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49 Cards in this Set
- Front
- Back
Three major goals in the treatment of hypothyroidism:
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replace the missing hormones, relieve symptoms, and achieve a stable biochemical euthyroid state
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Treatment of choice for almost all pts with HYPOthyroidism?
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LT4. Mimics the normal physiology of the thyroid gland, which secretes mostly T4 as a prohormone.
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What is one of the most serious adverse effects of antithyroid drug therapy?
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Agranulocytosis
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The growth and spread of thyroid carcinoma are stimulated by __. RCTs show that suppressive __ therapy reduces tumor growth and improves survival
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TSH
LT4 |
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Baseline measurements of serum TSH, FT4, fT3, antithyroid peroxidase antibody(Anti-TPOAb( and TSH receptor-stimulating antibodies(TSHR-SAb) should be perfomed when starting this medication. TSH, FT3, and FT4 should be checked __ months after initiation and then every __ to __ months.
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Amiodarone
3 months 3-6months |
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In patients with primary thyroid disease. What is the relationship b/w TSH level and thyroid function?
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There is an inverse relationship b/w the TSH level and thyroid funnction.
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Thyroid status:
Increased TSH Increased FT4 |
Pituitary hyperthyroidism
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Thyroid status:
Increased TSH FT4 WNL but TSH increases with TRH Stimulation |
Incipient hypothyroidism
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Thyroid status:
Increased TSH Decreased FT4 |
Primary hypothyroidism
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Thyroid status:
TSH WNL Decreased FT4 with increased TSH on TRH stimulation |
Pituitary-hypothalamic
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Thyroid status:
Decreased TSH Increased FT4 |
Primary Hyperthyroidism
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Thyroid status:
Decreased TSH Decreased FT4 |
Pituitary-hypothalamic
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Thyroid status:
Decreased TSH with blunted TSH upon TRH stimulation? |
Incipient hyperthyroidism
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TRH stimulation test determines if __ still responds, or measures it's function.
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Pituitary
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What test measures intrinsic thyroid function?
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Radioactive iodide uptake
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This test helps distinguish etiology of thyroid function.
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Thyroid scan
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A certain type of hyperthyroidism more prevalent in females.
It has elevated __, depressed ___ and _(inc/dec)__ RAIU. |
Grave's disease
Elevated T4, depressed TSH, increased RAIU. *Goiter usually present(2-4x normal size) |
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What are symptoms of hyperthyroidism?(6)
-Weight -skin -heart -Regularity -muscles |
-Nervousness
-Weight loos despite increased appetite -Excessive sweating and heat intolerance -Palpitations -Frequent bowel movements -Muscular weakness of the proximal type and tremor |
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What are sings of hyperthyroidism?(5)
-skin -eyes -systolic and diastolic mmHG -cardiac -muscles |
-Warm, smooth, moist skin
-With Grave's disease, eye signs such as stare, lid lag, and exopthalmos -Increased systolic and decreased diastolic blood pressures -Tachycardia or artrial fibrillation. Hyperdynamic cardiac pulsations witha accentuated S1. -Tremor and proximal muscle weakness |
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Hyperthyroidism:
1. Toxic diffuse goiter(disease) 2. Solitary toxic nodule(disease) 3. VIral infections could be main trigger, self-limiting |
1. Graves disease
2. Plummer's disease 3. Thyroiditis |
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Hyperthyroidism:
Thyroid storm can be a life-treatening medical emergency. What are S/S? -Typically follow... Lasts __to__ days -Tx: ? |
S/S: high fever, tachycardia, tachypnea, dehydration, delirium, coma, NVD
typically follow surgery or infection Lasts 3-8 days Tx: PTU, iodides, propranolol, IV corticosteroids |
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Treated with a short-acting Beata blocker such as IV esmolol, IV or PO iodide, large doses of propylthiouracil(PTU)
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Thyroid storm
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Hyperthyroidism:
What is MOA of Thioamide?(interferes with biosynthesis and conversion) Efficacy: |
-Interfere with Biosynthesis of thyroid hormones
-PTU interferes with peripheral conversion of T4 to T3. Efficacy: permanent remission in 30-50%. relapse upon D/c |
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Name one of the two thioamides used in pregnacy.
