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NAPLEX '22 Main Points > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

DOC for Hypothyroidism in pregnancy

A

Levothyroxine

30-50% increase in dose needed

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2
Q

DOC for Hyperthyroidism in pregnancy

A

1st trimester: PTU

Remainder to pregnancy: Methimazole

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3
Q

Compare T3 vs T4

A

T3 is more potent than T4 and has a shorter half-life

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4
Q

TSH and T4 in Hypothyroidism

A

T4: low
TSH: high

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5
Q

TSH and T4 in Hyperthyroidism

A

T4: high
TSH: low

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6
Q

What drugs causes hyperthyroidism?

A

Interferon
Amiodarone
Iodine

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7
Q

MOA of methimazole

A

Inhibits thyroid gland synthesis of T4 by blocking the oxidation of iodine in the thyroid gland

rationale
Methimazole is used in hyperthyroidism. T4 high and TSH low. So it stops the production of T4.

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8
Q

JH is a 73 yoF with heart failure and a history of an MI. She is 5’ and 103 lbs. JH was diagnosed with hypothyroidism and is to begin levothyroxine therapy. What is the starting dose?

A

25 mcg/day

Levothyroxine dosing 1.6 mcg/kg/day use IBW

If she didn’t have CAD then her starting dose would be 75 mcg/day but in CAD pts the starting dose is 12.5-25 mcg/day

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9
Q

Describe the normal regulation of thyroid function

A

TSH stimulates thyroid secretion of thyroxine (T4) and minimally, triithyroxine (T3). T3 is made as a result to T4 converting to T3 in the periphery.

*T3 more potent than T4.

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10
Q

Which organ secretes TSH which then causes T4 secretion?

A

Pituitary gland

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11
Q

Methimazole is preferred over PTU because it carries a lower risk of:

A

Liver damage

*PTU has a boxed warning for sever liver injury. Both can cause rash and agranulocytosis (bone marrow suppression)

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12
Q

What is the most common cause of hyperthyroidism?

A

Graves’ disease

*occurs in females 30s-40s. Graves’ is an autoimmune disorder that stimulates the thyroid to produce too much T4

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13
Q

Generic of Unithroid

A

Levothyroxine

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14
Q

A patient is experiencing a group of symptoms together such as muscle pain, weight loss, a butterfly rash o. Face and sunburn after sun exposure. What medication is she taking?

A

Methimazole

*rationale: weight loss is a cause in hyperthyroidism, DOC are PTU & methimazole.

Group of symptoms is called drug-induced lupus erythrmatosus (DILE): muscle/joint pain, butterfly rash, weight loss, photosensitivity, fatigue and depression

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15
Q

What is the most common cause if hypothyroidism?

A

Hashimoto’s disease

*autoimmune condition where patient’s own antibodies attacks the thyroid gland.

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16
Q

A newly diagnosed patient with hyperthyroidism was given propranolol. What does propranolol do to the thyroid?

A

Help control symptoms of hyperthyroidism.

*beta-blockers control symptoms of tremors and tachycardia associated with hyperthyroidism

17
Q

Desiccated thyroid

A

Contains T3 and T4.
Active ingredient of Armour Thyroid.

*Not used as 1st line

18
Q

Generic for Cytomel

A

liothyronine

19
Q

The thyroid gland is the only organ which has the ability to absorb:

A

Iodine

20
Q

S/SX of hyperthyroidism

A

SX reflect an increased metabolism

Heating intolerance/sweating
Weight loss
Agitation 
Frequent Bowel Movements 
Tachycardia 
Exophthalmos (protruding eyeballs) 
Thinning of hair 
Groiter
21
Q

What drug is synthetic T4?

A

Levothyroxine

DOC for Hypothyroidism

22
Q

S/SX of hyperthyroidism

A 
Slow metabolism 
Fatigue
Weight gain 
Dry skin
Constipation 
Depression 
Memory impairment 
Cold intolerance 
Heavy menses 
Hoarse voice 
Hair loss
23
Q

What medication will decrease the absorption of levothyroxine if administered at the same time?

A

Sevelamer

*antacids (Al, Ca, Mg), bile acid sequestrants, potassium-binding resin, phosphate-binders, iron, orlistat, sucralfate

24
Q

Patient takes levothyroxine 100 mcg daily at home. She is now in the hospital and provider wants to switch her to IV levothyroxine. What is the appropriate dose?

A

75 mcg

*IV:PO is 0.75:1

25
Q

Common side effect of propylthiouracil (PTU)

A

GI upset (N/V)

26
Q

Patient is on Levothyroxine 75 mcg daily, follow up 4/14. What changes should be made according to her labs?

3/10:
TSH 32 (0.3-3.0)
Free T4 0.3 (0.9-2.3)
hCG: negative

4/14:
TSH 4.7 (0.3-3.0)
hCG: positive

A

Increase her levothyroxine dose by 30-50% because she is pregnant

27
Q

TSH levels should be monitored how often?

A

4-6 weeks until it’s within the normal range and clinical symptoms have resolved.

28
Q

JS is sent to the hospital for emergent treatment. An order for PTU is written. What other medications should be initiated?

A

SSKI or Lugol’s solution + dexamethasone + Propranolol + APAP

*thyroid storm

NAPLEX '22 Main Points (11 decks)

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