Thyroid/parathyroid diseases

Question 1

Denosumab treats what and how

Answer 1

RANKL antibody that prevents bone resorption. Used to treat osteoporosis in post-menopausal women

Question 2

Sodium levothyroxine (Synthroid)

Answer 2

1 choice for the treatment of hypothyroidism

Question 3

Sodium liothyronine (Cytomel)

Answer 3

Treats hypothyroidism. Short-acting and rapid onset.

Question 4

What are the treatment options for hypothyroidism

Answer 4

1. Thyroid USP or desiccated thyroid (powdered animal thyroid gland): cheap but varying potencies
2. Thyroglobulin (proloid): the glycoprotein that thyroid hormone synthesis takes place on. Varying potencies.
3. Sodium levothyroxine
4. Sodium liothyronine
5. 4:1 mix of T4:T3: overpriced

Question 5

What does methimazole treat and how does it work?

Answer 5

1. treats hyperthyroidism
2. inhibits thyroid peroxidase (remember that’s what oxidzes iodide to its free radical form)
   * can get into breast milk so no breast feeding allowed

Question 6

Propylthiouracil. What. Is. It.

Answer 6

1. treats hyperthyroidism
2. inhibits thyroid peroxidase (remember that’s what oxides iodide to its free radical form)
   * can get into breast milk so no breast feeding allowed

Question 7

Why would you give Lugol’s solution to someone?

Answer 7

It is made of KI and I2 and is used to produce high Iodide levels that interfere with thyroid gland function (so can treat hyperthyroidism). Also can give preoperatively to someone undergoing thyroidectomy to reduce blood loss.

**This is known as the Wolff-Chaikoff effect (giving pharmacologic amounts of iodide to inhibit thyroid hormone production)

Question 8

(131)iodine is the drug of choice for __________

Answer 8

Toxic thyroid adenomas. *never use in pregger women

Question 9

What are 2 examples of thioamides and what do they treat?

Answer 9

Propylthiouracil and methimazol.

Hyperthyroidism.

Question 10

How can you treat hypoparathyroidism

Answer 10

Dietary Ca2+ and calcitriol (1,25(OH)2D3)

Question 11

How can you treat Psuedohypoparathyroidism (PTH levels are fine but serum Ca2+ is low)

Answer 11

Calcitriol (1,25(OH)2D3). PTH is not an effective tx since PTH levels are fiiiiiine

Question 12

Treatment for osteomalacia (inadequate bone matrix mineralization) and rickets

Answer 12

Vitamin D2 or D3

Question 13

Treatment for vitamin D-dependent rickets

Answer 13

Calcitriol (1,25(OH)2D3)

Question 14

Treatment for drug-induced osteopenia (by anticonvulsant drugs, which suppress intestinal absorption of Ca2+, causing 2’ hyperparathyroidism)

Answer 14

25(OH)D3, D2, or D3

Question 15

Treatment for Paget’s disease (which is overactive osteoclast activity causing demineralization of osteoid)

Answer 15

1. Calcitonin (nasal spray not oral)
2. Alendroate (oral)
3. Risedronate (oral)
4. Ibrandronate (oral)
5. Zoledronic acid (IV, 1x/yr)
   * (2-5 are all bisphosphonates, which SLOW the rate of demineralization of hydroxyapatite crystals in bone)

Question 16

How can you treat post-menopausal osteoporosis

Answer 16

1. Estrogen replacement therapy (cuz estrogen stimulates PTH remember!). This option is NOT recommended anymore because of risk of heart disease, breast cancer, & uterine cancer with HRT. Instead use:
2. A SERM (Selective estrogen receptor modulators), such as raloxifene; it’s safer
3. Bisphosphonates (Alendroate, Risedronate, Ibrandronate, Zoledronic acid)
4. Teriparatide: human PTH

Question 17

How do you treat vitamin D intoxication (too much sun time oh nooooo)

Answer 17

1. Get out of the sun (or stop vitamin D administration)

2. Administer glucocorticoids like prednisone, which block intestinal absorption of Ca2+

Question 18

How do you treat 1’ hyperparathyroidism

Answer 18

This is usually due to an adenoma of the parathyroid gland. So you take out the adenoma surgically. Too easy peasy.