treatment of thyroid diseases

Question 1

describe the process of regulation thyroid hormone

Answer 1

hypothalamus release TRH

TRH will stimulate pituitary to release TSH

TSH will release THYROID HORMONE

thyroid hormone will negatively inhibit TSH and TRH

Question 2

what are the stuff we can inhibit in case of hyperthyroidism ?

Answer 2

peroxidase enzyme which is responsible coupling and iodination

inhibit the release of thyroid

inhibit the uptake of iodine

Question 3

what drugs inhibit the peroxidase enzyme?

Answer 3

thioamides

Question 4

what drugs inhibit the uptake of iodine?

Answer 4

potassium iodide

Question 5

how do we inhibit the release of thyroid hormone?

Answer 5

lithium

Question 6

what is the normal level of TSH?

Answer 6

0.4 - 4.0 mIU/L

Question 7

what are some drugs that inhibit the release of TSH?

Answer 7

D2 receptor agonist

GHIH analogs –> octreotide

glucocorticoids

metformin

Question 8

what are some dopamine agonists ?

Answer 8

dopamine
dobutamine
levodopa
cabergoline
bromocriptine

these inhibit prolactin and GH ( in acromegaly ) and TSH

Question 9

what are some stuff that increases TSH secretion?

Answer 9

dopamine receptor antagonist ( D2 receptors )

Question 10

what are some dopamine receptor antagonists?

Answer 10

metoclopramide

domperidone

Question 11

what are the manifestation of hyperthyroidism ?

Answer 11

nervousness
emotional
disturbance
weight loss
heat intolerance
palpitations
proximal muscle weakness
increase frequency of bowel movements
irregular menses

Question 12

what is grave disease?

Answer 12

autoimmune disease where antibodies that are similar to TSH bind to the TSH receptor and stimulate more production thyroid hormone and the release of it

Question 13

what are the characteristics of graves disease?

Answer 13

thyroid enlargement

exophthalmos

Question 14

what are the none pharmacological therapy for hyperthyroidism?

Answer 14

surgery

thyroidectomy

Question 15

when do you consider surgery?

Answer 15

large thyroid gland

severe ophthalmopathy

lack of remission on antithyroid drug

Question 16

what are the drugs used for preparation of thyroidectomy?

Answer 16

thionamides –> inhibit production of T3,T4

beta blockers/ propranolol –? relief symptoms and inhibit T3 production

supersaturated iodine–> reduces gland vascularity

lethium carbonate –> block thyroid release

dexamethasone/corticosteroid —-> reduces TSH levels and inhibit T4 to T3 conversion

Question 17

what is wolff chaikoff effect?

Answer 17

when the body gets a large amount of iodine at once this will temporarily inhibit the thyroid synthesis due to inhibition of thyroid peroxidase

this will reduce the vascularity temporarily as well

Question 18

what are the pharmacological treatments for hyperthyroidism?

Answer 18

antithyroid medications

iodides

adrenergic blockers

radioactive iodine

Question 19

what are some antithyroid medications?

Answer 19

thionamides :

methimazole

propylthiouracil

Question 20

what is the MOA of methimazole?

Answer 20

inhibit coupling of MIT AND DIT to form T3 AND T4

Question 21

what is the MOA of propythiouracil ?

Answer 21

inhibit coupling

INHIBIT PERIPHERAL CONVERSION OF T4 to T3

more effective compared to methimazole because it works peripherally as well

Question 22

which antithyroid drug is the choice for pregnant women?

Answer 22

propylthiouracil

Question 23

what are the side effects of antithyroid medications ?

Answer 23

pruritic maculopapular rashes

arthralgias

fever

benign transient leukopenia

AGRANULOCYTOSIS –> LOW AMOUNT OF AGRANULOCYTES –> INFECTION –> major side effect

congenital malformation –> ONLY WITH METHIOMAZOLE

hepatoxicity

Question 24

what is the MOA of iodides?

Answer 24

temporarily block thyroid hormone release

inhibit thyroid hormone biosynthesis

decrease size of the gland

Question 25

what could happen if we give large doses of iodide ?

