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Sophomore - Pharm test 3 > Thyroid > Flashcards

Thyroid Flashcards

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1
Q

Thyroid stimulating hormone - stimulates the thyroid to do what?

A

Iodinize thyroglobulin and produce thyroxine (T4) and triiodothyronine (T3)

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2
Q

What does thyroid peroxidase do?

A

Oxidizes iodide to form iodine atoms which are then added onto thyroglobulin to produce thyroid hormones

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3
Q

What percentage of thyroid hormone secreted by the thyroid is T4?

A

80%

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4
Q

What percentage of thyroid hormone secreted by the thyroid is T3?

A

20%

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5
Q

What is the primary extra-thyroidal site of T3 production?

A

The liver

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6
Q

Thyroid effect on the brain?

A

Promote normal brain development

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7
Q

Thyroid effect on bones?

A

Promote normal growth and skeletal development

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8
Q

Thyroid effect on the heart?

A

Increases sympathetic response (increased B-receptors)

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9
Q

Thyroid effect on lungs?

A

Increased ventilation

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10
Q

Thyroid effect on kidneys?

A

Overall increase in renal function

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11
Q

Thyroid effect on overall metabolism?

A

Increased rate of carbohydrate consumption

Increased body temp

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12
Q

Primary hypothyroidism - describe?

A

90% of all cases of hypothyroidism are primary

Problem is malfunctioning thyroid

Increased TSH (Hellooooo, McFly!!)

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13
Q

Primary causes of hypothyroidisim - name three

A
  1. Hashimoto
  2. Surgery or radiation
  3. Iodine deficiency
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14
Q

What is going wrong in Hashimoto’s Disease?

A

Autoantibodies target thyroid peroxidase, resulting in decreased T3/T4 production

Hypothyroid disease

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15
Q

Secondary hypothyroidism - describe:

A

Hypothalamus or pituitary insufficiency (lack of TRH or TSH)

Thyroid gland itself is fine

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16
Q

Hypothyroidism - S/S?

A 
Intolerance to cold
Facial/eyelid edema
Fatigue
Anorexia
Brittle nails and hair
Menstrual disturbances
Lethargy
Dry skin
Constipation
Muscle aches
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17
Q

A neck goiter would be seen in…?

A

Iodine deficiency hypothyroidism

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18
Q

What is cretinism?

A

Severely stunted mental and physical retardation due to sustained congenital hypothyroidism

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19
Q

What is the drug of choice for treatment of primary hypothyroidism?

A

Levothyroxine (Synthroid)

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20
Q

Monitoring for thyroid replacement therapy?

A

Baseline TSH and FT4

Every 6 to 8 weeks until normal

Every 6 to 12 months if controlled

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21
Q

What type of drug is Levothyroxine?

A

Synthetic T4

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22
Q

Dessicated thyroid - problems?

A

Animal source

Greatest risk of hypersensitivity

Varied potency

Mad cow disease risk

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23
Q

Levothyroxine - note regarding older adults with cardiac disease?

A

They should start on a lower dose (25mcg/day)

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24
Q

Liothyronine - MOA?

