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3152 > pre-IC14 & IC14 > Flashcards

pre-IC14 & IC14 Flashcards

1
Q

Compelling indications for screening of thyroid disorders

A
  1. Presence of autoimmune disease (eg. T1DM, cystic fibrosis)
  2. First-degree relative with autoimmune thyroid disease
  3. Psychiatric disorders
  4. Taking amiodarone or lithium
  5. Hx of head / neck radiation for malignancies
  6. Symptoms of hypothyroidism / hyperthyroidism
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2
Q

2 ways in which TH is regulated

A
  1. Negative feedback
  2. Peripheral conversion of T4 to T3
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3
Q

Which population is likely to have elevated TBG levels?

A

Pregnant woman or on estrogen

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4
Q

What happens when TBG levels are elevated?

A

FT3 & FT4 levels will go down because more of T3 & T4 will bind to the extra TBG

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5
Q

Antibody specific and confirmatory for Graves’ disease

A

TRAb: thyrotropin receptor IgG antibodies

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6
Q

Antibodies tested when Autoimmunity thyroid disorder is suspected

A
  • ATgA: thyroglobulin antibodies;
  • TPO: Thyroperoxidase antibodies (significantly a/w hypothyroidism)
  • TRAb: thyrotropin receptor IgG antibodies
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7
Q

Who needs to undergo routine screening required for thyroid disease?

A

Pediatric patients and pregnant women

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8
Q

signs and symptoms of hyperthyroidism

A
  1. Weight loss or increased appetite
  2. Heat intolerance
  3. Goiter
  4. Fine hair
  5. Heart palpitations or tachycardia
  6. Nervousness, anxiety, insomnia
  7. Menstrual disturbances (lighter or more infrequent menstruation, amenorrhea)
  8. Sweating or warm, moist skin
  9. Exophthalmos in Graves disease
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9
Q

signs and symptoms of hypothyroidism

A
  • Cold intolerance
  • Dry skin
  • Fatigue, lethargy, weakness
  • Weight gain
  • Bradycardia
  • Slow reflexes
  • Coarse skin and hair
  • Periorbital swelling
  • Menstrual disturbances (more frequent, more blood)
  • Goiter
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10
Q

adverse effects for levothyroxine

A
  • Cardiac abnormalities (tachyarrhythmias, angina, myocardial infarction)
  • Risk of fractures
  • Signs of hyperthyroidism
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11
Q

monitoring of therapy for levothyroxine

A

Monitor TSH (or FT4 if central hypothyroidism) and symptomatic relief every 2 months

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12
Q

antibodies positive for Hashimoto disease

A

ATgA and TPO antibodies

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13
Q

What scenarios could cause increased Creatine phosphokinase (CPK) levels?

A

Hypothyroidism/ statin use

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14
Q

Labs for primary hypothyroidism

A
  • ↑TSH, ↓ T4
  • Positive antibodies (TPO, ATgA)
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15
Q

Labs for central hypothyroidism

A

↓TSH, ↓ T4

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16
Q

Dosing for levothyroxine

A
  • Young, healthy adults: 1.5 mcg/kg/d
  • 50-60 years of age and no cardiac issues: 50 mcg daily
  • With CVD: 25 mcg/d and titrate up
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17
Q

Titration for levothyroxine:

Can increase or decrease in _____ increments, or in ____ of weekly dose

A

12.5- to 25-mcg/day; 10%–15%

18
Q

MOA for levothyroxine

A

Synthetic T4

19
Q

endpoint for levothyroxine use

A

Treatment is lifelong but after a euthyroid state is achieved, thyroid function tests are recommended semiannually to annually in nonpregnant adult patients.

20
Q

How to counsel levothyroxine with regards to administration timings?

A

Take at least 30 mins before bfast/4h aft dinner; Avoid milk/antacids/iron or calcium supplements at least 2h

21
Q

MOA for Liothyronine

A

Synthetic T3

22
Q

When to use liothyronine (T3)?

A

Myxedema Coma (as it is more potent)/ going for diagnostics e.g. CT scan (due to short half-life)

23
Q

Dose incr for pregnant women with hypothyroidism

A

30-50% increase in pre- pregnant dosage to maintain euthyroid status

24
Q

Target TSH in pregnancy & hypothyroidism

A
  • 1st trimester: < 2.5 mIU/L
  • 2nd trimester: < 3.0 mIU/L
  • 3rd trimester: <3.5 mIU/L
25
Q

What is subclinical hypothyroidism

A

Elevated TSH with normal T4

26
Q

When to treat subclinical hypothyroidism

A
  • TSH > 10 mIU/L (widely accepted)
  • TSH 4.5–10 mIU/L and
    I. Symptoms of hypothyroidism
    II. TPO present
    III. History of cardiovascular disease, heart failure, or risk factors for such
27
Q

Treatment options for hyperthyroidism

A
  • Surgical resection
  • Radioactive iodine (RAI) ablative therapy
  • Thyroidectomy (complete removal of thyroid gland)
  • Antithyroid pharmacotherapy:
  • Thionamides
  • Iodides
  • Non-selective beta-blockers
28
Q

Absolute contraindication for Radioactive iodine (RAI) ablative therapy

A

Pregnancy

29
Q

Examples of thionamides

A

Carbimazole & Propylthiouracil (PTU)

30
Q

Adverse effects of thionamides

A
  • Hepatotoxicity risk (boxed warning for PTU)
  • Rash – risk for SJS
  • Agranulocytosis early in therapy (usually within 3 months)
  • Fever
31
Q

MOA of thionamides

A

Inhibits iodination and synthesis of thyroid hormones;
PTU can additionally block T4/T3 conversion in the periphery at high doses

32
Q

Thionamide: efficacy & monitoring

A
  • Maximal effect may take 4–6
    months
  • Monthly dosage titrations as needed (depending on symptoms and free T4 concentrations)
33
Q

2 main symptoms in Hyperthyroidism & Pregnancy

A
  • Failure to gain weight despite good appetite
  • Tachycardia
34
Q

Treatment for Hyperthyroidism & Pregnancy (for each trimester)

A

Treatment: Use lowest possible dose for thionamides; keep T4 at upper-normal limit
* 1st Trimester: Use PTU as Carbimazole have higher risk of congenital malformations
* 2nd and 3rd Trimesters: Use Carbimazole as PTU have higher risk of hepatotoxicity and yet less potent

35
Q

Most commonly used NSBB for hyperthyroidism

A

Propranolol

36
Q

MOA of NSBB for hyperthyroidism

A

Blocks many hyperthyroidism manifestations mediated by β- adrenergic receptors; also may block T4 conversion to T3 when used at high dose

37
Q

MOA for iodides

A

Inhibits the release of stored THs. Minimal effect on hormone synthesis. Helps decrease vascularity and size of gland

38
Q

What is Subclinical Hyperthyroidism

A

Low or undetectable TSH with normal T4

39
Q

When to treat Subclinical Hyperthyroidism

A

More compelling if TSH < 0.10 mIU/L

40
Q

Common drugs that induce hyperthyroidism

A

Amiodarone, lithium & IFN-alpha

3152 (18 decks)

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