Answer 25

hyperthyroidism or wolff chaikoff effect

Question 26

when is iodide contraindicated?

Answer 26

multinodular goiter

Question 27

what is the clinical use of iodine ?

Answer 27

before thyroid surgery

Question 28

what is the example of iodine we give?

Answer 28

potassium iodide

Question 29

what is an adjuvant therapy we can use for iodide?

Answer 29

iodide + radioactive iodine

Question 30

what are the side effects of iodide?

Answer 30

hypersensitivity salivary gland swelling/enlargement iodism --> burning of the mouth and throat , headache, metallic taste gynecomastia --> enlargement of breast tissue in males

Question 31

when is radioactive iodine given?

Answer 31

is the agent choice for : grave disease toxic autonomous nodules toxic mngs

Question 32

when is radioactive iodine contraindicated

Answer 32

pregnancy

Question 33

what is given before Radioactive iodide in elderies?

Answer 33

thioamides

Question 34

what type of adrenergic blockers we use in hyperthyroidism?

Answer 34

beta blockers NONE SELECTIVE bcz selectives dont work propranolol

Question 35

why do we use beta blockers?

Answer 35

js to relief the symptoms adjunctive therapy with antithyroid drugs, RAI, iodides

Question 36

what is the meaning QID?

Answer 36

4 times a day

Question 37

when is propranolol contraindicated?

Answer 37

decompensated heart failure sinus bradycardia

Question 38

what are the side effects of beta blockers?

Answer 38

nausea vomitting anxiety insomnia light headedness bradycardia hematologic disturbance asthma

Question 39

what is the first drug of choice in grave disease + pregnancy?

Answer 39

propylthiouracil

Question 40

what is the drug choice for neonatal and pediatric hyperthyroidism ?

Answer 40

methimazole first line if no effect = propythiouracil

Question 41

what is the first drug of choice in thyroid storm?

Answer 41

propythiouracil then antiadrenergic ( BB ) corticosteroids -> prednisone palliative treatment

Question 42

what are the drugs used in cause of hyperthyroidism associated with ophthalmophaty or Grave ophthalmopathy ?

Answer 42

Teprotumumab ---> antibody for IGF1 RECEPTOR IN EYE treat protrusion not hyperthyroidism if it is too severe surgery

Question 43

what are the signs and symptoms of hypothyroidism?

Answer 43

lethargy cold intolerance weight gain Constipation myxedema myxedema coma due to hypoglycemia

Question 44

what is the most common cause of hypothyroidism in adults?

Answer 44

hashimoto disease other causes : radioactive iodine surgical removal iodine deficiency pituitary/hypothalamic dysfunction --> Secondary hypothyroidism

Question 45

what is the treatment in cause of hypothyroidism?

Answer 45

thyroid replacement therapy

Question 46

what are examples of synthetic thyroid hormones?

Answer 46

levothyroxine liothyronine liotrix

Question 47

what is the drug of choice out of the 3?

Answer 47

levothyroxine

Question 48

why is levothyroxine the drug of choice?

Answer 48

chemically stable inexpensive uniform potency

Question 49

what are the disadvantages of liothyronine?

Answer 49

higher incidence of cardiac adverse effects higher cost difficulty monitoring with labs

Question 50

what is liotrix?

Answer 50

4 :1 mixture of T3 Advantages : stable, predictable , potency disadvantages : high cost

Question 51

what are the clinical features of myxedema coma?

Answer 51

hypothermia advanced stage of hypothyroid symptoms altered sensorium ranging from delirium to coma

Question 52

what is the initial treatment of myxedema coma?

Answer 52

IV bolus thyroxine then maintenance treatment also given IV IV hydrocortisone

Question 53

why is IV hydrocortisone given?

Answer 53

to rule out coexisting adrenal suppression Cuz low TSH is usually has Low ACTH as well so low cortisol

Question 54

what is the treatment in congenital hypothyroidism?

Answer 54

maintenance therapy early levothyroxine

Question 55

what is the treatment for hypothyroidism in pregnancy?

Answer 55

levothyroxine as well