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Hyperthyroidism Flashcards

1
Q

causes of hyperthyroidism

A

graves’ disease, TSH-secreting pituitary adenomas, toxic adenoma

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2
Q

graves’ disease is an

A

autoimmune syndrome that may include hyperthyroidism, diffuse thyroid enlargement, exophthalmos, pretibial myxedema, thyroid acropachy

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3
Q

in graves’ disease

A

thyroid stimulating immunoglobulin functions as an agonist at the TSH receptor, stimulating hormone production and release

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4
Q

Graves’s disease patients will have antibodies to

A

TPO

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5
Q

about 15% of graves’ patients will

A

spontaneously develop Hashimoto’s

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6
Q

TSH-secreting pituitary adenomas

A

release of biologically active hormone that is unresponsive to normal feedback control and occurs sporadically

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7
Q

toxic adenoma

A

autonomous thyroid nodule, seen as “hot: nodules on radioiodine scan

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8
Q

hyperthyroidism lab values

A

elevated free and total T3 and T4 with a low TSH and elevated RAIU

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9
Q

increased RAIU indicates

A

indicated true hyperthyroidism

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10
Q

decreased RAIU indicates that

A

the excess thyroid hormone is not a consequence of thyroid gland hyperfunction

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11
Q

thioamides

A

methimazole and propylthiouracil

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12
Q

methimazole

A

inhibits thyroid peroxidase (T4/T3 synthesis)

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13
Q

propylthiouracil

A

inhibits thyroid peroxidase, and inhibits 5’ deiodinase

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14
Q

half life of MMI

A

5 hours

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15
Q

half life of PTU

A

1 hour

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16
Q

duration of action of MMI

A

24 hours

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17
Q

duration of action of PTU

A

6-10 hours

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18
Q

metabolic clearance of MMI and PTU

A

decreased in renal and hepatic disease

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19
Q

MMI vs. PTU

A

MMI is 10-12 times more potent than PTU

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20
Q

MMI contraindications

A

pregnancy and breastfeeding

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21
Q

PTU contraindications

A

pregnancy

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22
Q

drug interactions of thioamides

A

warfarin - by correcting the underlying hyperthyroidism, metabolism of clotting factors will be reduced resulting in decreased response to warfarin

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23
Q

pregnancy and thioamides

A

PTU has historically been the preferred agent if treatment is necessary

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24
Q

thioamides - minor adverse effects

A

fever, rash, arthralgias, transient leucopenia

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25
thioamides - major adverse effects
agranulocytosis, hepatitis, vasculitis, lupus-like syndrome
26
PTU initial dose
300-600mg divided three to four times daily
27
PTU maintenance dose
50-300mg divided two to three times daily
28
PTU max dose
1200 mg/day
29
MMI initial dose
30-60mg divided three times daily
30
MMI maintenance dose
5-30mg daily
31
MMI max dose
120 mg/day
32
changing doses of thioamides
doses should not be changed more than monthly
33
treatment with thioamides
treatment is continued for 12-24 months
34
baseline monitoring for thioamides
leukocyte count
35
labs to monitor for thioamides
TSH, FT4, TT4
36
adverse reactions to monitor for in thioamides
weakness, fatigue, easy bruising/bleeding, urinary symptoms
37
Radioactive iodine is used for
chemical ablation of thyroid gland
38
MOA of radioactive iodine
incorporated into thyroid hormone and thyroglobulin leading to follicular necrosis
39
treatment of choice for graves' disease
radioactive iodine
40
pretreatment for radioactive iodine
pretreat with MMI/PTU in geriatric and cardio patients bc RI may transiently elevate thyroid hormone levels following treatment
41
with RI, euthyroid is reached in
2-6 months
42
in RI, hypothyroid typically happens within
4-12 months
43
contraindications of radioactive iodine
pregnancy, women should avoid getting pregnant for 6-12 months following therapy
44
thyroid eye disease and radioactive iodine
RAI exacerbates thyroid eye disease
45
exophthalmos treatment
begin glucocorticoid (prednisone 0.4-0.5 mg/kg/day) 4 to 7 days after RAI dose an taper over 2-3 months
46
possible reasons for surgery
- pediatric age group with toxic reaction to antithyroid medications - pregnant women requiring high doses of PTU or having a toxic reaction to PTU
47
symptomatic treatment of hyperthyroidism
beta-blockers and calcium channel blocker
48
beta-blockers
inhibit adrenergic effect - control symptoms of tachycardia and hypertension
49
graves disease - most patients over 40 years old should receive
radioactive iodine
50
pregnant women and children should receive
antithyroid drugs as initial therapy
51
inadequately treated maternal hyperthyroidism can result in
fetal tachycardia, severe growth restriction, premature birth, and 9-fold increased incidence of low birth weight
52
PTU is preferred agent in pregnancy because
80-90% protein bound, therefor limited transfer into the placenta and breast milk as compared to MMI
53
type one amiodarone-induced thyroiditis
occurs due to drug metabolism (iodine-induced)
54
type one treatment of choice
thioamides
55
MMI dose for type one
40-60 mg/day
56
PTU dose for type one
100-150 mg qid
57
for severe type one you add
lithium 200-400 mg/day and titrate to serum concentration of 0.6-1.2 mEq/L
58
type two amiodarone-induce thyroiditis
occurs due to direct toxic effects (inflammation)
59
type 2 treatment choice
glucocorticoids
60
dosing for type 2
prednisone 0.5-1.5 mg/kg/day and taper over 2-3 months; for most patients 40-60 mg/day
61
iatrogenic hyperthyroidism
patients who receive too much thyroid hormone supplementation
62
acute thyroiditis
infection of the thyroid gland
63
symptoms of acute thyroiditis
acute onset of severe pain typically accompanied by fever, dysphagia, and erythema
64
thyroid function in acute thyroiditis
remains normal but ESR is typically elevated
65
treatment of acute thyroiditis
treatment with appropriate antibiotics usually results in complete resolution
66
subacute thyroiditis
symptoms similar to pharyngitis and is though to be caused by viral infection
67
the inflammatory process of subacute thyroiditis can lead to
destruction of tissue and fibrosis
68
in subacute thyroiditis patient typically presents with
symptoms similar to hyperthyroidism at first; after hormone is depleted, will develop hypothyroidism
69
subacute treatment
anti-inflammatory doses of ASA or NSAIDs is typically sufficient, if not glucocorticoids may be used
70
thyroid storm
uncommon, life-threatening condition characterized by an exaggeration of the manifestation of hyperthyroidism
71
TS has morality of
20%
72
precipitating factors of TS
surgery, obstetrical delivery, infections, or any other stressful medical illness
73
thyroid storm symptoms
high fever, tachycardia, tachypnea, dehydration, delirium, congestive heart failure, and rapid atrial fibrillation
74
treatment of thyroid storm
antithyroid drugs via loading dose and then chronic therapy, beta blockers, iodide in some patients
75
supportive care for TS
fluids/electrolytes, antibiotics, and APAP for fever

Endocrine (7 decks)

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