

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4
Q

low T3 and T4…

A

sends signal to hypothalamus to release TRH

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5
Q

TRH activates…

A

pituitary to release TSH, stimulating thyroid to produce more t3 and t4.

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6
Q

graves disease

A

TSH antibodies mimic TSH, stimulate T3 and T4 production.

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7
Q

pituitary adenomas

A

excessive TSH secretion that doesnt respond to T3 negative feedback

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8
Q

toxic adenoma

A

leads to thyroid nodules

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9
Q

drug induced hyperthyroid disorder

A

excessive thyroid hormone dosage

or amiodarone tx

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10
Q

presentation of hyperthyroid

A 
weight loss
heat intolerance
goiter
fine hair
tachy
warm/moist skin
anxiety
insomnia
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11
Q

hyperthyroid: diagnostics

A

elevates t4
suppressed TSH
radioactive iodine uptake
thyroid antibodies

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12
Q

radioactive iodine uptake in hyperthyroidism

A

elevated if thyroid gland is actively and excessively secreting T4/T3.

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13
Q

tx for hyperthyroid

A

ablation
thiouereas
nonselective b blockers
iodines/iodides

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14
Q

2 examples of thioureas

A

methimazole (MMI)

propylthiouracil (PTU)

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15
Q

thiourea MoA

A

inhibits iodination and synth of thyroid hormones.

PTU will also block t3/t4 conversion in periphery.

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16
Q

thiourea onset of action

A

4-6 weeks. slow.

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17
Q

which is more potent, MMI or PTU?

A

MMI by 10x.

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18
Q

pregnant patients and thioureas

A

PTU in 1st tri

switch to MMI for 2nd and 3rd

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19
Q

AE thioureas

A 
hepatotoxicity
arthralgia
fever
rash
agranulocytosis
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20
Q

black box: PTU

A

hepatotoxicity

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21
Q

methimazole (MMI) dose

A

15-60mg/day in 3 divided doses

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22
Q

onset methimazole

A

12-18 hr

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23
Q

protein binding PK/PD

A

none

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24
Q

metabolism of PK/PD

A

hepatic

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25
PTU dosing | initial & maintenance
initial: 300 mg/day in 3 doses maintenance: 100-150mg/day in 3 doses.
26
onset PTU
24-36hr
27
protein binding: PTU
high. 80-85%
28
metabolism of PTU
hepatic
29
Nonselective B blocker for hyperthyroid
propranolol
30
propranolol MoA for hyperthyroid
blocks manifestations mediated by B adrenergic receptors | can block conversion of t4 to t3.
31
nonselective B blockers in hyperthyroid are
primarily for symptom relief
32
AE of b blockers for hyperthyroid
Brady hypoTN dizzy cardiac ischemia
33
blackbox: nonselective B blocker for hyperthyroidism
cardiac ischemia
34
Iodines/Iodides | drug
lugol solution | potassium iodide
35
MoA Iodines/iodides
inhibits release of stored thyroid hormone and can reduce vascularity of gland prior to surgery
36
when is iodine/iodide used?
before surgery after ablation or thyroid storm
37
AE iodine/iodide
metallic taste hypersensitivity burning mouth
38
thyroid storm
life threatening decompensated thyrotoxicosis
39
causes of thyroid storm
trauma infection noncompliance c meds severe inflammation of thyroid
40
thyroid storm presentation
``` fever tachy dehydrated coma delirium tachypnea ```
41
tx of thyroid storm
PTU or MMI
42
PTU and MMI as initial tx for thyroid storm
give loading doses, then around the clock
43
in thyroid storm, when should iodide be started?
1 hour after PTU
44
symptom control in thyroid storm
b blocker acetaminophen for fever corticosteroids
45
corticosteroids for thyroid storm
IV loading dose | then around the clock x 1-3 days.
46
hypothyroid disorders (4)
hashimoto iatregenic iodine deficiency secondary causes
47
Hashimoto disease
autoimmune-induced thyroid injury characterized by decrease in thyroid secretion
48
iatrogenic hypothyroid
thyroid resection
49
iodine deficiency
most common cause of hypothyroidism
50
secondary causes of hypothyroidism
``` pituitary insufficiency drug induced (amiodarone, lithium) ```
51
drugs that cause hypothyroid
amiodarone | lithium
52
hypothyroid presentation
``` cold weight gain fatigue bradycardia slow reflexes dry skin coarse hair ```
53
hypothyroid diagnostics
low T4 elevated TSH presence of thyroid abs
54
who should be screened for hypothyroid? and how?
patients >60 y.o thyroid panel
55
tx for hypothyroid
levothyroxine
56
levothyroxine MoA
synthetic T4
57
dosing of hypothyroid
1.6 mcg/kg/day
58
which bodyweight to use for levothyroxine?
ideal
59
titrate levothyroxine based off of
T4 | TSH
60
onset of action: levothyroxine
3-4 days oral | 6-8 hr IV
61
peak therapeutic effect of levothyroxine
4-6 wks
62
protein binding of levothyroxine
>99%
63
metabolism of levothyroxine
hepatic metabolism to T3
64
elimination of levothyroxine
urine
65
levothyroxine monitoring
monitor TSH q4-8wks after initiation/change
66
AE levothyroxine
hyperthyroidism cardiac inc risk fractures
67
myxedema coma
life threatening decompensated hypothyroidism
68
causes of myxedema coma
trauma infection HF drug induced
69
drugs which can induce myxedema
narcotics anesthesia lithium amiodarone
70
myxedema coma presentation
not always coma | AMS, hypoventilation, hypothermia
71
tx of myxedema
iv thyroid hormone replacement empiric abx corticosteroids
72
IV hormone replacement in myxedema
loading dose of IV levothyroxine then | large daily dose until PO meds are tolerated
73
abx in myxedema
empiric if infection is suspected
74
corticosteroids in myxedema
q8 hydrocortisone
75
normal TSH
0.5 - 4.5
76
normal T4
0.8 - 1.9
77
low TSH, high T4
hyperthyroid
78
high TSH, low T4
hypothyroid

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