thera 3 test 2 thyroid disorders

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coal
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268104
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thera 3 test 2 thyroid disorders
Updated:
2014-03-26 23:30:05
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thera test thyroid disorders
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thera 3 test 2 thyroid disorders
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thera 3 test 2 thyroid disorders
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  1. major role of thyroid in children vs adults
    • children - critical for normal growth and development
    • adult - maintain metabolic stability
  2. thyroid hormone production
    • hypothalamus 
    •    TRH
    • pituitary
    •    TSH
    • thyroid
    •    T4 & T3
  3. effects of thyroid hormone on the adipose tissue
    catabolic - lipolysis
  4. effects of thyroid hormone on the muscle
    catabolic - increased protein breakdown
  5. effects of thyroid hormone on the heart
    chronotropic - increased number and affinity of beta receptors (increase rate)

    ionotropic - enhanced response to catecholemines (increase strength)
  6. effects of thyroid hormone on the nervous system
    developmental - normal growth skeletal development
  7. effects of thyroid hormone on lipoprotein
    metabolic - increased rate of cholesterol absorption
  8. normal limit of TSH
    0.4-4.4 mIU/L
  9. what would you want a TSH level to be in a pregnant woman
    3
  10. T4 name
    thyroxine
  11. T3 name
    triodothyronine
  12. 3 drugs that contain iodine and can induce hyperthyroidism
    • amiodarone
    • lithium
    • interferon alpha
  13. 5 considerations when treating hyperthyroidism
    • severity of pt
    • SE
    • price
    • other disease states
    • surgeon skill
  14. 3 treatment options for hyperthyroidism
    • surgery
    • radioactive iodine
    • anti-thyroid medications
  15. adjunctive treatment for hyperthyroidism
    • beta blockers - control HR and tremor (propranolol 20-40 mg QID HR <90bpm)
    • iodides
    • alternate therapy CCB (diltiazem 120 mg q 8h)
  16. primary therapy for hyperthyroidism (medications)
    • propylthiouracil (PTU)
    • methimazole (MMI)
  17. expected response time after taking hyperthyroidism medication and what to do next
    • 4-8wks = decreased symptoms & change in hormone levels
    • when pt has some clinical and laboratory response do a monthly taper back to maintenance dose
    • length of treatment = 12-24 months if goal is remission
    • follow up 6-12 month periods to ensure remission
  18. adverse effects of antithyroid meds
    • hematologic (benign transient leukopenia, WBC < 4000)
    • agranulocytosis (fever, malaise, gingivitis, flu like symptoms, granulocyte count <250) = discontinue therapy, occurs most in first 3 months of therapy
    • N/V, hepatotoxicity (first 3 months)
  19. when using beta blockers as adjunctive therapy for hyperthyroidism, what pts would you use caution in
    • pre-existing lung disease (asthma, COPD)
    • unstable systolic CHF
    • bradycardia or heart block
    • diabetes
  20. 9 candidates for thyroidectomy
    • failure w/meds
    • young & comorbidities
    • nodules
    • goiter
    • malignancy
    • female desiring to get prego w/I 6 months
    • increase circulating levels of antibodies
    • eye manifestations
    • definitive & prompt control
  21. CI of RAI
    pregnancy and breast feeding
  22. T3 medication and dosing
    • cytomel, triostat
    • initial 25 mcg QD (lower in geriatric and cardiovascular disease)
    • maintenance 25-75 mcg QD
  23. T4 medication and dosing
    • synthroid, levoxy
    • average dose 1.6-1.7 mcg/kg/day alternate approach
    • conservative approach 50 mcg QD titrate or 100-125 mcg QD
    • elderly 25-50 mcg QD
  24. when to monitor T4 replacement levels of TSH
    • 4-6 weeks following dose initiation or change
    • 6-12 months once stabilized
  25. drugs that decrease uptake of levothyroxine
    • fiber supplements
    • antacids
    • cholestyramine
    • calcium containing products
    • coffee?
    • iron
  26. drugs that increase clearance of levothyroxine
    • rifampin
    • phenytoin
    • phenobaribital
    • carmamazepine
    • estrogen
  27. dessicated thyroid hormones and doses
    • armour, nature-thyroid, westthroid
    • initial - 15-30 mg/day
    • maintenance 60-120 mg/day

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