Lecture 4

Question 1

Antithyroid medications

Answer 1

• propythiouracil
• methamazole

Question 2

Antithyroid medication function

Answer 2

Block organification, decrease hormone production

Question 3

Pros of Antithyroid medication

Answer 3

• euthyroid
• controls symptoms
• allows time to consider options

Question 4

Cons of Antithyroid medication

Answer 4

• liver dysfunction
  -agranulocytosis

Question 5

Surgery for thyroid therapy

Answer 5

•Total or partial thyroidectomy
•Risks
• Laryngeal damage
• Hypoparathyroidism
• Possibility of inadequate resection
•Thyroid replacement hormones required (HRT

Question 6

Radioiodine therapy

Answer 6

•< 1110 MBq
•Therapy of choice in North America
•Beta emitter
•Effective for following diseases:
• Graves’
• Plummer’s
• Toxic adenomas

Question 7

Dose considerations for therapy

Answer 7

•Based on:
• Disease
• Graves’ vs toxic nodules
• Gland Size
• Normal 15-20 g
• Graves 40-80 g
• Size-based dose
• Uptake
• 6 hr or 24 hr

Question 8

Standard dose for less severe hyperthyroidism

Answer 8

• less hyper
  -diffuse goiter
  -no nodules
  -555 MBq
  -potentially more than one dose, 3-6 months apart

Question 9

Standard dose for severe hyperthyroidism

Answer 9

-severely hyper
-large gland
-cardiac disease
-significant nodules
- 1110 MBq
-one dose

Question 10

Therapy patient prep

Answer 10

Patient Preparation
•Established diagnosis
• Physical exam
• History
• Increased thyroid hormone levels, decreased TSH
• Uptake/scan
•NPO
•Pregnancy screening
•Cease breastfeeding/lactation
•Off ATDs 5-7 days
• Can restart 7-10 days post-therapy
•Education
•Written consent

Question 11

Education for patients

Answer 11

•Technologist/physician responsibility
•One-week post-therapy
• Wash hands frequently
• Shower daily, clean tub afterwards
• Use own towels and dishes
• Do not hold small children for extended periods
• No infant holding for 24 hrs
• Flush toilet 2-3 times after each use
• Sit when urinating
• No sexual activity or kissing
• Dispose of toothbrush

Question 12

Results/benefits

Answer 12

•3 weeks: symptom improvement
•3-6 months: full effect
•Only 10% of patients require subsequent
treatments with higher dose

Question 13

Risks of thyroid therapies

Answer 13

•Short Term
• Hypothyroidism: Grave’s vs toxic nodules
• Sore throat, dysphagia
• Thyroid Storm
• Extremely rare
• Increase in symptoms
• Life threatening if not treated
• Prevention: pre-treatment with ATDs
• Avoid pregnancy 3-6 months
•Long Term
• Hypothyroidism
• Thyroid cancer
• Leukemia