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Ph Thyroid

Pharm Endocrine

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)
Created by: Adam Barnard Adam Barnard