Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IPC Endocrine Week 3 > Thyroid > Flashcards

Thyroid Flashcards

(89 cards)

Start Studying
1
Q

Which is most biologically active, T3 or T4?

A

T3 is 4x more active than T4?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the role of Thyroid peroxidase (TPO)?

A
  1. oxidizes iodide
  2. conjugates two iodinated tyrosine residues
    bascially helps to made T3/T4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the major functions of TSH?

A

increase circulating T3/T4:
1. NIS upregulation
2. TG synthesis
3. TPO upregulation
4. endocytosis upregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is DIO1?

A

-liver
-kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is DIO2?

A

-CNS
-pituitary
-heart
-muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the half-life of T4?

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is secreted by hypothalamus?

A

TRH: thyrotropin releasing hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is secreted by anterior pituitary?

A

TSH: thyroid stimulating hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the levels of TSH and FT4 in secondary hyPOthyroidism?

A

-TSH: decreased
-FT4: decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens in secondary hypothryoidism?

A

pituitary has trouble producing TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the probable causes of secondary hypothyroidism?

A
  1. surgery
  2. radiation
  3. tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the levels of TSH and FT4 in primary hyPOthyroidism?

A

-TSH: increased
-FT4: decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the possible causes of primary hypothyroidism?

A
  1. autoimmune thyroiditis (Hashimoto’s disease)
  2. iatrogenic (d/t HCP)
  3. drug-induced
  4. Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In autoimmune thyroiditis, antibodies made by the body can target which 3 antigens?

A
  1. TPO
  2. TG
  3. TSH receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What antibody is most commonly found in patients with Hashimoto’s?

A

TPO Ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens to levels of TSH and FT4 in patients with secondary hypERthyroidism?

A

-TSH: increased
-FT4: increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common cause of secondary hyPERthyroidism?

A

-tumor on pituitary causing it to overproduce TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens to levels of TSH and FT4 in patients with primary hYPERthyroidism?

A

-TSH: low
-FT4: high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are possible causes of primary hypERthyroidism?

A

-Grave’s disease
-toxic adenoma (tumor)
-multinodular goiter (Plummer’s)
-Other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What antibody is most commonly found in patients with Grave’s disease?

A

TSHR Ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the role of TSHR Ab in Grave’s disease?

A

-acts like TSH
-stimulates other protein production ->increased hormone synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the s/sx of hyPOthyroidism?

A

-decreased metabolism
-decrease HR, CO
-increased PVR
-decreased appetitie, motility
-lethargy/weaknesss
-stiffness, carpal tunnel
-COLD intolerance, brittle hair
-sleep apnea
-weight GAIN
-FATIGUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the s/sx of hyPERthyroidism?

A

-increased metabolism
-increased HR, CO
-decreased PVR
-increased appetite, motility
-nervousness
-weakness, tremor, osteoporosis
-HEAT intolerance, thinning hair
-dyspnea, hypoventilation
-weight LOSS
-FATIGUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the absorption of levothyroxine affected by?

