therapeutics

Question 1

where does primary thyroid disease affect

Answer 1

thyroid gland

Question 2

where does secondary thyroid disease affect

Answer 2

pituitary gland

Question 3

where does tertiary thyroid disease affect

Answer 3

the hypothalamus

Question 4

where is the thyroid located

Answer 4

below the larynx in the neck region

Question 5

causes of primary hypothyroidism

Answer 5

autoimmune disease
previous treatment for hyperthyroidism
iodine imbalance
congenital hypothyroidism

Question 6

risk factors of primary hypothyroidism

Answer 6

female

Question 7

symptoms of hypothyroidism

Answer 7

lethargy/weakness
dry scaly skin 
depression 
hair loss 
memory loss 
weight gain 
constipation 
sensitive to cold weather

Question 8

what is primary hypothyroidism

Answer 8

high levels of TSH but low levels of unbound t4

Question 9

what thyroid function tests are carried out

Answer 9

TSH and unbound t4

Question 10

management of primary hypothyroidism

Answer 10

treat with lifelong t4 If TSH >10 or TSH 5-10 with low t4.

Question 11

what is the daily maintenance dose of thyroxine

Answer 11

50-200mcg

Question 12

what initial dose of thyroxine should a person with heart disease and over 50 have

Answer 12

25mcg od adjusted by 25mcg

Question 13

what initial dose of thyroxine can a person under 50 have

Answer 13

50-100mcg adjusted by 25-50mcg

Question 14

how long after prescribing thyroxine should TSH be measured

Answer 14

after 8-12 weeks

Question 15

what is he half life of t4

Answer 15

7 days

Question 16

how often should TSH levels be monitored in adults and children when prescribed thyroxine

Answer 16

every year for adults and every 4-6 months for children until they hit puberty

Question 17

during thyroxine treatment what should be carefully monitored

Answer 17

angina

Question 18

what other combination treatments can be considered for hypothyroidism

Answer 18

liothyronine and levothyroxine or natural thyroid extraction`xt

Question 19

are there any prescription charges for thyroxine

Answer 19

no

Question 20

what should you not take at the same time as thyroxine

Answer 20

calcium iron containing preparations or any caffeine beverages

Question 21

what is hyperthyroidism

Answer 21

low TSH high unbound t4

Question 22

what causes hyperthyroidism

Answer 22

stimulation of thyroid gland by antibodies on the TSH receptor

Question 23

risk factors

Answer 23

females

Question 24

symptoms

Answer 24

anxious, palpitations, tremor, weight loss, tachycardia, goitre, warm moist skin, heat intolerance, difficulty sleeping

Question 25

what is the most common drug therapy used for hyperthyroidism

Answer 25

carbimazole (methimazole is active metabolite)

Question 26

moa for hyperthyroidism drugs

Answer 26

inhibit thyroperoxidase activity in follicular lumen

Question 27

what drug is used to treat hyperthyroidism in pregnancy

Answer 27

propylthiouracil 200-400mg DIVIDED DOSES maintenance 50mg tds.

Question 28

carbimazole regimen

Answer 28

15-40mg od until TFTs normal then maintain for 12-18months then decrease monthly until 5-15mg.

Question 29

what is the blocking replacement regimen

Answer 29

carbimazole 40-60mg for 4 weeks the carb + thyroxine 50-100mg = temporarily hypothyroid. treat for 18 months

Question 30

are prescription charge necessary for treatment of hyperthyroidism

Answer 30

yes

Question 31

why can't carbimazole be used in pregnancy

Answer 31

increased foetal nail abnormalities. advise on contraception

Question 32

carbimazole side effects

Answer 32

agranulocytosis e.g. sore throat, mouth ulcer, bruising

Question 33

propythioluracil side effects

Answer 33

hepatic dysfunction

Question 34

in which case is radioactive iodine treatment considered

Answer 34

severe disease, failure to drug treatment, relapse after drugs, cardiac disease

Question 35

risks of surgery

Answer 35

high chance of long term hypothyroidism, damage to parathyroid gland, scarring

Question 36

what other combination treatments are considered for hyperthyroidism

Answer 36

beta blockers - relieve symptoms of palpitations/tremor (not in asthma) propranolol - may ned to be given more frequently as increased metabolism

Question 37

what happens with an overdose of iodine

Answer 37

inhibition of t3/4 release from thyroid

Question 38

why does amiodarone cause problems in thyroid disease

Answer 38

it contains organic iodine which inhibits t3/4 in hypothyroidism and increases TSH and t4 in hyperthyroidism

Question 39

problems associated with lithium

Answer 39

prevents t3+4 release as it inhibits iodine uptake