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PTU
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ADEs of PTU? (name major one)
What is half-life of PTU? |
Rash, arthralgias, fever, AGRANULOCYTOSIS, hepatotoxicity
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Methimazole&Hyperthyroidism)
Well absorbed, actively concentrated in ___. Half-life? Same ADEs as PTU |
thyroid gland
5 hours |
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Hyperthyroidism:
This therapy destroys thyroid tissue over period of ___ to ___. ADEs: |
Radioactive therapy
-ADEs: mild pain, tenderness, dyspagia, hair thinning, HYPOthyroidism |
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Mechanism of Iodide Tx for Hyperthyroidism:
Effect: Uses:(pre-surgery and post-RAI) |
Mechanism: acutely blocks thyroid hormone release, inhibits thyroid hormone biosynthesis
Effect: reduces size and vascularity of thyroid Uses: pre-surgery: to decrease size and vascularity Post-RAI: prevents transient hyperthyroidism |
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In the treatment of hyperthyroidism. BBlockers are used to decrease sx of palpitations, anxiety, tremor, heat intolerance. What is BB are contraindicated?
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Use CCB
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Lugols solution has __% Iodine and __% NaI
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5% iodine
10% NaI |
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If TSHRAbs is positive what does that indicate?
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Positive antibodies indicates Grave's disease
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Hypothyroidism is more common in what sex over what age?
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females over 60
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Hypothyroidism:
Increased or decreased? -T4 -TSH -RAIU |
Decreased T4
Increased TSH Decreased RAIU |
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cornerstone of Hypothyroidism therapy?
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Replace T3/T4
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RFs for HYPOThyroidism:
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Personal History(Previous thyroid dysfunction, Goiter, Surgery or radiotherapy affecting thyroid, DM, Vitiligo, pernicious anemia)
Family History(Thyroid disease, Pernicious anemia, DM, Primary adrenal insufficiency) |
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Diseases of Hypothyroidism:
1. Congenital Development defect aka __ 2. ___ deficiency Drug induced(what drugs) 3. Chronic Immune thyroidits aka __ 4. Iatrogenic from... *also can be primary idiopathic |
1. Cretinism
2. Iodine 3. Amiodarone, Li, TCAs, Sulfas 4. Radioblative, surgery |
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Start therapy for HYPO at what TSH levels?
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TSH >10mU/mL
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A life-threatening sequelae of uncorrected hypothyroidism.
GIve symptoms Tx? |
Myxedema coma
Symptoms: hypothermia, decreased DTRs, altered senosrium, hypercapnia, hypoglycemia, hyponatremia Tx: IV L-thyroxine 400mcg x 1, the 5--200mcg/d -also corticosteroids |
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Drug of choice for HYPO.
Who needs lower doses |
Levothyroxine
-lower for IV or elderly with Cardiac disease -try not to switch brand |
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Graves’: most common thyrotoxicosis
• Hyperthyroid tx: PTU or MMI, RAI, surgery; initial tx based on age, pregnancy, comorbidities, convenience • PTU and MMI similar in efficacy and ADEs but dosing differs • Response to PTU and MMI x-x weeks, tx for x-x years • Patients choose ablative tx • Surgery large goiter patients • Adjunctive tx • Hypothyroidism: • Monitor: |
Graves’: most common thyrotoxicosis
• Hyperthyroid tx: PTU or MMI, RAI, surgery; initial tx based on age, pregnancy, comorbidities, convenience • PTU and MMI similar in efficacy and ADEs but dosing differs • Response to PTU and MMI 4-6 weeks, tx x 1-2 years • Patients choose ablative tx • Surgery large goiter patients • Adjunctive tx beta-blockers • Hypothyroidism: Hashimoto’s, drug of choice: thyroxine • Monitor: s/s, TSH, FT4 |
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Give primary secondary and tertiary thyroid disorders
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Primary-thyroid dysfunction
secondary-pituitary dysfunction tertiary-hypothalamic dysfunction |
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this hormone useful in assessing pituitary function
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TRH-thyrotropin releasing hormone
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Magnifies change in T4 by 10 fold.
Uses(3) |
TSH-thyroid stimulating hormone
Uses: assess thyroid status causes of thyroid disease monitor treatment |
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Free thyroxine (FT4) Normal x-x ng/dL
- __% of T4 made in thyroid is bound to TBG __% plasma protein bound when in circulation T1/2 =? |
Free thyroxine (FT4) Normal 0.7-1.9 ng/dL
- 80% of T4 made in thyroid is bound to TBG 99.97% plasma protein bound when in circulation T1/2 = 7days |
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__ is influenced by changes in TBG but __ is not.(FT4 and TT4)
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Total T4 (TT4) is influenced by changes in TBG but FT4 is not.
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