DSM
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| 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
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| 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
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| What does total T4 measure? | free and bound T4
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| What test replaced the total T4 test and is a reactive test in which the protein binding has less influence? | Free T4 test
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| 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
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| Which tests are used when abnormalities of T3 or T4 are suspected? | Total and Free T3 tests
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| Which Thyroid function test is calculated? | Free Thyroxine Index, but measuring free T4 is a better alternative
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| What is the normal range for Free T4 levels? | 0.8-1.5 ng/dL
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| What is the normal range for TSH levels? | 0.25-6.7 mIU/L
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| 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
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| 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
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| Name 3 characteristics of clinical hypothyroidism | 1. elevated TSH
2. decreased free T4
3. symptomatic
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| List 3 characteristics of subclinical hypothyroidism | 1.mildly elevated serum TSH level
2. normal T4 level
3. asymptomatic
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| What are the primary causes of hypothyroidism? | 1. Iatrogenic causes (RAI/surgery. external radiation, drugs)
2.Hashimoto's thyroiditis
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| What are the secondary causes of hypothyroidism? | 1. Pituitary disease
2. hypothalmic disease
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| List the miscellaneous causes of hypothyroidism? | 1.Tumor on thyroid gland
2. Iodine deficiency
3. Goitrogens
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| 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
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| List the physical findings of hypothyroidism | yellow skin, coarseness or loss of hair, goiter, decreased deep tendon reflexes, depression, hyperlipidemia, bradycardia, hypothermia, dry skin
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| What do positive thyroid antibodies indicate? | Hashimoto's disease
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| cholesterol panel and cpk may be elevated in which thyroid disorder? | hypothyroidism
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| which diagnostic tests are used for hypothyroidism? | thyroid scan and ultrasonography
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| Complications of hypothyroidism include...? | Issues during pregnancy, prolonged QTc, accelrated atherosclerosis and coronary artery disease, bradycardia, infertility and menstrual irregularities, and MYEDEMA COMA
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| 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)
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| What medications are used to treat hypothyroidism? | Thyroid USP (Dessicated), Levothyroxine(Synthroid), Liothyronine (Cytomel, Triostat), Liotrix (Thyrolar)
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| 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
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| 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
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| 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
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| How do oral contraceptive interact w/levothyroxine? | Estrogen increases thyroid binding globulin levels, resulting in lowered free thyroid hormone
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| how does warfarin interact with levothyroxine? | Warfarin increases the metabolism of clotting factors; as thyroid dose increases, warfarin dose may need decreased
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| how does amiodarone interact w/levothyroxine? | amiodarone blocks conversion of T4 to T3 and has high iodine content; can cause hypo or hyperthyroidism
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| how does lithium interact w/levothyroxine? | Lithium inhibits synth and release of thyroid hormone
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| 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
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| What is the incidence of hyperthyroidism? | 2% of females, 0.1% of males
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| Risk factors for hyperthyroidism are.... | Female, stress, cig smoking, Grave's disease in family hx
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| 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
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| What are the primary causes of hyperthyroidism? | 1. Graves' disease
2. excess thyroid production
3. exogenous sources
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| What is Graves' disease? | an autoimmune sysndrome, the most common cause of hyperthyroidism, evidenced by exopthalmus (bulging eyes)
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| What are the exogenous sources which can cause hyperththyroidism? | overcorrection of hypo, thryroid hormones in euthyroid pts, iodine-induce hyperthy, amiodarone
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| 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
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| 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
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| TSH is increased and free T4 is decreased in what illness? | Hypothyroidism NOT hyperthryroidism
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| TSH is deceased and free T4 is increased in what disease? | Hyperthyroidism
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| What lab values besides TSH and Free T4 should be checked with hyperthyroidism? | Radioactive iodine upatke (RAIU) AND TSAb
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| What diagnostic tests are used for hyperthyroidism? | Ultrasound, fine needle aspiration, 123I thyroid scan (radioactive tracer)
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| Name some complications of hypterthyroidism | palpitations, tachycardia, atrial fibrillation (5-155, TSH should be checked if a fib is new), osteoporosis, miscarriage, thryoid storm
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| 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
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| What non-pharmacological options are used for hyperthyroidism? | Surgery-based on pt sx, preop tx with iodides,anti-thyroid drugs or propanolol
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| 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
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| Anti-thyroid drugs indicated when... | monotherapy for mild hyperthyroidism, small goiters, and kids; also pretreatment before RAI (PTU preferred)
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| 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
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| Describe the use of iodines | use 7-014 days before surgery but DO NOT use prior to RAI, use 3-7 days after RAI
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| Why use beta blockers for hyperthyroidism? | adjunct therapy to decr. action of thyroid hormone
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| Why use corticosteroids in hyperthyroidism? | used for thyroiditis and thyroid storm, decr. thyroid action, and decr. immune response in Graves' disease
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| 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
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| What is a thyroid storm? | life-threatening medical emergency cause by precipitating factors
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| 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
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