Thyroid

Question 1

What does the thyroid gland effect?

Answer 1

Brain function, bone growth, oxygen to organs, sexual maturation, tooth and bone development,

Question 2

What does the hypothalamus stimulate the release of?

Answer 2

TSH T3 and T4

Question 3

As T4 levels rise the the TSH levels ____

Answer 3

Fall

Question 4

What is iodine used for by the body

Answer 4

Synthesis of thyroid hormones

Question 5

How much iodine is recommended an intake?

Answer 5

150 or for pregnancy or BF 200-220

Question 6

How does thyroid hormone effect GFR

Answer 6

High thyroid = higher GFR LOWERR = lower GFR

Question 7

What is cretinism

Answer 7

Severe lack of TSH from iodine deficiency causing retardation, short stature, delayed motor development, protuberant abdomen, coarse hair

Question 8

At what age should you check TSH of no risk for hypothyroid

Answer 8

60

Question 9

Where are the T4 and T3 synthesis within the thyroid gland?

Answer 9

Follicular cells of the thyroid gland

Question 10

What enzyme stimulated by TSH oxidizes iodide to iodine

Answer 10

Thyroid peroxidase

Question 11

Condensation of two molecules DIT yields what substance?

Answer 11

T4

Question 12

Which disorder decreases GFR hypo or hyperthyroidism

Answer 12

Hypo

Question 13

T or F sea salt contains about the same amount of iodine as table salt

Answer 13

False

Question 15

What is the leading cause of hyperthyroid in all ages?

Answer 15

Graves

Question 16

What can hyperthyroidism lead to in children?

Answer 16

Cardiomegaly and heart failure

Question 17

What causes neonatal Graves’ disease?

Answer 17

Maternal IgG antibodies and it resolves when the child is 3-4 months old

Question 18

What are the symptoms of graves in children?

Answer 18

Hyperactivity, nervousness, emotional lability, ADHD

Question 19

What two pregnancy hormones can cause increased thyroid levels?

Answer 19

HCG and estrogen

Question 20

What can hyperthyroidism in pregnancy lead to?

Answer 20

Still birth, miscarriage, or pre eclampsia, premature birth, and low birth weight

Question 21

How does hyperthyroidism in older adults present?

Answer 21

Atypical, atrial arrhythmias, heart failure, and osteoporosis

Question 22

What is the second most common cause of hyperthyroidism?

Answer 22

Solitary adenoma or toxic nodule

Question 23

I’what are signs you can see in hyperthyroidism?

Answer 23

Fast speech, tachycardia, tremor, goiter, a fib, moist skin, thrill or bruit over thyroid

Question 24

What do labs look like with hyperthyroidism?

Answer 24

Low TSH less than .03, elevated T4 and T3

Question 25

What is a thyroid antagonist?

Answer 25

Thioamides like methimazole and PTU

Question 26

What are the tx options for hyperthyroid?

Answer 26

Medicine, radioactive iodine, and surgery,

Question 27

What is the MOA of thioamides

Answer 27

Prevent thyroid hormone synthesis by inhibiting the thyroid peroxidase catalyzed reactions and blocking the incorporation of iodine into thyroglobulin

Question 28

When does remission occur in 50% of people on thioamides

Answer 28

12 months

Question 29

Which thioamide drug is more potent MTZ or PTU

Answer 29

MTZ

Question 30

How often is PTU dosed?

Answer 30

TID or QID

Question 31

T or F thioamides are considered safe in breast feeding

Answer 31

T

Question 32

What are the most common AEs of the thioamides

Answer 32

GI distress, maculopapular rash

Question 33

Which thioamide is jaundice more common in?

Answer 33

MTZ

Question 34

Who is more at risk for agranulocytosis on thioamides?

Answer 34

People with reduced bone marrow, older than 40, receiving more than 40mg a day of MTZ.

Question 35

Why should you monitor a WBC on thioamides?

Answer 35

It can induce a granulocytosis bone marrow suppression

Question 36

Which drugs interact with thioamides?

Answer 36

Warfarin and heparin, potassium iodide, lithium, and amiodarone

Question 37

Which med can you NOT take with thioamides

Answer 37

Amiodarone

Question 38

What is myxedema crisis and what causes it?

Answer 38

Thyroid storm caused by PTU

Question 39

What should you give for hyperthyroidism if beta blockers are contraindicated in cases like asthma?

Answer 39

Diltiazem

Question 40

When can radioidine be used in front line therapy?

Answer 40

When patients are not at high risk for hyperthyroidism complications

Question 42

What is secondary causes of hypothyroidism?

Answer 42

Insufficient thyroid stimulation caused by adenoma, radiation, Cushing, and acromegaly

Question 43

What labs are affected in adults with hypothyroidism that is not TSH related?

Answer 43

Elevated lipid levels

Question 44

Which thyroid drug contains T3

Answer 44

Liothyromine sodium

Question 45

What is the average replacement dose of T4

Answer 45

1.7mcg /kg a day

Question 46

What decreases the absorption of TSH

Answer 46

PPI and and people who have a had resections of the bowel

Question 47

What food effect levothyroxine?

Answer 47

Soybean flour, infant formula, cotton seed meal, walnuts, fiber, and calcium foods and juices.

Question 48

What conditions increases TBG

Answer 48

Pregnancy hepatitis, estrogen, porphyria