Thyroid and anti thyroid Flashcards by merry curry

used in pyrotechniques before being used for the tx of hyperthyroidism

PERTECHNATE

PERCHLORATE

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inhibits iodide trapping ➡️ hypothyroidism

THIOCYANATE

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transport to apical membrane drug

PENDRINLODINE

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a clinical manifestation similar to cretinism

patients have dwarfism and mental retardation

Pendrin syndrome

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organification inhibition

IODIDES

THIONAMIDES

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proteolysis drug

IODIDES

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minimal effect of thiodamides

preipheral deiodinization

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inhibition of conversion of T4 to T3

PTU>METHIMAZOLE

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used for arrhythmia

there is greater risk of hypothyroidism due to inhibition of the conversion of T4 to T3

AMIODARONE

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those without ISA including PROPRANOLOL and ACEBUTOLOL act by

inhibition of conversion to T3 and helps in reversal of hyperthyroidism

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inhibition of conversion of T4 to T3

iodinated contrast media, steroids

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decrease the metabolism by inhibition of thyroid hormone conversion

starvation
illness
trauma

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most thyroid hormones are bound to

TBG

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thyroid hormones are least bound to

albumin

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increased TBG in

estrogen
pregnancy
oral contraceptive

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if there is increase in tbg you need to increase the

thyroid hormones

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decreased TBG by

androgens

steroids

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increased displacement from TBG

SALICYLATES
MEFENAMIC ACID
FUROSEMIDE

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inhibits T4 absorption

CHOLESTYRAMINE
CHROMIUM PICONILATE
COLESTIPOL
CIPROFLOXACIN
PROTON PUMP INH
SURALFATE
AL OH
FE SULFATE
CA CARBONATE
COFFEE
BRAN
SOY

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treatment for hypothyroidism

iodine supplementation

thyroid hormones

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iodine dose for adults

150’ug per day

- 75 ug used for TH synthesis

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iodine children dose

90-120 ug per day

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pregnant women iodine

200ug per day

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iodine supplementation can either lead to

Wolff chaikoff (hypothyroidism)
Jod Basedow (hyperthyroidism)

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moa of thyroid hormones

binds with receptors in the nucleus, mitochondria and plasma membranes

large number of thyroid hormone receptors are found in

``` pituitary liver kidney heart skeletal muscle lungs intestines ```

affinity of the receptor site for T4 is

low

uses of thyroid hormones

hypothyroidism as a result of RAI therapy and surgery, myxedemam cretinism, excessive administration of anti- thyroid drugs simple goiter without hyperthyroidism

thyroid preparations

``` synthetic LEVOTHYROXINE LIOTHYRONINE dessicated thyroid LIOTRIX THYROGLOBULIN I-LEVOTHYROIXINE Na ```

stable uniformity of contents, low cost, lack of allergenic proteins, easily measurable, long half life

SODIUM LEVOTHYROXINE T4, Eltroxin, Letter 25,50,100mcg tab

not available | more unstable,3-4 times more potent, shorter half life, higher cost, hard to measure, more AE

LIOTHYRONINE T3,Cytomel,Tertoxin 20 mcg tab

unstable presence of protein antigenicity, rarely used

dessicated thyroid

used for short term reversal of TSH levels given during thyroid storm uniform ratio of T3,T4

LIOTRIX | thyroixine,liothyronine

infant and children mgt of hypo

10-15ug/kg/day

adults mgt hypo

1.7ug/kg/day

myxedema coma dose

50-100 ug/day with 500 ug loading dose

hypo after graves

75-125 ug/day | increased by 25-50ug

older px hypo

12.5-25 per day | ⬆️25 ug every 2 weeks

pregnant women hypo

30-50% increase in dose TSH: 0.5-3.0 mU/L

subclinical hypothyroidism

treat TSH > 10 mU/l

initial tx in graves dse

antithyroid drugs

main tx for graves dse

thyroidectomy

antithyroid drugs

THIAMIDES IODIDES RADIOACTIVE IODINE PROPRANOLOL

acts on iodine organification in the thyroid gland and deiodinase rxn in the cells of other tissues in the body

THIOAMIDES

prep of THIOAMIDES

METHIMAZOLE PROPYLTHIOURACIL CARBIMAZOLE

moa of thioamides

inhibit synthesis of thyroid hormones primarily by inhibiting organification of Iodine and coupling of the iodotyrosines inhibit peripheral conversion of T4 to T3 may have direct effect on the immune by decreasing circulating thyroid stimulating ab and restoration of normal suppressor activity

absorption of thioamides

almost completely absorbed

thioamides peak serum levels attained at

1 hour after admin

serum half life of PTU

1-1.5 hours

serum half life of METHIMAZOLE

5 hours

10 x more potent thioamide

METHIMAZOLE

more strongly protein bound - used in pregnancy

PTU

concentrated in fetal thyroid

METHIMAZOLE

admin of PTU

every 6-8 hours | 3-4 x a day

METHIMAZOLE admin

once a day

thioamide slower renal excretion

METHIMAZOLE

Most common ae of thioamides

maculopapular rash

AE of thioamides

maculopapular rash benign transient leukopenia agranulocytosis

converted to METHIMAZOLE in vivo

CARBIMAZOLE

methimazole dose

10-29 mg q8-12 hours | titrated to 2.5-10mg

PTU dosing

100-200 mg q6-8 hours titrated to 25-50 mg must be titrated every month

assessment of thioamide tx

6-8 weeks (FT4, FT3) 30-50% euthyroid in 18-24 months

not mainstay tx for hyperthyroidism inhibits iodide organification and proteolysis and peripheral deiodination rxn

IODIDES

iodides can lead to

hyperthyroidism-Jod basedow phenomenone

iodide dose

6mg per day in 2-7 days

iodides in pregnancy

CI | crosses the placenta

iodides in nuclear accidents

inhibits attachment of radioactive iodine in the receptor thus prevention of radioactive absorption to the cell

AE of iodides

``` iodism acneiform rash similar to bromism swollen salivary glands mucous membrane ulcerations conjunctivitis rhinorrhea drug fever metallic taste bleeding disorders rarely anaphylactoid reactions ```

given as an adjunct can alleviate clinical condition without an effect on thyroid hormones given only to those who respond to thioamide

BETA blockers

moa of beta blockers

acts on adrenergic receptors or iodinase 2 enzyme (converts t4 to t3)

beta blocker on iodinase 2 enzyme

has little effect because it acts on the peripheral iodinase reaction

blockers without ISA

PROPRANOLOL METOPROLOL ATENOLOL

most commonly used given 4 times a day

PROPRANOLOL | 40-80mcg q6 (160mg/day)

METOPROLOL amt

100 mg q12 twice a day

ATENOLOL amt

100 mg OD once a day

only isotope used in thyrotoxicosis

131 iodine

dose of radioactive iodine

185-555 mbq

PTU should be stopped before radioactive iodine tx

3-4 weeks

METHIMAZOLE, CARBIMAZOLE should be stopped before radioactive iodine tx

3 days only

in 5-10 yrs radioactive iodine leads to

hypothyroidism

after tx of RAI treat px with

antithyroid for 3-6 months

patient tx with RAI should be isolated for

8 days

Thyroid and anti thyroid Flashcards

(82 cards)