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Endocrine > Hyper / Hypo thyroidism & Osteoporosis > Flashcards

Hyper / Hypo thyroidism & Osteoporosis Flashcards

(42 cards)

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1
Q

What is Hyperthyroidism?

A

Over secretion of thyroid hormones, leading to thyrotoxicosis (an excess of circulating thyroid hormones)

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2
Q

What characterises hyperthyroidism?

A
  • Low TSH (thyroid stimulating hormone)
  • High Thyroxine [T4]
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3
Q

What is the active form of T4?

A

T3 - triiodothyronine

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4
Q

What are the signs and symptoms of hyperthyroidism?

A
  • A goitre
  • Disturbed sleep
  • Hyperactivity
  • Heat intolerance
  • Unintentional weight loss
  • Complications (like thyroid storm, pregnancy complications, HF, AF, reduced bone mineral density)
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5
Q

What are the signs and symptoms of hyperthyroidism?

A
  • A goitre
  • Disturbed sleep
  • Hyperactivity
  • Heat intolerance
  • Unintentional weight loss
  • Complications (like thyroid storm, pregnancy complications, HF, AF, reduced bone mineral density)
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6
Q

What are the two reasons antithyroid drugs are given?

A

To prepare for thyroidectomy

OR

For long term management

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7
Q

What are the two reasons antithyroid drugs are given?

A

To prepare for thyroidectomy

OR

For long term management

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8
Q

What drugs is mainly used for hyperthyroidism? And what do they do?

A

Carbimazole
Or Propylthiouracil as an alternative

They interfere with synthesis of thyroid hormones

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9
Q

What can antithyroid drugs cause during pregnancy?

A

It can cause fetal goitre

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10
Q

What can over treatment if antithyroid drugs cause?

A

Hypothyroidism

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11
Q

What is blocking replacement therapy?
Can it be used in pregnancy?

A

Because antithyroid drugs can lead to hypothyroidism, thyroid has to be given when thyroid levels (FT4) get to a certain range

This therapy needs to be avoided in pre

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12
Q

What drugs are used in blocking replacement regimen? Can this regimen be used in pregnancy?

A

Carbimazole + Levothyroxine

Cannot be used in pregnancy

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13
Q

What other drugs are used in thyroidism?

A

Iodine - used with antithyroid drugs (not did long term use)

Radioactive sodium iodide - treatment of thyrotoxicosis

Propranolol - reliefs thyrotoxic symptoms (can be used in conjunction with iodine)

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14
Q

What is used to treat thyroid storm (thyrotoxic crisis)?

A
  • I.V fluids
  • Propranolol
  • Hydrocortisone
  • Oral iodine solution, Carbimazole, Propylthiouracil
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15
Q

Which antithyroid drugs can be used in pregnancy?

A

Carbimazole and Propylthiouracil can be be given; but never radioactive iodine.

Propylthiouracil is used in 1st trimester because Carbimazole causes congenital effects

Then switch to Carbimazole in 2nd trimester because there is a risk of hepatotoxicity with Propylthiouracil

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16
Q

What are are the signs of hepatotoxicity?

A
  • dark urine
  • jaundice
  • anorexia
  • pruritus
  • vomiting
  • fatigue
  • nausea
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17
Q

What are the main side effects of Carbimazole?

Study These Flashcards
A

Neutropenia & Agranulocytosis.
Shown by:
- Bone marrow suppression (stop treatment immediately)

  • Signs of infection like sore throat (report immediately)

Then white blood cells should be performed if any sign of infection.
And stop Carbimazole immediately if any clinical or laboratory evidence of neutropenia

18
Q

What advice must be given to Carbimazole?

Study These Flashcards
A

Advice to report immediately, any signs of:
- sore throat
- mouth ulcers
- bruising
- fever
- malaise
- development of non-specific illness

19
Q

What MHRA advice is given with Carbimazole?

Study These Flashcards
A

Can cause congenial malformations esp in 1st trimester, and at high doses.

  • Women of child bearing age should use contraception.

Can cause acute pancreatitis. Stop drug immediately if occurs

20
Q

What monitoring is required for Propylthiouracil?

Study These Flashcards
A

Monitor hepatotoxicity

  • Discontinue if severe liver-enzyme abnormalities develop
21
Q

What monitoring is required for Propylthiouracil?

Study These Flashcards
A

Monitor hepatotoxicity

  • Discontinue if severe liver-enzyme abnormalities develop
22
Q

What patient advice should be given with Propylthiouracil?