A

Synthetic T3

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25
Liothyronine - notable for..?
Good option for patients who cannot convert T4 to T3
26
Liotrix - MOA?
T4/T3 4:1 ratio (mimic the body’s natural balance) Remember LioTRIX is a MIX of T4 and T3
27
Myxedema coma - describe:
The end state of untreated hypothyroidism Loss of brain function
28
Myxedema coma - tx?
Levothyroxine | Hydrocortisone (until adrenal suppression can be rules out)
29
Thyrotoxicosis - describe:
Condition caused by overactive thyroid leading to too much thyroid hormone in the body
30
Hyperthyroidism - values for TSH and FT4?
Low TSH (pituitary saying “stop making it!”) High FT4 (thyroid making too much)
31
Thyroid storm - describe:
Decompensated form of thyrotoxicosis Can be fatal
32
What is the most common cause of hyperthyroidism?
Graves Disease (60-80% of cases)
33
Describe Graves Disease:
Autoimmune disorder Autoantibodies that mimic TSH stimulate T4/T3 production in the thyroid
34
What is Plummer’s Disease?
Excessive thyroid secretion from autonomous hyperfunctioning nodules
35
Hyperthyroidism - S/S?
``` Hyperthermia Exopthalmos Facial flushing Tachycardia Hypertension Muscle wasting Tremors Diarrhea ``` Older patients: anorexia, confusion, constipation
36
What is the treatment of choice for non-pregnant patients with Graves Disease, multinodular goiter, or toxic ademona?
Radioactive iodine
37
What is a common unintended effect of radioactive iodine?
Patients become hypothyroid (then we can just give synthroid)
38
Contraindication for radioactive iodine?
Pregnancy
39
Treatment of choice for severe hyperthyroidism?
Partial or total thyroidectomy
40
Thioamide - MOA?
Inhibits thyroid perioxidase, blocking iodination of thyroid hormones May block T4-T3 conversion in the periphery, as well Takes several weeks to work
41
What is the preferred agent for pharmacologic tx of hyperthyroid?
Methimazole (Tapazole)
42
Methimazole - pregnancy category?
D
43
Propythiouracil (PTU) - use?
Tx of Hyperthyroid Drug of choice for pregnancy, nursing, and thyroid storm
44
Thioamides (PTU and methimazole) - Black box warning?
Severe liver injury and acute liver failure
45
Thioamides - AE’s?
``` Jaundice Agranulocytosis Leukopenia Arthralgia (lupus-like symptoms) Rash ```
46
Which thioamide uses once daily dosing?
Methimazole
47
Which thioamide must be dosed three times a day?
Propylthiouracil (PTU)
48
Iodides - MOA?
Temporary inhibition of thyroid hormone synthesis (acute) by flooding the thyroid with iodide Reduces thyroid gland’s vascularity and size
49
Iodides - clinical use?
Pre-op thyroidectomy Toxic adenoma or toxic nodular goiter
50
Iodide - drug interactions?
Must discontinue anti-thyroid meds (methimazole, PTU) at least 3-4 days prior to administration of iodide
51
Radioactive iodine - what must you check before administration?
If the patient is pregnant
52
Which procedure results in a 25-yr 80% incidence of permanent hypothyroidism?
Administration of Radioactive iodine
53
Effects of lithium with respect to radioiodine?
Lithium may prolong the retention of radioiodine and increase its efficacy
54
Non-selective beta blockers - use in hyperthyroidism?
Control the sympathetic symptoms of thyroiditis or thyroid storm
55
What medicine has the most evidence of use in treatment of thyrotoxicosis?
Propranolol
56
Which medicine is given in the ICU for thyroid storm?
Esmolol (IV)
57
Which two beta blockers also inhibit the peripheral conversion of T4 to T3?
Propranolol and Nadolol
58
Metoprolol - use in hyperthyroidism?
Not as common because it is specific to B1 (non-specific beta blockers are preferred)
59
If B-blockers are contraindicated in your hyperthyroid patient, what could you use to control tachycardia?
Verapamil or diltiazem
60
What is thyrotoxicosis factitia?
Refers to any state characterized by thyroid hormone excess, including ingestion of excess thyroid hormone and THYROIDITIS
61
Precipitating causes of thyroid storm?
Trauma, infection, antithyroid agent withdrawal
62
Thyroid storm - presentation?
Tachycardia, tachypnea, N/V, dehydration, delirium
63
Therapeutic management of thyroid storm - how many therapies involved?
6
64
First step of thyroid storm treatment?
Suppress new hormone synthesis (PTU, methimazole)
65
Second step in thyroid storm treatment?
Block the release of thyroid hormone (iodide solution - rapidly blocks release of pre-formed thyroid hormone)
66
Third step in thyroid storm treatment?
Antiadrenergic therapy (symptom control) Propranolol (most common) or Esmolol
67
Fourth step of thyroid storm management?
Administration of Acetaminophen Lowers fever and stabilizes BP
68
Fifth step in thyroid storm management
Corticosteroid therapy Reduces T4 to T3 conversion
69
Sixth step in thyroid storm management?
Bile acid sequestrants Decrease recycling of existing thyroid hormone

Sophomore - Pharm test 3 (7 decks)

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