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Thyroid Disorders


Which thyroid hormone is active but less potent, is converted to another hormone in the periphery, accounts for 80% of thyroid hormones, and is 99.97% protein bound to TBG, pre-albumin and albumin? T4
Which thyroid hormone is 99.7% protein bound, 4x more potent than a similar hormone,and 80% of it comes from that similar hormone? T3
What does total T4 measure? free and bound T4
What test replaced the total T4 test and is a reactive test in which the protein binding has less influence? Free T4 test
Which test is the most common, is very sensitive to abnormalities in thyroid function, is used to rule out hyper or hypothyroidism, and is used to monitor therapy? TSH test
Which tests are used when abnormalities of T3 or T4 are suspected? Total and Free T3 tests
Which Thyroid function test is calculated? Free Thyroxine Index, but measuring free T4 is a better alternative
What is the normal range for Free T4 levels? 0.8-1.5 ng/dL
What is the normal range for TSH levels? 0.25-6.7 mIU/L
These characteristics describe the incidence of what disease? 1.5-2% of women 0.2% men increases with age primary form is the most common incidence of hypothyroidism
You are at increased risk of hypothyroidism if you are....? female older than 60 have autoimmune disease like Hashimoto have a history of thyroid disease
Name 3 characteristics of clinical hypothyroidism 1. elevated TSH 2. decreased free T4 3. symptomatic
List 3 characteristics of subclinical hypothyroidism 1.mildly elevated serum TSH level 2. normal T4 level 3. asymptomatic
What are the primary causes of hypothyroidism? 1. Iatrogenic causes (RAI/surgery. external radiation, drugs) 2.Hashimoto's thyroiditis
What are the secondary causes of hypothyroidism? 1. Pituitary disease 2. hypothalmic disease
List the miscellaneous causes of hypothyroidism? 1.Tumor on thyroid gland 2. Iodine deficiency 3. Goitrogens
List the symptoms of hypothyroidism fatigue, weight gain, muscle aches, cramps, pain, cold intolerance, constipation, memory/mental impairment,irregular or heavy menses and infertility, slow speech, decreased concentration, decreased appetite, decreased perspiration
List the physical findings of hypothyroidism yellow skin, coarseness or loss of hair, goiter, decreased deep tendon reflexes, depression, hyperlipidemia, bradycardia, hypothermia, dry skin
What do positive thyroid antibodies indicate? Hashimoto's disease
cholesterol panel and cpk may be elevated in which thyroid disorder? hypothyroidism
which diagnostic tests are used for hypothyroidism? thyroid scan and ultrasonography
Complications of hypothyroidism include...? Issues during pregnancy, prolonged QTc, accelrated atherosclerosis and coronary artery disease, bradycardia, infertility and menstrual irregularities, and MYEDEMA COMA
What are the goals of therapy when treating a patient with hypothyroidism? restore TSH to normal level (0.25-6.7 units/mL), restore free T4 to normal level (0.8-1.5 ng/ dL), provide symptomatic relief, minimize side effects, prevent overcorrection of TSH (hyperthyroidism)
What medications are used to treat hypothyroidism? Thyroid USP (Dessicated), Levothyroxine(Synthroid), Liothyronine (Cytomel, Triostat), Liotrix (Thyrolar)
Explain how levothyroxin is dosed... start w/ 100 micrograms/day or 50 micrograms/day in patients over 65 or with cv risk factors, adjust dose by 12.5-25 mcg/day, most ppl need 1.6-1.7 mcg/Kg/day (older ppl need less), TSH should be monitored at least 6 weeks after dosage change
Adverse effects of levothyroxine include... may increase PACS, excessive replacement can cause high output heart failure or unmask MI,allergic rxns to animal products, over-replacement acan lead to osteoporosis and fractures
How do bile acid sequestrants interacts w/ levothyroxin? Bile acid sequestrants decrease thyroid hormone absorption so you should separate the doses by 4-6 h
How do oral contraceptive interact w/levothyroxine? Estrogen increases thyroid binding globulin levels, resulting in lowered free thyroid hormone
how does warfarin interact with levothyroxine? Warfarin increases the metabolism of clotting factors; as thyroid dose increases, warfarin dose may need decreased
