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Ph Thyroid
Pharm Endocrine
Question | Answer |
---|---|
Tx for Graves dz | PTU (esp for PG/BF)(TID); Tapazole (qd) |
Cytomel = | T3 drug |
Cytomel AE | inc cardiotoxicity risk |
Armour thyroid: problems | Unpredictable hormonal stability; allerg rxn risk; Lacks bioequivalency among brands |
PTU works within: | 17 weeks |
Tapazole works within: | 6 wks (w/fewer AE)(QD dosing, so better compliance than PTU TID) |
PTU & Tapazole AE: | Benign rash; potl agranulocytosis; hepatotoxicity |
Surgery for hyperthyroid: subtotal or total thyroidectomy: indicated in: | pts with obstructions, malignancy, pregnancy in 2nd trimester, or those with contraindications to RAI or thioamides |
Tx of choice for hyperthyroid in US: | radioactive I ablation (CI in PG) |
Hyperthyroid tx adjuncts: | beta-blockers; c'steroids (dec action of thy hormone & imm response in Graves); Iodine (blocks thy hor release) |
PTU / Tapazole: If miss a dose: | take as soon as remember. Double up doses if necessary! |
Tx for thyroid storm | PTU; Propranolol; Corticosteroid; Iodide; Supportive measures; mortality 20% |
Myxedema Coma: findings | Emergency: elderly in winter; Hypothermia; Resp depression; Unconsciousness |
Myxedema Coma: tx | stat IV levothyroxine; then check labs |
hypothyroid Tx: T4/T3 ratios | Liotrix 4:1; thyroglobulin 2.5:1; armour = not consistent |
thyroid replacement tx dosing | <45 yo 100%; > 45 or LT/severe dz 50%; CVD or >65 25%; PG: inc dose by 50% |
Hyperthyroid tx monitoring | TT4 & FTI after 4-6 wks; after change in tx; then q 6-12 mo (for RAI: TSH/FT4 qmo) |