Thyroid Diseases

Question 1

Methimazole initial tx dose for mild ____thyroidism

Answer 1

15 mg/day

Hyper

Question 2

Methimazole initial tx dose for moderate ____thyroidism

Answer 2

30-40 mg/day

Hyper

Question 3

Methimazole initial tx dose for severe ____thyroidism

Answer 3

60 mg/day

Hyper

Question 4

Length of tx on Initial methimazole tx, end at _____

Answer 4

6-8 weeks

Euthyroid

Question 5

Euthyroid

Answer 5

normal thyroid levels

Question 6

Methimazole is preferred in what trimesters of pregnancy?

Answer 6

2nd and 3rd ONLY

Question 7

Methimazole dose for breastfeeding

Answer 7

20-30 mg/day (1st line)

Question 8

Methmazole maintenance dose for _____thyroidism

Answer 8

5-15 mg/day

Question 9

PTU Propylthiouracil 1st line for

Answer 9

thyroid storm

1st trimester of pregnancy

Question 10

MOA Methimazole

Answer 10

• Inhibits thyroid hmone synthesis

- depletes stored hmone

Question 11

MOA Propylthiouracil

Answer 11

-Inhibits peripheral T4 to T3 conversion within hours

Question 12

Thioamide Monitoring: Reassess pt every

Answer 12

4 weeks

until Euthyroid

Question 13

Remission is

Answer 13

Euthyroid for 12 mo

Question 14

Thioamide Monitoring: low dose every 2-3 mo check

Answer 14

T4, TSH and s/sx

keep tapering

Question 15

Thioamide adverse effects

Answer 15

GI upset
Arthralgia
Rash, uticarua, pruritis

Question 16

Thioamide severe adverse effect

Answer 16

Agranulocytosis
(granulocyte count <250, give em ABX!!)
Hepatotoxicity
(higher risk PTU)

Question 17

How soon should TSH be tested after a pt achieves remission?

Answer 17

2-3 mo

Question 18

Iodine MOA

Answer 18

bombard the body with iodine so it inhibits hmone release and dec. hmone syntheses

Question 19

Iodine tx lasts for

Answer 19

D/C after 1-2 weeks! short tx

Question 20

Iodism s/s (adverse effect!)

Answer 20

(iodine OD) burn in mouth, metallic taste, sore teeth/gums, cold s/s

Question 21

Iodine Adverse effects (other)

Answer 21

rash, GI upset, salivary gland swelling, immune hypersensitivity rxn, paresthesia

Question 22

Iodine initial dose to tx _____thyroidism

Answer 22

120-400mg orally in H20 or juice

Hyper

Question 23

Lithium dose to tx _____thyroidism

Answer 23

300 mg Q8hrs

Hyper

Question 24

Lithium MOA

Answer 24

block T3/T4 release

Question 25

Lithium: Monitor

Answer 25

serum level < 1 mEq/L

Question 26

Beta Blockers MOA to tx ____thyroidism

Answer 26

Hyper | block B adrenergic receptors

Question 27

B Blocker- Esmolol use in ___ via ___ dose____

Answer 27

ICU- thyroid storm IV 50-100 mcg/kg/min

Question 28

Propanolol dose

Answer 28

10-40 mg PO 3-4x/day | may dec T4 to t3 conversion

Question 29

Nadolol dose

Answer 29

40-60 mg PO 1 x day may dev T4 to T3 conversion don't use in pt with COPD

Question 30

Atenolol dose

Answer 30

25-100 mg PO 1-2 x day

Question 31

Metoprolol dose

Answer 31

25-50 mg PO 4x day

Question 32

Preferred tx in Thyroid Storm

Answer 32

high dose PTU

Question 33

Radioactive Iodine is a tx cure for ____ | goal:

Answer 33

Hyperthyroidism | goal: induce hypothyroidism

Question 34

Radioactive Iodine MOA:

Answer 34

taken into thyroid by TSH-R Ab incorporated into thyroid hmone and stored in colloid emit B particle to irreversibly damage thyrocytes

Question 35

RAI Contrindications

Answer 35

Pregnancy (hold 6-12 mo) Lactation Thyroid Cancer

Question 36

RAI Monitor

Answer 36

T3/T4 2-4 weeks post tx

Question 37

RAI adverse effects

Answer 37

dysphagia, thyroid tenderness

Question 38

Pt in Thyroid Storm, what meds to initiate?

Answer 38

1. PTU 2. B Blocker (propranolol) 3. cool blankets 4. Tylenol 5. Hydrocortisone

Question 39

1st Line Med for hypothyroidism

Answer 39

Levothyroxine!

Question 40

Initiate Treatment when TSH > | and pregnancy

Answer 40

TSH > 10 mlU/L | TSH 2.5-4.5 mlU/L (pregnancy)

Question 41

Levothyroxine full replacement dose

Answer 41

1.6 mcg/kg/day | multiply x kg body weight

Question 42

IV Levothyroxine

Answer 42

75% of oral dose

Question 43

Monitor Levothyroxine @normal level

Answer 43

TSH and FT4 1x ever 6-12 mo

Question 44

Levothyroxine is a _____

Answer 44

synthetic thyroid supplement, mimics T4

Question 45

Liothyronine dose

Answer 45

relative dose = 15-37.5 mcg

Question 46

Liothyronine acts as

Answer 46

Synthetic T3

Question 47

Liotrix dose

Answer 47

50-60mcg T4 and 12.5-15mcg T3 in 1 tablet

Question 48

Liotrix is a ratio of

Answer 48

T4:T3 4:1

Question 49

ADE Synthetics

Answer 49

uncommon at appropriate doses | if overt treat then hyperthyroid s/sx

Question 50

Natural Thyroid Hmone from

Answer 50

hog, beef and sheep

Question 51

Contraindications Natural Hmone

Answer 51

Religious beliefs- no pork | DIs

Question 52

Natural Hmone Dose

Answer 52

1 grain= about 60mg T4 but variable

Question 53

PTU initial dose

Answer 53

100-150mg every 6-8 hrs

Question 54

PTU maintenance

Answer 54

50-150mg/day

Question 55

Lithium Adverse Rxn

Answer 55

Tremor, polyuria, renal failure, seizure, arythemia, bradycardia, suicide, toxicity

Question 56

Decrease Absorption Levothyroxine

Answer 56

``` Aluminum hydroxidie Cholestyramine Calcium Carbonate Dietary Fiber Ferrous Sulfate FOOD Soybean formula Sucralfate ```

Question 57

Amiodarone

Answer 57

inc or dec thyroid levels | monitor TSH and FT4 every 6mo + baseline

Question 58

Digoxin

Answer 58

inc digoxin levels | dec dose thyroid meds

Question 59

Warfarin

Answer 59

inc or dec anticoagulation | monitor INR

Question 60

hyperthyroid + warfarin

Answer 60

more likely for pt to bleed bc inc metab of clotting factors

Question 61

insulin

Answer 61

inc risk hyperglycemia | inc insulin, pt monitor blood glucose