Card Set Information
t/f hypothyroidism is more common in women
what is the significance of thyroid function in children?
critical for normal growth and developement
what is the significance of thyroid function in ADULTS?
major role is to maintain metabolic stability
what two mechanisms hormone production is regulated by?
TSH is under negative feedback control by circulating levels of free thyroid hormone
Extrathyroidal deiodination of T4 to T3 regulated by nutrition, drugs and illness
what is the normal value of TSH?
0.4 to 4.4
what are the primary etiologies of hyperthyroidism?
what are the secondary etiologies of hyperthyroidism?
tumor from pituitary or ovary
pituitary resistance to pit hormones
what are the main drugs that cause hyperthyroidism?
How is TSH affected in hyperthyroidism?
How is T4 effected in hyperthyroidism?
Free T 0.8 - 2.7
Total T4 4.6- 10.9
What OTHER laboratory finding is found in hyperthyroidism?
Thyroid antibody found in graves
What are the neurological ss of hyperthyroidism?
extreme cases phychosis and mania
What are the reproductive ss of hyperthyroidism?
What are the Gi SS of hyperthroidism?
What are the metabolic SS of hyperthyroidism?
inc vitamin utilization
inc insulin degradation
What are the musculoskeletal ss of hyperthyroidism?
brisk deep tendon reflexes
What are the cardiac ss of hyperthyroidism?
high output heart failure
What are the integumentary ss of hyperthyroidism?
warm and moist skin
in graves only pretibial myexodema
What are the ocular ss of hyperthyroidism?
wide eye stare
What is thyroid storm?
Tachycardia, fever, agitation, nausea, vomiting, diarrhea, restlessness, psychosis
How do you treat thyroid storm?
must treat thyroid disorder and underlying cause
What is a CI to RAI?
What is the MOA of PTU and MMI?
Prevent organificaiton and coupling
What are the adverse effects of PTU and MMI?
Benign transient leukopenia (WBC < 4000) (does not mean that you need to dc therapy)
Hepatic (usually within the first 3 months of therapy)
Usually after 6 months-
pruritic macupapular rash
lupus like syndrome
How does bb effect hyperthyroidism?
many of the dx of hpyerthroidism are mitigated by bb (tremor and hr)
very small effect blocking peripheral conversion of t3 and t4
When is BB the primary mode of tx in hyperthyroidism?
Adjunctive treatment with PTU or MMI, RAI or iodides
Primary treatment for thyroiditis or iodine-induced cases where alleviation of symptoms will tide patient over until condition resolves
What are the pts use caution with bb?
Pre-existing lung disease (especially asthma, COPD)
Unstable systolic CHF
Bradycardia or heart block
what is the moa of I?
Acutely block hormone release and inhibit synthesis of hormone by interfering with intrathyroidal iodide utilization
can make worse if used long term
what is I role in therapy?
To achieve rapid control if patient is decompensated
In preparation for thyroid surgery (due to decrease in size and vascularity of the gland)
Following RAI to prevent rapid hormone release after gland destruction
What are the pts that should consider surgery?
or lack or remission on antithyroid drug
what is a main disadvantage of rai?
cannot have human contact for 1 week, cannot sleep in the same bed as someone and not rec to be standing next to someone for more than 5 mins
What are the lab values for overt hypothyroidism?
T4 is low
What are the lab values for subclinical hypothyroidism?
What are the neurologic ss of hypothyroidism?
What are the endocrine ss of hypothyroidism?
increased prolactin levels
What are the hematologic ss of hypothyroidism?
What are the reproductive ss of hypothyroidism?
alteration in sex hormones
What are the cv ss of hypothyroidism?
Dec sv hr co with INC PVR to maintain bp
may lead to cardiomegaly
distant heart sounds
What are the pulmonary ss of hypothyroidism?
late stage may lead to co2 retention
What are the renal ss of hypothyroidism?
Dec renal blood flow
What are the gi ss of hypothyroidism?
dec glucose absorption and delayed uptake
inc sensitivity to insulin
elevated serum lipids
What are the musculskeletal ss of hypothyroidism?
muscle aches and stiffness
aching stiff joints
what are the integumentary ss of hypothyroidism?
dry flakey skin
brittle head and body hair
dec hair and nail growth
What are the other ss of hypothyroidism?
non pitting boggy edema
may have goiter
What ss is present with severe hypothyroidism?
What are the characteristics of myexedema coma?
hypothermia without shivering
precipitated by illness, stroke, medications, ER situations
What are the two complications of hypothyroidism?
what are the characteristics of cretinism?
absence of thyroid tissue or hormone
child will be dwarfed with short limbs, and mentally challenged
What are the treatments of hypothyroidism?
remove drug-related causes initially
replace thyroid hormone
what is the prognosis of hypothyroidism?
if adequately treated and monitored, good
requires lifelong supplementation and mx
needs fluctuate with pregnancy (inc) and age (decrease)
what are the three classes of medications available for hypothyroidism?
what is liothyronine's role in therapy?
not recommended over levothyroxine
no advantage of t3 alone
worse adverse effects (long term)
increase risk of hyperthyroidism
use in certain deiodinase gene polymorphisms
What is levothyroxine's role in therapy?
bioequivalence in all generics and brands
over tx occurs in 20% of pts
over tx = cv AE, skeletal effects, possible affective disturbances
what is dosing for levothyroxine?
slam with full dose (1.6 to 1.7 mcg/kg/day)
or titrate - inc by 12-25 mcg every 6 wks
Drug interactions that dec levothyroxine uptake?
dg interactions that inc clearance of levothyroxine?
what is liotrix's place in therapy?
T3 + T4
same issues as liothyronine
what is armour thyroid's place in therapy?
not recommended in tx of hypo or for use over levothyroxine
what are neutraceutical's (traic, triatricol) place in therapy?
not considered a remedy for hypo
may contain iodine or sympathomimetic amines