1Thyroid hormones increase
metabolism
2What increases under the influence of thyroid hormones?
oxygen and energy consumption
themogenesis
3What is the function of the thyroid?
lowers serum calcium
4The precursor procalcitonin plays an important role as a marker for
bacterial infection
5Which thyroid hormone is more potent?
t3
6What is the half life for t3?
1 day
7What is the half life for t4?
1 week
8What are some agents that disrupt thyroid hormone synthesis, release and metabolism?
nitrate
sulfonamides
lithium salts
9What are some s/s seen with hypothyroidism?
cool dry skin
intolerance to cold
constipation
weight gain
hyporreflexia (woltman sign)
excessive fatigue
10Which thyroid disorder is associated with high cholesterol?
hypothyroidism
11What is the most common cause of hypothyroidism world wide?
dione deficiency
12Levothyroxine is a synthetic form of
t4
13What is liothyronine?
synthetic form of t3
14Thyroid hormones increase
metabolism
15What are some warnings associated with L thyroxine drugs?
CV disease may worse
decreased bone density in postmenopausal women
16What are the AE of L-thyroxine drugs?
sweating
heat intolerance
tachycardia
palpitations
arrhythmias
CP
tremors
weight loss
17What are the DDIs associated with L thyroxine replacement?
estrogen
glucocorticoids
SERM
digoxin
SSRIs
omeprazole
calcium carbonate
phenytoin
carbamazepine
propranolol
warfarin
18When is reduced dosage of L thyroxine replacement necessary?
patient is on glucocorticoids
19How should you handle a pregnant pre-existing hypothyroid patient?
increase dose but then reduce after baby is born
20What should you educate your patient on when taking thyroid hormones?
patient should try to take single dose in the morning
21What is a myxedema coma?
life threatening decompensation of preexisting thyroid hormone deficiency
22What are some triggers for myxedema coma?
infections
severe illness
trauma
certain drugs
d/c of thryoid supplements
23What do the lab studies show with myxedema coma?
high TSH
low T3 and T4
hypoglycemia
hyponatremia
24What treatment is given for myxedema coma?
levothyroxine +/- liothyronine + hydrocortisone
25How do older patients with hypothyroidism present?
dementia or depression
26What is defined as a hypermetabolic condition caused by inappropriately high level of circulating thyroid hormones irrespective of the source?
thyrotoxicosis
27What is defined as a condition characterized by the overproduction of thyroid hormones by the thyroid gland ?
hyperthyroidism
28Labs for overt hyperthyroidism?
low TSH
high T3 and T4
29What labs are seen with subclinical hyperthyroidism?
low TSH
normal T4 and T3
30What is the treatment of hyperadrenergic symptoms in patients with thyrotoxicosis?
propranolol
31What is the alternative treatment for hyperadrenergic symptoms if there is a CI to beta blockers (severe asthma, raynaud phenomenon)?
CCB (verapamil or diltiazem)
32What treatment should be avoided for cardiac complications in patients with thyrotoxicosis?
amiodarone
33In addition to checking thyroid hormones what other labs should you get for hyperthyroidism?
CBC
BMP
liver
cholesterol
ESR
ECG
34What are the three effect initial treatment options for graves disease?
antithyroid drugs
RAIA
surgery
35What treatment is recommended in patients older than 40?
radioactive iodine
36Surgery for treatment of graves disease is usually reserved for patients
with large goiters
suspected malignancy
37What are the thionamides?
PTU
methimazole
38What is the MOA of methimazole?
inhibits thyroid peroxidase causing blockage of iodide oxidation, organification, and coupling
39What is the MOA of PTU?
inhibits 5'-deiodinase (preventing conversion of T4 to T3)
40What is used to treat graves opthalmopathy?
glucocorticoids
41What is used in first trimester hyperthyroidism?
PTU
42What is the most common SE of thionamides?
pruritic rash
43If patient has a mild reaction to methimazole what should be done?
switch to PTU
if patient has a severe reaction - avoid all thionamides
44What are the hematoligcal side effects of thionamides?
agranulocytosis
aplastic anemia
thrombocytopenia
45What other SE are associated with PTU?
hepatitis
cholestatic jaundice
liver failure
46What SE are seen with both thionamides?
diffuse goiter
dysgeusia
47What are the potassium iodides?
lugol's iodine
saturated solution of potassium iodide
ipodate/iopanoate
48What is the MOA of potassium iodides?
inhibit proteolytic cleavage of T3 and T4 from thyroglobulin which inhibits thyroid hormone release
decrease thyroid vascularity and size of gland
49What are the SE associated with potassium iodides?
oral or gastric mucosal irritation
allergy
teratogenicity
50Potassium iodides must be stopped ..
a week before radioactive iodine ablation
51What should the patient be educated on when taking antithyroid medications)
dietary sources of iodine should be reduced/eliminated
patient should report sore throat, fever, chills, rash and unusual bleeding (signs of agranulocytosis)
52What is the treatment for thyroid storm?
propranolol
APAP
electrolytes
PTU and glucocorticoid OR methimazole and glucocorticoid
53If a patient is in a thyroid storm and has HF what BB should you give?
esmolol
54If patient has COPD (or severe asthma) what beta blocker should you give?
atenolol
metoprolol
55Relationship between PTH and calcitonin
work opposite
56When is PTH secreted?
when serum calcium levels are low
57PTH increases osteo_____ activity?
clast
58PTH secretion is inhibited by
increase serum calcium
marked hypomagnesium
59Hypoparathyroidism triggers what symptoms?
muscle cramps
seizures
HF
60What are the chronic manifestations of hypoparathyroidism?
extrapyramidal disorders
ocular disease
skeletal manifestations
dental abnormalities
dry puffy coarse skin
61When should you use IV calcium supplementation?
if serum calcium is equal to or less than 7.5 mg/dL
severe or symptomatic hypocalcemia
prolonged QT interval
62When should you use oral calcium supplementation?
serium calcium between 7.6-8.4
paresthesias (mild or no symptoms)
63What are the IV calcium supplements?
calcium gluconate
calcium chloride
64What is a DDI associated with IV calcium?
digoxin or digitoxin
65What drug can cause hypocalcemia?
loop diuretics
66What is the MOA of cinacalcet?
increases sensitivity of calcium sensing receptor in the parathyroid cells thereby downregulating PTH levels and lowering serum calcium and phosphorus
67What are the warnings associated with cinacalcet?
may lower calcium too low so should monitor for seizures and monitor hepatic levels
68What are the AE of cinacalcet?
diarrhea
n/v
myalgia