Study These Flashcards
A
  • Recognise signs of liver disorders
  • Seek medical immediately if:
    • dark urine
    • jaundice
    • abdominal pain
    • vomiting
    • fatigue
23
Q

What is the cause for hypothyroidism?

Study These Flashcards
A

Caused by underproduction and secretion of thyroid hormones

24
Q

What characterises hypothyroidism?

Study These Flashcards
A

High TSH - above range
Low free thyroxine [FT4]

25
Which levels are considered during pregnancy in thyroidism?
Only TSH levels, not FT4
26
What are the signs and symptoms of Hypothyroidism?
- Fatigue - Wight gain - Constipation - Menstrual irregularities - Depression - Dry skin - Intolerance to the cold - Complications like HF, CHD etc
27
What are the primary causes of hypothyroidism?
Primary causes: - Iodine deficiency - Autoimmune disease (hashimoto thyroiditis) - Radiotherapy - Surgery - Drugs Secondary causes: - Pituitary or hypothalamic disorder
28
What are the treatments of Hypothyroidism?
Levothyroxine - 1st line for maintenance Liothyronine - more rapidly metabolised & more rapid effects, so used in more severe hypothyroid states when a rapid response is required I.V Liothyronine - used for hypothyroid coma
29
What is Osteoporosis?
Progressive bone disease Increases risk of fractures
30
What are the risk factors for osteoporosis?
- Postmenopausal women - Men over 50 years - Patients taking long term oral corticosteroids (glucocorticoids) - Vitamin D deficiency - Low calcium intake - Early menopause - Family history of hip fractures - Low body mass index (BMI) - Rheumatoid arthritis & Diabetes - also associated with osteoporosis
31
What lifestyle changes need to be done for those with osteoporosis?
- Increase physical activity - Stop smoking - Maintain normal BMI (20-25kg/m2) - Reduce alcohol intake - Increase dietary intake of Vitamin D n Calcium - Elderly patients have an increased risk of falls
32
What drugs are used in Postmenopausal Osteoporosis?
- Oral bisphosphonates, alendronic acid & risedronate sodium - are 1st like treatment Alendronic acid and risedronate are used to reduce fractures If both contraindicated, ibandronic acid, denosumab or raloxifene
33
What drugs are used in Postmenopausal Osteoporosis?
- Oral bisphosphonates, alendronic acid & risedronate sodium - are 1st like treatment Alendronic acid and risedronate are used to reduce fractures If both contraindicated, ibandronic acid, denosumab or raloxifene
34
Who can be given HRT and why?
Younger postmenopausal women because in older postmenopausal women, there is an increased risk of cardiovascular disease and cancer
35
Which drug can induce osteoporosis?
Glucocorticoids - as they can cause bone loss and increase risk of fractures. Occurs early after initiation of glucocorticoid and increases with dose and duration.
36
What is the prevention and treatment of glucocorticoid?
- Oral bisphosphonates - Alendronic acid - Risedronate
37
What is the drug treatment for osteoporosis in men?
- Oral bisphosphonates - Alendronic acid - Risedronate
38
What is the drug action for Bisphosphonates?
They are absorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution and therefore reducing the rate of bone turnover
39
What are the MHRA/patient advice for Bisphosphonates?
Advice is mainly for patients taking it long term 2+ years. 1) Atypical fermoral fracture - report any thigh, hip, or groin pain during treatment 2) Osteonecrosis of the jaw (jaw bone starved of blood) - during treatment maintain good oral hygiene( routine dental check ups, report any oral symptoms. Risk rather with I.V than oral bisphosphonates. 3) Ostenecrosis of external auditory canal - report any ear pain, discharge from ear, or an ear infection during treatment
40
What are the side effects of Alendronic acid?
Oesophageal reactions So advice patients to seek medical advice if symptoms develop: - Dysphagia - New or worsening heartburn - Pain on swallowing - Retrosternal pain
41
What is the dose for Alendronic acid?
10mg DAILY or 70mg once WEEKLY - Postmenopausal osteoporosis women 10mg DAILY in men
42
What are the counselling points for Alendronic acid?
- Swallow whole - Oral solution should be swallowed as single 100ml dose - Take doses with plenty of water while sitting or standing - Take on empty stomach at least 30 mins before breakfast (or any other oral med) - Stand or sit upright for at least 30 mins after administration

Endocrine (7 decks)

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