how does amiodarone interact w/levothyroxine? amiodarone blocks conversion of T4 to T3 and has high iodine content; can cause hypo or hyperthyroidism
how does lithium interact w/levothyroxine? Lithium inhibits synth and release of thyroid hormone
What is myxedema coma and how is it treated? Myxedema coma is the end of uncorrected hypothyroidism. Symptoms: hypothermia, delirium, and hypoglycemia. Tx is Synthroid 300-500 mcg IV bolus follwed by 75-100 mcg/day IV until switch to oral, hydrocortisone 100 mg IV for 8 hours and warm blankets
What is the incidence of hyperthyroidism? 2% of females, 0.1% of males
Risk factors for hyperthyroidism are.... Female, stress, cig smoking, Grave's disease in family hx
Compare clinical and subclinical hyperthyroidism Clinical: Decr. serum TSH level, incr. T4 level, symptomatic Subclinical:mildly decreased serum TSH level, normal free T4 level, asymptomatic
What are the primary causes of hyperthyroidism? 1. Graves' disease 2. excess thyroid production 3. exogenous sources
What is Graves' disease? an autoimmune sysndrome, the most common cause of hyperthyroidism, evidenced by exopthalmus (bulging eyes)
What are the exogenous sources which can cause hyperththyroidism? overcorrection of hypo, thryroid hormones in euthyroid pts, iodine-induce hyperthy, amiodarone
List the symptoms of hyperthyroidism nervousness, irritability, insomnia, mental issues, heat intolerance, incr. sweating, alt appetite, freq. bm or diarrhea, sudden paralysis, exertional intolerance, menstrual disturbance, less fertility, changed vision, photophobia, fatigue,muscle weakness
List the signs of hyperthyroidism palpitations, tremor, weight loss or gain, dependent lower extremity edema, dyspnea, eye irritation, diplopia, expthalmus, enlarged thyroid, goiter, pretibial myxedema
TSH is increased and free T4 is decreased in what illness? Hypothyroidism NOT hyperthryroidism
TSH is deceased and free T4 is increased in what disease? Hyperthyroidism
What lab values besides TSH and Free T4 should be checked with hyperthyroidism? Radioactive iodine upatke (RAIU) AND TSAb
What diagnostic tests are used for hyperthyroidism? Ultrasound, fine needle aspiration, 123I thyroid scan (radioactive tracer)
Name some complications of hypterthyroidism palpitations, tachycardia, atrial fibrillation (5-155, TSH should be checked if a fib is new), osteoporosis, miscarriage, thryoid storm
What are the goals of tx of hyperthyroidism? restore TSH to normal(0.25-6.7 u/mL), restore T4 (0.8-1.5ng/dL), symptom relief,prevent long term issues
What non-pharmacological options are used for hyperthyroidism? Surgery-based on pt sx, preop tx with iodides,anti-thyroid drugs or propanolol
Radioactive Iodine (RAI) characteristics sodium iodid preferred, colorless & tasteless liq, used in adult pts poor sugery candidates, only 1 tx needed, takes up to 12 weeks to work, usually results in hypothyroidism, might worsen opthalmopathy
Anti-thyroid drugs indicated when... monotherapy for mild hyperthyroidism, small goiters, and kids; also pretreatment before RAI (PTU preferred)
Explain the two kinds of thioamides 1.propylthiouracil (PTU) is the drug of choice in thyroid storm, pregnancy or lactation 2. methimazole-preferred except in preganancy or lactation
Describe the use of iodines use 7-014 days before surgery but DO NOT use prior to RAI, use 3-7 days after RAI
Why use beta blockers for hyperthyroidism? adjunct therapy to decr. action of thyroid hormone
Why use corticosteroids in hyperthyroidism? used for thyroiditis and thyroid storm, decr. thyroid action, and decr. immune response in Graves' disease
When would surgery be a good option? resistance to drug therapy, those who won't do 131 I therapy, very large goiters, old pts w/ giant nodular goiters risk of hypothyroidism, SSKI should be given 2 wks b4 op, PTU or methimazole must be given also
What is a thyroid storm? life-threatening medical emergency cause by precipitating factors
How is a thyroid storm treated? supression of thyroid hormone formation and secretion w/ PTU thioamide give iodine after PTU anti-adrenergic therapy corticosteroids tylenol treat complications
Created by: lulu5745