exam 3 thyroid disorders Flashcards

Question

hyperthyroidism surgery

Answer 1

A

Hypothyroidism: underactive thyroid

Hyperthyroidism: overactive thyroid

Answer 2

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Serum TSH is the single best screening test for thyroid dysfunction

Serum Free T4 (FT4) is recommended to confirm suspicion of hypothalamic or pituitary disease

Answer 3

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Under-production of thyroid hormones

More common in females and incidence increases with age

Answer 4

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Hashimoto’s disease – most common

Autoimmune condition in which a patient’s antibodies attack their own thyroid gland

Iodine deficiency

Surgical removal of part or all of the thyroid gland

Congenital hypothyroidism

Drugs: amiodarone, interferons, lithium, nitroprusside, tyrosine kinase inhibitors

Thyroid gland ablation with radioactive iodine (secondary hypothyroidism)

Pituitary failure (secondary hypothyroidism)

Answer 5

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Cardiovascular disease

Cardiomyopathy, heart failure, hyperlipidemia, coronary artery disease

Myxedema coma

End stage of long-standing uncorrected hypothyroidism requiring IV thyroid hormone

Depression

Infertility

Answer 6

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Cold intolerance

Bradycardia

Weight gain

Weakness

Fatigue

Constipation

Coarse, thinning hair

Myalgias

Menorrhagia

Goiter

Answer 7

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↑ TSH (always collected) and ↓ FT4 (may or may not be collected)

↓ T4, ↓ T3 – not routinely measured

Answer 8

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Desiccated thyroid (Armour Thyroid ®): T3 and T4

Discouraged since preparations can contain variable amounts
Conversion of desiccated to levothyroxine: 1 grain (60-65 mg) = 100 mcg

Liotrix (Thyrolar ®): T3 and T4 in 1:4 ratio

Also not recommended

Liothyronine (Cytomel ®, Triostat ®): T3

Also not recommended

Answer 9

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↑ TSH with normal FT4

Controversy if should treat with levothyroxine

Likely to benefit: TSH > 10 mIU/L
Consider treatment: TSH 5-10 mIU/L + symptoms
Benefits clearest in younger populations

Generally lower dose compared to when treating hypothyroidism (e.g. levothyroxine 25-75 mcg/day)

Answer 10

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Observe clinical signs and symptoms

Check TSH levels (T4 rarely):

Initially every 4 - 8 weeks until levels are normal or when change dose or preparation
6 months
Yearly

Over-dosing in elderly patients leads to atrial fibrillation and fractures

May need dose reduction as patient ages

Answer 11

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Pregnant women with hypothyroidism may have children at risk of impairment in their intellectual function and motor skills, unless appropriately treated

Levothyroxine – pregnancy risk factor A

Preferably initiated prior to pregnancy
Will require 30-50% ↑ in dose throughout pregnancy course
Mother will require ↑ dose for several months post-partum – monitored freqently

Upper limit of normal TSH goals

1st trimester – 2.5 mIU/L
2nd trimester – 3 mIU/L
3rd trimester – 3.5 mIU/L

Answer 12

A

Take in the morning on an empty stomach ≥ 30 - 60 minutes before breakfast

Increases absorption

Different brands of levothyroxine may not work the same

If your new pills look different, ask the pharmacist

Tell your doctor if you become pregnant during treatment

If you become pregnant, your dose will likely need to be increased

You may notice a slight reduction in symptoms within 1 to 2 weeks, but the full effects can take up to two months

Even if you feel better, continue taking this medication for the rest of your life

Your blood will need to be tested at least annually to make sure your dose is optimal

Answer 13

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Over-production of thyroid hormones

Answer 14

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Grave’s disease – most common cause

Autoimmune disorder where the antibodies simulate the thyroid to produce too much T4

Toxic Multinodular Goiter

Growth of multiple thyroid nodules that results in unregulated T3 and T4

Toxic Adenoma

Growth of a single, usually benign thyroid nodule that produces unregulated T3 and T4

Thyroiditis

Inflammation of the thyroid gland commonly due to a viral infection

Drugs: iodine, amiodarone, interferons, excessive doses of thyroid hormone

Answer 15

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Heat intolerance

Goiter

Weight loss

Exophthalmos

Agitation

Diplopia

Anxiety

Fine, thinning hair

Palpitations

Tachycardia

Fatigue

Tremor

Muscle weakness

Irregular menses

Diarrhea

Insomnia

Answer 16

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↓ TSH and ↑ FT4

↑ T4, ↑ T3 – not routinely measured

Answer 17

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Arrhythmias

Heart failure

Osteoporosis

Answer 18

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Beta blockers

Reduce palpitations, tremors, and tachycardia
- However, does not correct underlying disorder (only treats the symptoms)
May use any beta blocker, although propranolol and nadolol may block T4 to T3 conversion at high doses (not clinically significant) – this is an advantage

Answer 19

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Anti-thyroid medications, radioactive iodine (RAI-131), or surgery
Anti-thyroid medications
- Thionamides – inhibit synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland (decrease levels of thyroid hormones)
  - Additional mechanism of Propylthiouracil: inhibits peripheral conversion of T4 to T3
- Onset of action is not seen until stored hormone is depleted, which may take 4-8 weeks (monitor TSH)
  - When clinical symptoms begin to diminish and thyroid function tests begin to decline, the dose is decreased to a maintenance dose (prevents hypothyroid state)
  - Continued for 12-24 months until the patient is in remission – high relapse rate

Answer 20

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Answer 21

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exam 3 thyroid disorders Flashcards

(29 cards)