A

-food
-pH
-fiber
-drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the notable DDIs associated with levothyroxine?
Interference with absorption: -PPIs, bile acid sequestrants, metal cations, PO bisphosphonates, coffee Inhibition of DIO3: -beta blockers, AMIODARONE, corticosteroids
26
What are thioamides used for?
-TPO inhibitor: used for hyperthyroidism
27
Which agents are thioamides?
-MMI: methimazole -PTU: propylthiouracil
28
Which is more potent, MMI or PTU?
MMI
29
Which thioamide has longer DOA?
MMI
30
Which thioamide has more ADR?
PTU
31
Which thioamide blocks DIO1?
PTU
32
Which thioamide can safely be used in pregnancy?
PTU: does not cross placenta
33
What is the half-life of radioactive iodine?
5 days
34
What is the MOA of iodides?
-blocks TSH release and inhibits T3/T4 synthesis
35
What are examples of iodides used?
SSKI, Lugol's solution
36
When are beta-blockers recommended?
all patients with symptomatic thyrotoxicosis especially if: -resting HR>90 -elderly -CV disease
37
What is the MOA of propanolol?
-inhibits DIO2, prevents T4 conversion to T3
38
What are the levels of TSH and FT4 in OVERT primary hypothyroidism?
-TSH: high -FT4: low
39
What are the levels of TSH and FT4 in subclinical primary hypothyroidism?
-TSH: high -FT4: normal
40
When do we use pharmacological treatment for hypothyroidism?
patients with: 1. overt hypothyroidism (low FT4 AND high TSH) 2. subclinical if TSH >10.0 3. pregnancy/planning if TSH >2.5 AND TPO AB (+)
41
True or false: one lab draw is enough to diagnosis a patient with subclinical hypothyroidism if TSH is high and FT4 is normal.
FALSE: need to have more than 1 lab draw, retest in 1-3 months to confirm
42
When do you CONSIDER treatment of hypothyroidism?
1. sublinical if TSH 4.5-10.0 AND -TPO Ab (+), CAD/CHF or risk factors 2. pregnany/planning AND not hypothyroid AND: -TSH 2.5-ULN (1st trimester) -TSH 3.0-ULN (2nd trimester) -TSH 3.5-ULN (3rd trimester) -normal TSH but TPO Ab (+)
43
What is normal TSH level?
0.45-4.12
44
What are the treatment goals of hypothyroid treatment?
1. biochemically euthyroid (use TSH) 2. symptomatic resolution 3. avoid over supplementation in elderly (can lead to afib or osteoporosis)
45
What drugs do we use for hypothyroidism?
1. desiccated thyroid 2. levothyroxine 3. liothyronine
46
Which has better bioavailability, levothyroxine or liothyronine?
liothyronine
47
What do you need to know about liothyronine?
-synthetic T3 -BID dosing -potential ADR: cardiac toxicity -for life-threatening hypothyroidism
48
What is the initial levothyroxine dosing for healthy patients <65 y/o?
1.6 mcg/kg/day
49
What is the initial levothyroxine dosing for healthy patients ≥ 65 y/o?
50 mcg/day
50
What is the initial levothyroxine dosing for patients with known CAD?
12.5-25 mcg/day
51
When should you recheck TSH after initiation of levothyroxine?
in 4-6 weeks
52
How much do we titrate levothyroxine dose by?
12.5-25 mcg/day up or down
53
How should levothyroxine be taken?
-with H20 only -60 mins before breakfast or 3 hours after evening meal -be consistent
54
What are some ADR of levothyroxine?
-afib -osteoporosis -transient alopecia -allergies
55
What are the options for treatment of Grave's disease?
1. antithyroid drug (thioamide) 2. Ratioactive iodine 3. thyroidectomy
56
When is it favorable to go the pharmacotherapy route for treatment of Grave's disease?
-mild disease -mod-severe thyroid eye disease -can't have surgery for some reason (risk, access) -previous operation on neck
57
When is it favorable to use radioactive iodine for the treatment of Grave's disease?
-can't have surgery for some reason -planning pregnancy that is >6 months out -CIs to drug use
58
When is it favorable to go down the surgery route for the treatment of Grave's disease?
-large goiter -cancer suspected -planning pregnancy <6 months out -mod-severe TED -TR Ab levels are high
59
True or false: thioamides will cure GD
FALSE, high remission rate
60
Which thioamide is preferred in treatment?
Methimazole
61
When is PTU preferred?
-pregnancy -thyroid storm
62
What side effects does PTU have?
liver toxicity
63
What is the starting dose of MMI if FT4 is 1-1.5 x ULN?
5-10 mg/day (QD)
64
What is the starting dose of MMI if FT4 is 1.5-2 x ULN?
10-20 mg/day (QD or BID)
65
What is the starting dose of MMI if FT4 is 2-3 x ULN?
30-40 mg/day (BID)
66
What is the maintence dose of MMI?
30-50% reduction from initial dose
67
When do we check FT4 after initiation of MMI?
2-6 weeks
68
What are some ADR of thioamidse?
-agranulocytosis -aplastic anemia -exfoliative dermatitis -hepatitis -rash -leukopenia -arthalgia
69
True or false: the goal of radioactive iodine therapy is to render a patient hypothyroid.
True
70
When should propanolol be given during the RAI treatment timeline?
At diagnosis
71
When should a pregnancy test be administered before RAI?
48 hours prior
72
Who should be recieving MMI prior to initiation of RAI?
those with severe disease: FT4 2-3 x ULN
73
If patient needs MMI prior to RAI, when should it be started?
at diagnosis
74
If patient needs MMI prior to RAI, when should it be discontinued?
2-3 days before RAI
75
What patients should steroid be given to for RAI treatment?
patients with mild, active TED
76
When should propanolol be tapered in RAI treatment?
weeks after RAI treatment
77
When should steroid be given in the RAI treatment timeline?
1-3 days after RAI treatment
78
When should PRN MMI be given after RAI treatment?
3-7 days after
79
What should be tapered weeks after RAI treatment?
-MMI -Propanolol -steroid
80
How long should steroid be given in patients with mild active TED after RAI treatment?
1 month
81
What should be monitored after RAI treatment?
FT4, T3, TSH: Q4-6 weeks for 6 months
82
What is the key early marker of RAI treatment success?
FT4
83
When should MMI be given prior to surgery?
6-8 weeks
84
When should iodide be given before surgery?
10-14 days before surgery
85
When should beta blocker be given before surgery?
7-10 DAYS
86
What are some complications of thyroidectomy?
-transient or permanent hypocalcemia -vocal abnormalities -hyperthyroidism (lack of efficacy)
87
What labs need to be taken prior to discharge after surgery?
-serum calcium -PTH levels
88
What is the treatment duration of thioamides?
12-18 months
89
What is teprotumumab?
for TED

IPC Endocrine Week 3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions