Thyroid Flashcards
S/S of hypERthyroidism?
- Tachycardia
- Hypertension
- Cardiac dysrhythmias
- Heart failure
- Low cholesterol
- Anxiety or insomnia
S/S of hypOthyroidism?
- Decrease in cardiac output
- Decrease in BP
- Decrease in HR
- Cardiac enlargement
- Heart Failure
- Weight gain
- Constipation
- Poor appetite
- Risk of atherosclerosis development and high cholesterol
- Emotional dullness
- Lethargy
What labs do we look at for thyroid issues?
- TSH (can screen and diagnosis for hypo and hyper)
- Serum T4
- Serum T3
- Thyroid antibodies
What does the lab TSH tell us?
- Elevated = hypo
- Decreased= hyper
What does the serum T4 lab tell us?
Used to see how effective treatment is
What does the serum T3 lab tell us?
More commonly used to officially diagnose hyper
What do thyroid antibody labs tell us?
Just looking to see if there is any autoimmune type function
What drug therapy is used for hypOthyroidism?
Levothyroxine
What drug therapy is used for hypERthyroidism?
- Methimazole (MTM)
- Grave’s disease (cause of hyper): second line drug for this disease is Propylthiouracil (PTU)
- Radioactive Iodine
What is the mechanism of action for Levothyroxine?
- Synthetic preparation of thyroxine (T4)
- Taken to replace missing hormone (T4)
When do we give Levothyroxine?
Taken in morning on empty stomach 30-60 minutes before breakfast
What are adverse effects of Levothyroxine?
Possibility of hyperthyroidism
What are therapeutic effects of Levothyroxine?
- Decrease in TSH
- Increase in T3 and T4
- Lessening symptoms of hypothyroidism
What patient teaching is needed with Levothyroxine?
- Take first thing in morning on empty stomach
- S/S of hypothyroidism should get better
- If S/S of hypo don’t get better then need new labs and plan
- Lifelong medication
- Black box warning
- Frequent monitoring of serum drug levels, TSH, T4 and T3 needed
- Brand name= synthroid
What is the black box warning for Levothyroxine?
Person with normal thyroid can not take this, or serious side effects will occur
What does the drug PTU stand for?
Propylthiouracil
What is the mechanism of action of PTU?
- Suppresses synthesis of thyroid hormones
- Short half-life compared to MTM (about 90 min)
When is PTU given?
2-3 daily doses (every 8 hours)
What adverse effects are there with PTU?
- Can cause drowsiness, N/V, and GI upset
- Look for S/S of hyperthyroidism
- Black box warning
What is the black box warning for PTU?
-Causes severe liver injury that can result in acute liver failure or death
What are therapeutic effects of PTU?
- Tx of Grave’s disease (2nd line drug)
- Adjunct to radiation therapy
- Preparation for thyroid surgery
- Tx of Thyrotoxic crisis (preferred)
- Expect to see S/S of hyperthyroidism lessen
- Expect decrease in T3 and T4 and an increase in TSH
What patient teaching is needed with PTU?
- Monitor for S/S of hypothyroidism
- Full benefits may take 6-12 months (needs to build up in system)
What does MTM stand for?
Methimazole
What is the mechanism of action for MTM?
Inhibits synthesis of thyroid hormones by blocking oxidation of Iodine
