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Flashcards in Thyroid Disorders Deck (14):
1

Hyperthyroidism

- Drugs induced
- S/S
- Onset of drug therapy

Drugs induced:
- L-thyroxine, Lithium, iodides, aminodarone, interferone, interleukin-2

2

Tapazole

- Indication
- MOA
- Preg Cat
- SEs
- Monitor
- Pt counseling

Methimazole

- Indication: hyperthyroidism
- MOA: block hormone synthesis.

- Preg Cat: D
In preg: start w/ PTU 1st then change to MMI

SEs:
- Hypothyroidism, rash, wt gain
- Agranulocytosis
- Hepatitis, jaundice
- Infection

Monitor:
- WBC, TST Q4-6W, LFT

Pt counseling
- s/s of agranulocytosis: fever, sore throat, signs of infection, HA, rash
- Hepatitis: yellowing of skin

3

PTU

- Indication
- MOA
- BBW
- Preg Cat
- SEs
- Monitor
- Pt counseling

Prophylthiouracil

- Indication: hyperthyroidsm use in pt who fail other therapy. Can also use for thyroid storm b/c it inhibits conversion of T4 to T3
- MOA: block hormone synthesis. PTU also inhibits peripheral conversion of T4 to T3.

- BBW: severe liver injury

- Preg Cat: D
In preg: start w/ PTU 1st then change to MMI

SEs:
- Hypothyroidism, rash, wt gain
- Agranulocytosis
- Hepatitis, jaundice
- Infection

Monitor:
- WBC, TST Q4-6W, LFT

Pt counseling
- s/s of agranulocytosis: fever, sore throat, signs of infection, HA, rash
- Hepatitis: yellowing of skin

4

Other treatment for hyperthyroidism

Radioactive: RAI (Iodotope)
- Destruction of thyroid gland. Slow onset
- Advantage: simplicity: drink it

Thyroidectomy: surgical removal of thyroid gland

Lugol's sol'n:
- Block hormone release.
- Adv: rapid effect: symptomatic relief, thyroid storm, pre-op adjunct

Sodium ipodate (Oragafin):
- Block T4 converts to T3

Propranolol (inderal)
- Blocker peripheral action of thyroid hormone. No effect on the disease state. Blocks conversion of T4 to T3

Diltiazem: alternative for beta blocker

Cholestyramine: increase fecal excretion of T4 by binding to T4 in the intestine.

5

Oragafin

Ipodate

6

Inderal

Propanolol

7

Thyroid replacement for hypothyroidism is preg cat?

Pre Cat A

8

Armour thyroid

- Came from/Content
- Adv
- Disadv

Desiccated thyroid

- Dried pig thyroid. Provides both T3 and T4.
- Adv: inexpensive
- Disadv: variable potency

9

Levoxyl
Synthroid
Levothyroid

- Content
- Adv
- Disavd

L-thyroxine

- Synthetic pure T3
- Adv: long half life = 7d
- Disadv: slow onset

10

Cytomel
Triostat

- Content
- Adv
- Disadv

Liothyronine

- Synthetic pure T3
- Adv: rapid abs, rapid onset
- Disavd: Multiple daily doses required. Short half life. High level of T3 can produce toxicity

11

Thyrolar

- Content
- Adv
- Disadv

Liotrex

- Synthetic T4:T3(4:1) ratio
- Adv: short and long acting effects
- Disadv: expensive

12

Pt counseling on thyroid hormones

Too much levothyroxine

Counseling:
- Should be taking in AM on empty stomach at least 30 min b/4 foods. Abs can be decreased by Ca, iron, fiber, coffee and other substances
- Wait at least 30 min b/4 eating and wait 4h to take supplements with Ca, Iron, Mg, Al, sucralfate, cholestyramine, orlistat
- Use brand name product

Too much levothyroxine causes atrial fibrillation => no need to adj dose for obesity or wt loss pt

13

During pregnancy

- TSH level increase 25-30%
- Check levels Q4W
- Increase thyroid hormone dose by 25%
- As soon as pt delivery, goes back to normal dose b/4. Check TSH in 6wks
- Lack of therapy causes impaired fetal brain development and lower IQ; increases the risk of miscarriage, preterm birth, and low birth weight.

14

Levothyroxine

- IV:PO conversion
- Dilution
- Shelf life

- IV:PO = 1:2
- Dilution: NS
- Shelf life: use immediately