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Thyroid Disorders
| Question | Answer | |
|---|---|---|
| The thyroid gland produces hormones | which regulate metabolism, including processes needed to maintain life: cardiac/nervous systems, body temp, muscle strength, skin dryness, menstrual cycle, weight and cholesterol levels. | |
| Hyperthyroidism | Overactive thyroid-thyrotoxicosis - FT4 is high and TSH is low | |
| Hypothyroidism | Under-active thyroid - deficiency in T4 and consequently a elevation of TSH | |
| The 2 thyroid hormones produced by the thyroid gland are | T3-triodothyronine T4-thyroxine | |
| The thyroid gland is the only ORGAN that can | Absorb Iodine-required for the production of both hormones | |
| T3 is More potent than T4 | but has a shorter half life. | |
| TSH | Thyroid stimulating hormone -which regulates the thyroid hormone production AKA thyrotropin, its secreted by the pitituary gland, located in the brain and regulated growth and development. | |
| Free T4 is unbound | active form that is monitored in patients with thyroid disorders | |
| Key Drugs that cause HYPOthyroidism | I-TALC I-Interferons T-Tyrosine Kinase inhibitors A-Amiodarone- L-Lithium C-Carbamazempine | |
| MAIN Condition that causes HYPOthyroidism | Hashimoto's Disease | |
| Select drugs and conditions that can cause HYPOthyroidism | Oxcarbenzepine Eslicarbazepine Phenytonin Conditions: Iodine deficiency, Pitituary failure, Surgical removal of thyroid gland, congenital hypothyroidism, Thyroid gland ablation with radioactive iodine, External irradiation | |
| S/Sx of HYPOthyroidism | Cold Intolerance/sensitivity, Dry skin, Fatigue, Muscle cramps, voice changes, constipation, weight gain, Goiter (possible), Myalgias, Weakness, Depression, Bradycardia, coarse hair or hair loss, Menorrhagia, Memory and mental impairment | |
| Low free T4 normal range | 0.9-2.3 mg/dL | |
| High TSH normal range | 0.3-3 mIU/L | |
| TSH is the primary test to monitor thyroid function and should be monitored | every 4 to 6 weeks until levels are normal, then 4 to 6 months later, then yearly | |
| TOO high of a thyroid hormone replacement dose in Elderly can cause | Atrial fibrillation and fractures | |
| Levothyroixine is the | Drug of choice for hypothyroidism and is 99% highly protein bound | oral solution can be given undiluted or diluted in water only-store in original container |
| Levothyroxine (T4) | synthyroid, levoxyl, unithyroid , Euthyrox, Tirosint, Tirosint-sol | comes in capsule, tab, injection, oral solution |
| Levothryoxine dosing | FULL replacement: 1.6 mcg/kg/day (IBW) IF known CAD, start with 12.5-25mcg daily | Elderly patients often need 20-25% less per Kg, may require < 1mcg/kg/day |
| Levothyroxine IV: PO | 0.75:1 | |
| Levothyroxine counseling point | Should be taken by mouth with plain water at the same time each day -at least 60 min before breakfast or at bedtime (3 hrs after last meal) | Let dr know if pregnant- may need dose increase, also be sure to tell dr if color changes of tab |
| Thyroid Desiccated USP (T3 & T4) | Amour thyroid, Nature thyroid, Westhroid, WP thyroid- they are natural procine-derived and have less predictable potency/stability | Dosing: 15-30 mg daily (15 mg in cardiac disease) titrate in 15 mg increments -usual dose is 60-120 mg |
| Liothyronine (T3) | Cytomel, Triostat (tab and injection) | Dosing: 25 mcg daily then titrate to 12.5 mcg to 25 mcg increments -usual dose is 25 to 75 mcg daily |
| Liotrix (T3 and T4 in 1:4 ratio) | Thyrolar-tablet-shorter half life causes fluctuations in T3 levels | Start 25 mcg levo/6.25 mcg liothyronine daily-usual dose is 50-100 mcg levo/12.5-25 mcg liothyronine |
| Hyothyroidism treatment BW | Ineffective and potentially toxic when used or obesity or weight reduction- high doses can cause serious, life threatening toxic effects, when used in anorexic drugs | |
| Hyothyroidism treatment CI | uncorrected adrenal insufficency | |
| Hyothyroidism treatment Warnings | decreased dose in CVD (chronic hypothyroidism predisposes to CAD), decreased mineral density which can lead to osteoporosis | |
| Levothyroxine Orange tablet | 25 mcg | |
| Levothyroxine white tablet -no dye | 50 mcg | |
| Levothyroxine violet tablet | 75 mcg | |
| Levothyroxine Olive tablet | 88 mcg | |
| Levothyroxine yellow tablet | 100 mcg | |
| Levothyroxine Rose tablet | 112 mcg | |
| Levothyroxine Brown tablet | 125 mcg | |
| Levothyroxine Turquoise tablet | 137 mcg | |
