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IOS 9 Exam 3
Thyroid disorders
| Question | Answer |
|---|---|
| What are the 3 functions of the thyroid gland | Developmental regulation (fetal), Requlation of energy (cardiac function), Metabolism (cholesterol metabolism, sentaziation of B-adrenergic cells to NE) |
| MOA of thryroid hormones | Hormones bind receptors, translocation and bind DNA to cause gene transcription |
| CNS regulation of thyroid secretion occurs by | Hypothalamus stimulated to secrete-TRH which stimulates anterior pitutary to release TSH, this acts upon thyroid gland in 2 ways- increase inter cellular iodine and second to produce thyroid hormone - cause negative feedback at hypothalamus& anterior pitu |
| Synthesis of thyroid hormone occurs by | Increase in TSH stimulates intercellular I- and leads to iodination of thyroglobulin (1 or 2 iodinated on tyrosines) |
| Thyroxine and triiodothyronine from iodotyrosines occurs by | 2 Iodinated tyrosines from same thyroglobulin are linked via ester bond- 2 combine they become T4=thyroxine, and further if an iodine is removed T3=triiodothyronine (4x potent) |
| Thyroid hormones are highly protein bound so DI with | Estrogens, Glucocorticoids, phenytoin,carbamzepines, as well as dx states-liver, HIV |
| Lab assessment of choice | Free T4- Direct measure of T4 more reliable and can be used to evaluate euthyroid sick patients |
| DI with thyroid replacement therapy- 2 meds are | Warfarin and Amiodarone |
| Warfarin DI MOA | Thyroid hormone causes an increase in metabolism of cloting factors- this with warfarin increased bleed risk |
| Amiodarone DI MOA | Two MOA- Blocks peripheral conversion of T4-T3, the compound itself is highly iodinated blocking iodine transport |
| S/S of hyperthyroid are | Nervousness, weight loss, palpitations, muscle weakness, tremor, hair thining |
| Causes of Hyperthyroid are | Graves disease (Ab), Multinodular goiter, Subacute thyroiditis |
| Graves disease overview | Antibodies, High T4, low TSH |
| Treatment for hyperthyroidism | Thioamides, Iodines, B-blockers, radioactive iodine, surgery) |
| What is the DOC for treating hypothyroidism | Methimazole, if pregnant-propythiouracil |
| Graves Opthalmopathy is | A symptom of 50% of patients where they have problems with lid retraction, lid laging- treat by correcting hyperthyrodism & smoking cessation |
| Subclinical Hyperthyroidism is | an asymptomatic presentation but framingham noted increase in pulse, bone loss and risk of A. fib in patients with suppressed TSH |
| S/S of hypothyroidism | Women, weight gain, cold intolerance, constipation, depression, bradycardia |
| Risk risk for hypothyroidism | Autoimmune disease or FHX of hypothyroid, female, >60, TSH>10, antibody + |
| Cause of hypothyroidism is | Hashimotos, Iatrogenic -Amidarone, immunotherapy or subclinical hypothyroidism |
| Treatment for hypothyroidism | Levothyroxane, L-triiodthyronine, Thyroid USP, Liotrix |
| Euthroid Sick syndrome is | Inability to have peripheral T4 to T3 conversion |
| Myxedema Coma is | Long standing uncorrected hypothyroidism |
| Clinical pearls of dosing | Elderly may need 25/50ug/d due to decreased clearance |
| Monitoring hypothyroid therapy should occur | Initially every 2-3 months until dose established and adjust by 12.5-25mcg/d within 2 weeks |
| Hyperthyroidism cause | Bone loss, A fib |
| L-triidothyronine has the | Narrowest theraputic index |
| Levothyroxane is the most | stable and predictable |
| Side effects of methiazole are | Gi upset, angranulocytosis, hepatitis, rash |
| Starting dose of levothyroxine is | 25-50ug/day and test in 6 weeks |
| Starting dose of methimazole is | 30-40mg/QD |
Created by:
liza001
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