Thyroid Disorders

Question 1

An autoimmune disease resulting from cell and antibody mediated thyroid injury.

Answer 1

Hashimoto disease

Question 2

Hyposecretion of the thyroid hormone causes what?

Answer 2

Myxedema, goiter and cretinism

Question 3

Signs and symptoms of Hypothyroidism.

Answer 3

Sensitivity to cold, constipation, brady and weight gain.
Signs: dry flaky skin, coarse hair, slurred speech, puffyface, hands, feet and hearing loss. Dec libido, slow return of deep tendon reflexes

Question 4

Diagnostic tests and results for Hypothyroidism.

Answer 4

Initial test is serum TSH assay and TSH levels are elevated in primary hypothyroidism and low serum free T4
Inc. serum TSH, dec. FT4 and TT4

Question 5

Thyroid hormones increase what drug effect and how?

Answer 5

Warfarin effect. Increases catabolism of vitamin K dependent clotting factors= inc. warfarin effect.

Question 6

What declines with initiation of levothyroxine?

Answer 6

Glycemic control. Antihyperglycemic agents may be required.

Question 7

These drugs reduces absorption due to binding to levothyroxine.

Answer 7

Antiepileptics
cholestyramine, colestipol (separate 6)
Iron salts Ca, Mg and sucralfate (2h)
do not take Al

Question 8

Levothyroxine dosing.

Answer 8

T4: 1.6mcg/kg/day
12.5-25mcg/day pts w Coronary Artery Disease or elderly
Pregnancy: Increase dose

Question 9

Common form of hyperthyroidism, antibodies produced against autoantigens stimulates secretion of thyroid hormone.

Answer 9

Grave’s disease.

Complete opposite of Hashimoto= inhibits secretion of thyroid hormone

Question 10

Hyperthyroidism may cause what and give symptoms.

Answer 10

Intolerance to heat, weight loss, weakness and anxiety.

Signs: heart palpitation, nervousness, diarrhea and tachycardia

Question 11

Hyperthyroidism diagnosis

Answer 11

Decreased TSH (sensitive)
Increased T4 and T3

Question 12

What is the essential functional group for antithyroid activity?

Answer 12

Thiocarbamide (R-C=S)-NH-R)

Question 13

Explain antithyroid drug mechanism of action Deiodination.

Answer 13

Inh. iodination of Tyrosine in thyroglobulins and thyroid peroxidase thus inh.T4 to T3.
Deiodination is activation of thyroxine T the degradation of thyroid horm. eliminated by feces and urine. T4 to actv triiodothyronine T3 in peri. and liver tissues.

Question 14

Oral drops of Iodide, will stain.
Decreases gland size and blood supply therefore used for surgery preparation.
Inhibits uptake of I2 by what amino acid?

Answer 14

Lugol’s solution (KI + I)
10% KI and 5% I
Inhibits uptake of I2 by Tyrosine.

Question 15

DOC for hyperthyroidism for pregnanct and lactating women.

Answer 15

Propylthiouracil

does not cross BBB

Question 16

Side effects of MMI and PTU

Answer 16

Allergy, rash, agranulocytosis, hepatotoxicity and nephrotoxicity (rare)
Cholestic jaundice from MMI

Question 17

For thyroid storm.

Thyrotoxicosis.

Answer 17

Lugol’s solution

Radioactive Iodine I^131

Question 18

Which is more secreted in breast milk, PTU or MMI

Answer 18

MMI.

PTU is more strongly protein bound.

Question 19

What are the factors that affect breast milk excretion?

Answer 19

Inc: lipid solubility and basicity
Dec: protein binding and acidity

Question 20

PTU is excreted in the kidneys as what?

Answer 20

Glucuronide (inactive)

Question 21

Use to ablate thyroid tissue in patients with Grave’s disease, toxic autonomous nodules and toxic multi-nodular goiters.
And dose.

Answer 21

Radioactive Iodine
Sodium iodide I^131 (Iodotope)
As single oral dose only.

Question 22

Structurally related to thyroxine and how does this affect T4.

Answer 22

Amiodarone. Interferes with peripheral conversion of T4 to T3
Whereas Dronedarone has NO Iodides

Question 23

Methimazole MOA

Answer 23

Inhibit I oxidation
Catalyze the incorpz of I into tyrosine
Inhibit the syn. of thyroid horm.

Question 24

What Beta blocker is used for hyperthyroidism?

Answer 24

However propanolol is also used in the short-term preoperative management of thyrotoxic crises.

Question 25

``` What are the following lab test increase indicate myopathies? A. Creatinin kinase (CK-MM) B. Creatinin kinase (CK-BB) C. Creatinin kinase (CK-MB) D. ADH, AST, ALT, ALP E. ALP, ALT ```

Answer 25

A. MM indicator of skeletal muscles BB brain MB cardio

Question 26

``` Which of the following laboratory investigations help to determine, myocardial infarction? A) Troponin-I and CK-MB B) CK-MB, Troponin C and ECG C) ECG, Troponin I, CK-MM D) Troponin I, CK-MB, ECG E) Troponin C, CK-MB, ECG ```

Answer 26

E. What are the following lab test increase indicate MI: Troponin I ??

Question 27

A patient using warfarin should be monitored for? I. INR II. Prothrombin time III. activated Prothrombin time (aPTT)

Answer 27

Only I and II

Question 28

A patient has dark urine, and muscle pains. SE of what statin

Answer 28

Atorvastatin | *Statins and Benzfibrate can inc. CK-MM

Question 29

``` A patient creatinine clearance is 300 ml/hr, it is a? A. chronic renal disease B. normal renal function C. excessive renal function D. severe renal disease E. Acute renal disease ```

Answer 29

D | normal: 80-120 mL/min

Question 30

Most sensitive test for liver cirrhosis -cholestasis jaundice -Acetaminophen toxicity AST ALT ALP CK

Answer 30

- AST - ALP - AST

Question 31

``` Which of the following is the major ketone increase in blood diabetic ketoacidosis? A) Acetone B) Beta hydroxy butyric acid C) Ethyl and methyl ketone D) Long change ketones E) Acetyl acetic acid ```

Answer 31

B

Question 32

What phils are increased to pts with asthma and allergies

Answer 32

Baso and Eisinophils