Thyroid Disorders

Physiology

100

The more potent thyroid hormone

Triiodothyronine (T3)

200

The type of T4 we measure

Free T4

300

The other name for T4

Thyroxine

400

The name of the axis involved in thyroid function

Hypothalamic-Pituitary-Thyroid (HPT) axis

500

Normal levels of TSH (per guidelines)

Lower limit: 0.3 or 0.4

Upper limit: 4.5 or 5.0

Hypothyroidism

100

Drug of choice for hypothyroidism treatment

Levothyroxine

200

Brand name for liothyronine

Cytomel

300

Autoimmune disease that cause hypothyroidism

Hashimoto's Disease

400

Most severe clinical presentation of hypothyroidism

Myxedema Coma

500

Medications that cause transient hypothyroidism

Lithium, amiodarone, guaifenesin, iodinated contrast, kelp tablets, thalidomide

Levothyroxine Dosing

100

Initial adult levothyroxine dose <65y.o.

1.5- 1.8 mcg/kg/day

200

Initial geriatric levothyroxine dosing

12 - 50mcg per day

300

Initial neonatal levothyroxine dose

10  - 15mcg/kg/day

400

Ideal time to recheck TSH after initiating levothyroxine

6 weeks

500

Estrogen's effect on levothyroxine dose requirement

Increases

 -  predictably in pregnancy

 -  mildly with exogenous administration 

        - menopause and transgender females

Hyperthyroidism

100

2 definitive treatments of hyperthyroidism

Surgery and radioactive iodine ablation

200

1 Advantage and 1 disadvantage of thionamides

Less invasive, chance of sustained remission, avoidance of permanent hypothyroidism

Difficult to titrate, agranulocytosis, vasculitis, hepatotoxicity

300

Due to systemic autoantibodies, this complication of cured hyperthyroidism persists

exophthalmos

400

Medications for Thyroid Storm

beta blockers

iodinated contrast

PTU or methimazole

cholestyramine

glucocorticoids

500

Preferred thionamide in the first trimester

PTU

Hyperparathyroidism

100

PTH acts on these 3 organ systems (directly and indirectly)

what are bone (osteoclastic activity) kidney (calcium resorption in the proximal tubule) and intestines (calcium absorption due to increased vitamin D from kidney)

200

This is the first test to order when a BMP shows hypercalcemia

what is ionized calcium?

300

Of ionized calcium, PTH, and vitamin D, this test is always high in primary hyperparathyroidism, and low and secondary hyperparathyroidism

What is ionized calcium?

400

Any of these are indications for surgical management of primary hyperparathyroidism.

<50y.o.

ionized calcium >1mg/dL high

osteoporosis

CRI or nephrolithiasis

symptoms

500

In nonsurgical management, these management items need to be addressed.

osteoporosis: bisphosphonates

hypercalcemia: calcimimetics

vitamin d deficiency

nephrolithiasis: thiazide diuretics