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t/f hypothyroidism is more common in women
t
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what is the significance of thyroid function in children?
critical for normal growth and developement
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what is the significance of thyroid function in ADULTS?
major role is to maintain metabolic stability
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what two mechanisms hormone production is regulated by?
TSH is under negative feedback control by circulating levels of free thyroid hormone
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- Extrathyroidal deiodination of T4 to T3 regulated by nutrition, drugs and illness
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what is the normal value of TSH?
0.4 to 4.4
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what are the primary etiologies of hyperthyroidism?
- Graves
- subacutre thyroiditis
- drugs
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what are the secondary etiologies of hyperthyroidism?
- tumor from pituitary or ovary
- pituitary resistance to pit hormones
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what are the main drugs that cause hyperthyroidism?
- Amiodarone
- Lithium
- Interferon ALpha
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How is TSH affected in hyperthyroidism?
suppressed <0.4
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How is T4 effected in hyperthyroidism?
- Increased
- Free T 0.8 - 2.7
- Total T4 4.6- 10.9
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What OTHER laboratory finding is found in hyperthyroidism?
Thyroid antibody found in graves
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What are the neurological ss of hyperthyroidism?
- aigitation
- nervousnes
- iritability
- poor []
- emotional lability
- extreme cases phychosis and mania
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What are the reproductive ss of hyperthyroidism?
- Amenorrhea
- Dec libido
- Dec firtility
- Gynechomastia
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What are the Gi SS of hyperthroidism?
- Increased peristalsis
- Diarrhea
- Nausea
- Vomitting
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What are the metabolic SS of hyperthyroidism?
- Inc apeptite
- weight loss
- inc vitamin utilization
- inc gluconeogenesis
- inc insulin degradation
- osteoporosis
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What are the musculoskeletal ss of hyperthyroidism?
- weakness
- tremor
- brisk deep tendon reflexes
- muscle wasting
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What are the cardiac ss of hyperthyroidism?
- tachycardia
- afib
- high output heart failure
- angina
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What are the integumentary ss of hyperthyroidism?
- warm and moist skin
- execessive sweating
- heat intolerance
- fine hair
- temporary balding
- in graves only pretibial myexodema
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What are the ocular ss of hyperthyroidism?
- wide eye stare
- lid lag
- proptosis
- exophthalmy
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Tachycardia, fever, agitation, nausea, vomiting, diarrhea, restlessness, psychosis
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How do you treat thyroid storm?
must treat thyroid disorder and underlying cause
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What is a CI to RAI?
Prego
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What is the MOA of PTU and MMI?
Prevent organificaiton and coupling
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What are the adverse effects of PTU and MMI?
- Benign transient leukopenia (WBC < 4000) (does not mean that you need to dc therapy)
- Agranulocytosis
- N/V
- Hepatic (usually within the first 3 months of therapy)
- Usually after 6 months-
- arthralgias
- pruritic macupapular rash
- lupus like syndrome
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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
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When is BB the primary mode of tx in hyperthyroidism?
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- 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
- Thyroid storm
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What are the pts use caution with bb?
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- Pre-existing lung disease (especially asthma, COPD)
- Unstable systolic CHF
- Bradycardia or heart block
- Diabetes
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what is the moa of I?
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- Acutely block hormone release and inhibit synthesis of hormone by interfering with intrathyroidal iodide utilization
can make worse if used long term
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what is I role in therapy?
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- 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
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What are the pts that should consider surgery?
- large gland
- severe pohthalmopathy
- or lack or remission on antithyroid drug
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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
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What are the lab values for overt hypothyroidism?
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What are the lab values for subclinical hypothyroidism?
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What are the neurologic ss of hypothyroidism?
- confusion
- slurred speech
- ha
- bradyphrenia
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What are the endocrine ss of hypothyroidism?
increased prolactin levels
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What are the hematologic ss of hypothyroidism?
anemia
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What are the reproductive ss of hypothyroidism?
- alteration in sex hormones
- decreased libido
- impotence
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What are the cv ss of hypothyroidism?
- Dec sv hr co with INC PVR to maintain bp
- may lead to cardiomegaly
- distant heart sounds
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What are the pulmonary ss of hypothyroidism?
- Dyspnea
- Pleural effusion
- late stage may lead to co2 retention
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What are the renal ss of hypothyroidism?
- Dec renal blood flow
- dec gfr
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What are the gi ss of hypothyroidism?
dec appetite
- constipation
- weight gain
- dec glucose absorption and delayed uptake
- inc sensitivity to insulin
- elevated serum lipids
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What are the musculskeletal ss of hypothyroidism?
- muscle aches and stiffness
- slow movement
- slow dtr
- aching stiff joints
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what are the integumentary ss of hypothyroidism?
- dry flakey skin
- brittle head and body hair
- dec hair and nail growth
- cold intolerance
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What are the other ss of hypothyroidism?
- non pitting boggy edema
- hoarse voice
- may have goiter
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What ss is present with severe hypothyroidism?
myexedema
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What are the characteristics of myexedema coma?
- rare
- medical ER
- diminished consciousness
- hypothermia without shivering
- hypoventilation
- hypotension
- hypoglycemia
- lactic acidosis
- precipitated by illness, stroke, medications, ER situations
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What are the two complications of hypothyroidism?
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what are the characteristics of cretinism?
- absence of thyroid tissue or hormone
- child will be dwarfed with short limbs, and mentally challenged
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What are the treatments of hypothyroidism?
- remove drug-related causes initially
- replace thyroid hormone
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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)
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what are the three classes of medications available for hypothyroidism?
- natural
- synthetic
- neutraceuticals
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what is liothyronine's role in therapy?
- only T3
- twice daily
- not recommended over levothyroxine
- no advantage of t3 alone
- worse adverse effects (long term)
- increase risk of hyperthyroidism
- use in certain deiodinase gene polymorphisms
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What is levothyroxine's role in therapy?
- only T4
- bioequivalence in all generics and brands
- well tolerated
- DOC
- over tx occurs in 20% of pts
- over tx = cv AE, skeletal effects, possible affective disturbances
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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
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Drug interactions that dec levothyroxine uptake?
- antacids
- cholestyramine
- fiber
- calcium products
- iron
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dg interactions that inc clearance of levothyroxine?
- rifampin
- phenobarbital
- carbamazepine
- estrogen
- phenytoin
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what is liotrix's place in therapy?
- T3 + T4
- same issues as liothyronine
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what is armour thyroid's place in therapy?
not recommended in tx of hypo or for use over levothyroxine
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what are neutraceutical's (traic, triatricol) place in therapy?
- not considered a remedy for hypo
- may contain iodine or sympathomimetic amines
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