| Levothyroxine Blue tablet | 150 mcg | |
| Levothyroxine Lilac tablet | 175 mcg | |
| Levothyroxine Pink tablet | 200 mcg | |
| Levothyroxine Green tablet | 300 mcg | |
| Drugs that decrease levothyroxine absorption | Antacids, polyvant cations (iron, ca, al, mg, multivitamins (ADEK, folate, iron),cholestryramine, orlistat (xenical, alli), sevelamer and sucrafate | Separate doses by 4 hours from thyroid therapy |
| Sodium polystyrene Sulfonate and Patiromer (Veltassa) separate doses by | 3 hours from thyroid replacement therapy | |
| Lanthanum separate doses by | 2 hours from thyroid replacement therapy | |
| Drugs that decrease thyroid levels | Estrogen, SSRIs, Hepatic inducers | |
| Drugs that can decrease the effectiveness of Levothyroxine | Beta blockers, amiodarone, propylthiouracil (PTU) and systemic steroids | |
| Thyroid hormone replacement treatment can | INCREASE the effects of WARFARIN (increased in INR/PT) | |
| Thyroid hormone replacement treatment can | DECREASE levels of Theopylline | |
| S/Sx of HYPERthyroidism | Heat intolerance, Increased sweating, Weight loss, Agitation, nervousness, irritability, anxiety, Palpitations/Tachycardia, Fatigue/muscle weakness, Frequent bowel movements/diarrhea, Insomnia, Tremor, Thinning hair, Goiter, exothalmos/Diplopia,Light MP | |
| If left untreated HYPERthryoidism can cause | HF, tachycardia, arrhythmia's, osteoporosis | |
| Most common cause of HYPERthyroidism | Graves disease- less common-thyroid nodules and thyroiditis | |
| Drugs that can cause HYPERThyroidism | IODINE Amiodarone Interferons | |
| For HYPERthyroidism Symptom control | Beta blockers can be used to reduce palpitation, tremors, and tachycardia | |
| Thionamides | Inhibit synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland, PTU also inhibits peripheral conversion of T4 to T3 | PTU and Methimazole |
| Propylthiouracil (PTU) | Dosing: 50-150 mg Q8H initially until euthryoid (higher doses for more severe hyperthyroidism)-followed by dose reduction | Preferred in thyroid storm if methimazole is NOT tolerated. Preferred in Pregnancy in the FIRST trimester |
| Methimazole | Tapazole Dosing: mild-5 mg Q8H until euthyroid-increased doses for severe)-then 5 to 15 mg daily | DRUG of choice usually, Can be used in Pregnancy in the 2nd and 3rd trimester (to decrease liver tox from PTU) |
| Propylthiouracil (PTU) BW | severe liver injury and acute liver failure | |
| Thionamides (PTU/Methimazole) Warnings | Hepatotoxicity, bone marrow supression (rare but includes agranulocytosis) DILE, vasculitis | |
| Thionamides (PTU/Methimazole) SIDE effects | GI upset, HA, RASH (exfoliative dermatitis, pruritus), fever, constipation, loss of taste/taste perversion, lymphadenopathy, bleeding | |
| Thionamides (PTU/Methimazole) Monitoring | FT4 and T3 every 4 to 6 weeks until euthyroid , TSH, CBC, LFTs, PT, monitor for liver toxicity and infection | |
| Iodides | temp inhibit secretion of thyroid hormones, T4 and T3 levels will be reduced for several weeks but effect will not be maintained | Potassium iodine and iodine solution (Lugol's sol) Saturated sol. of potassium iodine (SSKI, Thyrosafe) |
| Iodides CI | Hypersensitivity to iodine or iodide, dermatitis herpetidormis, hypocomplmentemic vasculitits, nodular thyroid conditions with heart disease | |
| Iodides SE | Rash, metallic taste, sore throat/gums, GI upset, urticaria, hypo/hyper thyroidism with prolonged use | |
| Iodides monitoring | Thyroid function tests, s/sx of hyperthyroidism | Dilute in glassful of water, juice,or milk, taken with food or milk to decrease GI upset, SSKI is also used as expectorant |
| When exposed to Radiation you use | Potassium Iodide (KI)-this blocks the accumulation of radioactive iodine in the thyroid gland preventing thyroid cancer - taken asap | |
| Thyroid storm | LIFE threatening medical emergency characterized by decompensated HYPERthyroidism that can happen from infection, trauma, surgery, radioactive iodine treatment or non-adherence to anti-thyroid meds. | |
| S/Sx of thyroid Storm | Fever (> 103°F) Tachycardia Tachypnea Dehydration Profuse sweating Agitation Delirium Psychosis Coma | |
| Thyroid STORM DRUG treatment | Anti-thyroid therapy (PTU-500-1000 mg LD, then 250 mg PO Q4H), SSKI or Lugols sol. plus BB (propranolol 40-80 Q6h) PLUS systemic steroid (DEX) PLUS aggressive cooling (APAP and cooling blankets) | |
| Pregnant HYPOthyroidism patients need a | 30-50 % increase in dose of levothyroxine |
Created by:
mrgarci3