Patient Supplements
What is the metabolic effect of St. John's Wort
What is a CYP 450 Inducer
What is the most common cause of hypothyroid?
The most common cause of hypothyroidism is an autoimmune disorder
What is liothyronine?
What is a synthetic form of T3
What is levothyroxine?
What is the synthetic form of T4 (thyroxine which is the main hormone produced by thyroid gland)
What is a thyroglobulin test?
What is a type of tumor marker test
What is the mechanism of action of L-Carnitine?
L-carnitine inhibits both triiodothyronine (T3) and thyroxine (T4) entry into the cell nuclei. Helpful for tx of hyperthyroidism
What are the symptoms associated with generalized mixedema? Minimum 3
Doughy skin texture, puffy appearance
Myxedematous heart disease (dilated cardiomyopathy, bradycardia, dyspnea)
Hoarse voice, difficulty articulating words
Pretibial and periorbital edema
Myxedema coma
Through which mechanism can PPis affect levothyroxine therapy?
What is PPIs can reduce levothyroxine absorption
What is the most commonly used medication for treating hypothyroidism?
What is Levothyroxine
What is thyroglobulin?
What is a precursor of thyroid hormones: produced exclusively by the thyroid gland
What are 3 adverse effects of Panex Ginseng?
Nausea, diabetes, euphoria, insomnia, headaches, hypertension, hypotension, mastalgia, vaginal bleeding, blood pressure abnormalities
What are 2 diseases associated with goiter
Hashimoto thyroiditis or atrophic thyroid
Besides PPIs, list 3 drugs that can reduce levothyroxine absorption.
What are Calcium Salts, Ferrous Sulfate, and Bile Acid Sequestrants
Which of these conditions would allow for the best absorption of levothyroxine?
Before a meal? During a meal? After a meal?
What is before a meal
What is the radioactive iodine uptake test?
What is a thyroid function test that quantifies iodine absorption by the thyroid
Name 2 drugs that Panex Guinseng should not be used with.
What are contaminant use with phenelzine, warfarin, oral hypoglycemics, insulin, or caffeine
What is the woltman sign and disease associated with a positive woltman sign?
a delayed relaxation of the deep tendon reflexes, which is commonly seen in patients with hypothyroidism, but may also be associated with advanced age, pregnancy, and diabetes mellitus.
Why is T4 more commonly used than T3?
When T4 hormones come into contact with other cells in the bloodstream, they give up an iodine atom to interact with those cells. When T4 loses an iodine atom, it becomes T3.
When this T4 to T3 conversion occurs, T3 then conveys the metabolic "message" to the other cells throughout the body. The benefit of taking only T4 therapy is that you're allowing your body to perform some of the actions it is meant to do, which is taking T4 and changing it into T3. The half-life of T4 is also longer compared to T3 (7 days versus 24 hours), which means that it will stay for a longer time in your body after ingestion.
Name 2 types of supplements/medications that can interfere with levothyroxine absorption.
What are Iron supplements, calcium supplements, and antacids (take at least 4 hours apart from thyroid hormone replacement meds)
What are the steps for the radioactive iodine uptake test?
1-Radioactive iodine is administered orally
2-Several hours-Days later, a thyroid probe or gamma camera is used to determine the percentage of administered radioactive iodine taken up by the thyroid gland
What is the active ingredient in licorice that has mineral corticoid effects?
Contains glycyrrhetinic acid (a steroid) which has a weak mineralocorticoid effect and in large amounts
52 y/o female presents to the ED with weight gain, constipation and a positive woltman sign. What is her diagnosis?
Hypotension
Miriam is a 40 y/o female taking a medication for an episode of asthma exacerbation which is associated with immunosuppressive side effects and osteoporosis but there is concern this drug interferes with her levothyroxine dosage leading the physician to reduce her dosage. Which drug is Miriam taking ?
What are Glucocorticoids
Should soy intake be increased or decreased when taking levothyroxine? Why?
What is decreased because soy is rich in compounds known as isoflavones which can interfere with metabolism and effectiveness of levothyroxine
After radioactive thyroid ablation therapy, what time period are:
Radioactive iodine levels expected to decline?
Patients allowed to start returning to normal daily routine including work and exercise?
Time periods:
Immediately after, Day 1-7, Week 1-2, Week 2-4, Month 1, Months 3-6
Radioactive iodine levels expected to decline: Week 2-4
Patients allowed to start returning to normal daily routine including work and exercise: Month 1