Pharmacology > Hypo & Hyperthyroidism > Flashcards

Hypo & Hyperthyroidism Flashcards

(16 cards)

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1
Q

Thyroid Function Tests

A
  • TSH is used to screen for hypo and hyperthyroidism.
  • Free T3 and T4 can confirm diagnosis
  • Thyroid scan can be used to evaluate for goiter
  • Routine screening is not recommended
  • Screen women before pregnancy and in first trimester
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2
Q

Hyperthyroidism

A

Excessive levels of thyroid hormone

  • May be life-threatening
  • Caused by Grave’s Disease, anterior pituitary disorders, Plummer’s disease, amiodarone therapy
  • Commonly Causes Grave’s Disease

Clinical effects from hypermetabolic state
- Heat intolerance, tachycardia

Treatment: anti-thyroid drugs
- Propylthiouracil (PTU) and methimazole

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3
Q

Anti-Thyroid Agents: Pharmacodynamics

A

PTU, methimazole (Tapazole)

  • Block synthesis of thyroxine and triiodothyronine
  • Neither drug treats the underlying pathology in hyperthyroidism
  • High relapse rates; studies show less if treated for 18-24 months

Goal of Treatment: correcting hypermetabolic state

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4
Q

Hyperthyroidism: Drug Therapy

A

Antithyroid drugs used for remission:

  • Beta blockers may be used to reduce symptoms while waiting for antithyroid drugs to work
  • Iodides (potassium iodide or Lugol’s solution) may be used as adjuvant treatment

Antithyroid drugs are used for at least a year in treating Grave’s disease

Older patients may respond best to radioactive iodine

Pregnant patients are treated with PTU because it is a bit safer

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5
Q

Anti-thyroid Agents: Precautions, Contraindications, ADRs, and Drug Interaction

A
  • Precautions & Contraindications
  • – Pregnancy category D: readily crosses the placenta; recommendation NOT to get pregnant while on these drugs
  • – PTU not recommended in children
  • ADRs: agranulocytosis, drowsiness, HA, alopecia, skin rashes, renal/hepatic failure
  • Drug Interaction: lithium, warfarin
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6
Q

Hyperthyroidism- Drug Therapy: Preoperative drugs to avoid Thyroid Storm while awaiting thyroid surgery

A
  • Antithyroid drugs
  • Beta blockers
  • Potassium iodide
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7
Q

Hyperthyroidism- Drug Therapy: Monitoring and Outcome Evaluation

A 
Monitoring 
- Clinical status
- Thyroid function tests: TSH and free T4 
- Assessment of visual acuity 
Outcome evaluation 
- Based on TSH and free T4 levels 
- Referral to endocrinology as necessary
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8
Q

Hyperthyroidism- Drug Therapy: Patient Education

A
  • Overall treatment plan
  • Length of treatment
  • Medication Administration
  • Precautions if treated with idone-131 (I133)
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9
Q

Hypothyroidism: Primary and Secondary

A

Primary

  • Congenital hypothyroidism
  • Hashimoto’s Thyroiditis: an immune-mediated disorder where TSH receptors are damaged
  • Subacute thyroiditis: inflammation of thyroid

Secondary

  • Pituitary or hypothalamic failure
  • Cushing’s Syndrome
  • Overtreatment with antithyroid drugs
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10
Q

Hypothyroidism: Goals of Treatment & Rational Drug Selection

A

Goals of Treatment
- Correction of hypometabolic state and return to euthyroid state

Rational Drug Selection

  • Synthetic thyroid hormone
  • Generic vs. brand name controversy
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11
Q

Thyroid Hormones: Pharmacodynamics

A
  • T3, T4, and liotrix (a 4:1 mixture of T3 and T4)
  • These hormones produce the same effects in the body as do endogenous thyroid hormones
  • They also produce a negative feedback loop to reduce further secretion of TSH and thyroid hormones
  • T4 is the drug of choice for thyroid replacement and suppression therapy because of its longer half-life
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12
Q

Hypothyroidism: In Pregnancy and Children

A

Pregnancy

  • Untreated hypothyroidism increases maternal health risks, still births, low birth weight, and possible abnormal fetal brain development
  • T4 is pregnancy category A

Infants and children with hypothyroidism need treatment for normal cognitive and physical development

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13
Q

Hypothyroidism: Associated Diseases

A

Recent acute MI
CAD
Osteoporosis: women with osteoporosis require careful monitoring
Infertility and menstrual irregularity: may improve with thyroid hormone replacement
Depression: hypothyroid evaluation should be part of depression workup

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14
Q

Hypothyroidism: Monitoring

A
  • TSH and free T4 levels should be evaluated:
  • – every 4-8 weeks until euthyroid state reached
  • – during pregnancy, at 8 weeks and 6 months gestation
  • Clinical symptoms frequently do not parallel actual value
  • Evaluate for anemia
  • Monitor BP and lipids
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15
Q

Hypothyroidism: Outcome Evaluation

A
  • Reduction of clinical symptoms and normal TSH/Free T4
  • Endocrine consult considered for:
  • – Pediatric patients
  • – Pregnant patients
  • – Cardiac patients
  • – Complex patients or those not responding to therapy
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16
Q

Hypothyroidism: Patient Education

Study These Flashcards
A
  • Overall treatment plan and disease process
  • Role of iodine intake
  • Pregnancy
  • Need for regular follow-up and lab tests, especially dual energy x-ray absorptiometry
  • Drug administration
  • – Should be taken in morning on empty stomach
  • – Many drug interactions
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