treatment of thyroid disorders Flashcards

1
Q

Clinical manifestations of hypothyroidism

A

“slow”

dry skin, cold intolerence, wt gain, constipation, weakness, lethargy, fatigue, depression, coarse hair, cold skin, periorbital puffiness, bradycardia, speech slow and hoarse

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2
Q

Normal ranges for thyroid tests

A

TSH 0.4-4.8
FT4 0.8-1.7
anti TPOAb-present in AI hypothyroidism
TSHR-SAb- confirms Graves disease

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3
Q

Tx of hypothyroidism

A

Levothyroxine

Thyroid USP

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4
Q

Levothyroxine (Synthroid)

A

MOA: synthetic T4
AE: HTN, tachycardia, insomnia, diarrhea, excessive dose may lead to heart failure, angina pectoris, MI, reduced bone density
Dosing: 1.7 mcg/kg/day (around 100-125 mcg/day_
take first thing in the am on an empty stomach and wait 30 min before eating and 4 hours to take calcium, iron, Mg, Al, sucralfate, cholestyramine, and orlistat

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5
Q

Levothyroxine (Synthroid)

A

MOA: synthetic T4
AE: HTN, tachycardia, insomnia, diarrhea, excessive dose may lead to heart failure, angina pectoris, MI, reduced bone density
Dosing: 1.7 mcg/kg/day (around 100-125 mcg/day_
take first thing in the am on an empty stomach and wait 30 min before eating and 4 hours to take calcium, iron, Mg, Al, sucralfate, cholestyramine, and orlistat

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6
Q

clinical presentations of thyrotoxicosis

A

“fast”

nervousness, emotional lability, easy fatiguability, heat intolerence, prox muscle weakness, wt loss with increased appetite, anorexia, increased fx of bowel movement, palpitations, irregular menses, warm, smooth moist skin, unusually fine hair, onycholysis, lid lag

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7
Q

Antithyroid agents

A

Propylthiouracil and Methimazole

MOA: inhibit the synthesis of thryoi hormone

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8
Q

Antithyroid agents

A

Propylthiouracil and Methimazole
MOA: inhibit the synthesis of thryoid hormone by blocking the oxidation of iodine in the thyroid gland,block synthesis T4 and T3 BUT do not inactivate circulating T3 and T4
AE: (minor) pruritic maculopapular rash, arthralgias, fevers, benign transient leucopenia
(major) agranulocytosis (first 3 mo), arthralgias and lupus like syndrome (6 mo), GI intolerence,
hepatotoxicity
-MMI usually within 3mo
-PTU any time on the drug therefore should be reserved for patients who can’t tolerate other tx, females trying to get pregnant or during first tri, tx of thryoid storm

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9
Q

Antithyroid agents

A

Propylthiouracil and Methimazole
MOA: inhibit the synthesis of thryoid hormone by blocking the oxidation of iodine in the thyroid gland,block synthesis T4 and T3 BUT do not inactivate circulating T3 and T4
AE: (minor) pruritic maculopapular rash, arthralgias, fevers, benign transient leucopenia
(major) agranulocytosis (first 3 mo), arthralgias and lupus like syndrome (6 mo), GI intolerence,
hepatotoxicity
-MMI usually within 3mo
-PTU any time on the drug therefore should be reserved for patients who can’t tolerate other tx, females trying to get pregnant or during first tri, tx of thryoid storm

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10
Q

Other tx for hyperthryoidism

A

Beta blockers
Iodides
radioactive iodine
surgery

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11
Q

Other tx for hyperthryoidism

A

Beta blockers
Iodides
radioactive iodine
surgery

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12
Q

Tx of hyperthyroidism caused by graves disease

A

antithyroid drugs (MMI and PTU)
radioactive iodine
surgery

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13
Q

Thyroid storm s/s

A

high fever, tachycardia, tachypnea, dehydration, delirium, GI disturbances
precipitated by infection, trauma, surgery, radioactive iodine tx, and sudden withdrawal of antithyroid meds

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14
Q

Tx of thyroid storm

A
short acting Beta blocker
IV or oral iodide
large doses of PTU
supportive care
IV hyrocortisone d/t the potential presence of adrenal insufficiency
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