thyroid disorder summary pdf

Question 1

syndrome of deficient thyroid hormone production that results in a decrease of all metabolic functions

Answer 1

hypothyroidism

Question 2

hypothyroidism results in what for infants and children

Answer 2

retardation of growth

Question 3

prevalence of hypothyroidism

Answer 3

grater in women
increases with age

Question 4

caused by direct thyroid gland failure

Answer 4

primary hypothyroidism

Question 5

other causes of hypothyroidism

Answer 5

thyroidectomy
iodine deficiency
increasing age

Question 6

hypothyroidism s/s

Answer 6

cold intolerance
fatigue
somnolence
constipation
menorrhagia
myalgia
hoarseness
thyroid gland enlargement or atrophy
bradycardia
edema
dry skin
weigh gain

Question 7

end stage hypothyroidism

Answer 7

myxedema coma
s/s- weakness
confusion
hypothermia
hypoventilation
hypoglycemia
hyponatremia
coma
shock

Question 8

T4

Answer 8

thyroxine

Question 9

T3

Answer 9

triiodothyronine
more potent

Question 10

T4 secretion is stimulated by

Answer 10

TSH

Question 11

TSH is inhibited by what

Answer 11

T3
this creates a negative feedback loop

Question 12

autoimmune mediated disease resulting from cell and antibody mediated thyroid injury

Answer 12

hashimotos

Question 13

what is the initial test

Answer 13

plasma TSH assay

Question 14

in hypothyroidism TSH levels are

Answer 14

elevated

Question 15

in hypothyroidism T$ levels are

Answer 15

low
this confirms diagnosis

Question 16

what is the typical maintenance dose of levothyroxine

Answer 16

125mcg

Question 17

what is the starting dose for elderly and patients with CAD

Answer 17

25mcg

Question 18

what dose do most adults reach

Answer 18

1.7mcg/kg/day at ss

Question 19

what is the goal of therapy

Answer 19

to maintain TSH in normal range

Question 20

doses are changed on what interval

Answer 20

6-8 weeks until TSH is normalized

Question 21

patient compliance can be monitored using what

Answer 21

T4 levels

Question 22

MOA of thyroid hormones

Answer 22

enhance oxygen consumption by most tissues and increases basal metabolic rate and metabolism of carbs, lipids, and proteins

Question 23

counseling points

Answer 23

take 30 minutes before breakfast because food may decrease absorption
usually lifelong therapy do not discontinue
watch for irregular heartbeat, chest pain, SOB, nervousness, irritability, tremors, heat intolerance, and weight loss

Question 24

thyroid hormones ADE

Answer 24

tachycardia
arrhythmia
angina
MI
tremor
HA
nervousness
insomnia
irritability
hyperactivity
diarrhea
vomiting
cramps
weight loss
fatigue
menstrual irregularities
excessive sweating
heat intolerance
fever
muscle weakness
hair loss
decreased bone mineral density
hypersensitivity

Question 25

thyroid hormone box warning

Answer 25

can cause weight loss do not use for treatment of obesity or weight loss

Question 26

thyroid hormone interactions

Answer 26

amiodarone may cause hypothyroidism or hyperthyroidism in euthyroid patients antidiabetic meds may be less effective with levothyroxine, may need increase dose antacids, calcium, bile acid sequestrants, sucralfate and iron supplements may decrease absorption of levothyroxine, take 4 hours apart lithium causes hypothyroidism levothyroxine may enhance warfarins effects, may need decreased dose levothyroxine can reduce digoxin levels soybean can decrease levothyroxine absorption sympathomimetic drugs may increase the effects of levothyroxine

Question 27

thyroid hormone monitoring

Answer 27

plasma TSH every 6-8 weeks s/s should improve in a few weeks once optimum dose draw TSH every 6-12 months patients at risk for CAD should be monitored for s/s of angina

Question 28

oral absorption of levothyroxine is improved by

Answer 28

fasting but decreased fiber and food

Question 29

switching from oral to IV levothyroxine

Answer 29

decrease dose by 25-50%

Question 30

liothyronine compared to levothyroxine

Answer 30

has a shorter half life higher incidence of cardiac side effects more difficult to monitor

Question 31

when tissues are exposed to high levels of thyroid hormones more common in women

Answer 31

hyperthyroidism (thyrotoxicosis)

Question 32

most common cause of hyperthyroidism and another cause

Answer 32

graves disease exogenous ingestion of thyroid hormone

Question 33

life threatening sudden exacerbation of thyrotoxicosis with fever, tachycardia, delirium, and coma

Answer 33

thyroid storm

Question 34

hyperthyroidism s/s

Answer 34

heat intolerance weight loss weakness palpitations anxiety tremor tachycardia weakness eyelid lag warm moist skin a fib CHF

Question 35

autoimmune disease where thyroid stimulating antibodies are produced, these mimic the action of TSH on thyroid tissue

Answer 35

graves disease

Question 36

hyperthyroidism diagnosis

Answer 36

elevated T4 or T3 in the presence of decreased TSH

Question 37

treatment of choice for graves disease

Answer 37

radioactive iodine (RAI)

Question 38

MOA- inhibit the synthesis of thyroid hormones by preventing the incorporation of iodine into iodotrysines and by inhibiting the coupling of monoiodotyrosine and diliodotyrosine to form T4 and T3

Answer 38

thioamides (propylthiouracil and methimazole)

Question 39

propylthiouracil box warning

Answer 39

severe liver injury and acute liver failure only use when pt can't tolerate methimazole and not appropriate to use RAI or surgery

Question 40

antithyroid therapy ADE

Answer 40

fever HA paresthesia rash arthralgia urticaria jaundice hepatitis agranulocytosis leukopenia bleeding

Question 41

antithyroid drug interactions

Answer 41

increase warfarins effects

Question 42

MOA- blocks hormone release and inhibits thyroid hormone synthesis may be used to rapidly reduce thyroid hormone secretion (in thyroid storm) decrease glandular vascularity before thyroidectomy

Answer 42

iodides

Question 43

why are iodides not used long term

Answer 43

harsh taste tachyphylaxis

Question 44

iodides pt insturctions

Answer 44

dilute with water or fruit juice for taste watch for fever, skin rash, metallic taste, swelling of throat, burning of mouth

Question 45

iodides ADE

Answer 45

rash swelling of salivary glands metallic taste burning of mouth GI distress hypersensitivity goiter

Question 46

iodide drug interactions

Answer 46

lithium enhances antithyroid effects