Hyperthyroidism
In terms of lab values, which ones are high and low?
TSH = Low
T3 & T4 = High
What is the first line drug for Hypothyroidism?
Levothyroxine
What class of drug is preferred in Gestational Hyperthyroidism?
Thionamides
Explain how the HPT axis functions
T/F: Levothyroxine is best taken with a full meal.
FALSE, taken on empty stomach
What class of drugs are class of drugs is primarily used for Hyperthyroidism, what is the name of those drugs and which one is the preferred drug of choice for Hyperthyroidism?
Thionamides
Methimazole (preferred)
Propylthiouracil
In terms of lab values, what values are high and low?
TSH = High
T3 & T4 = Low
What is the preferred medication for the 1st trimester and the 2nd/3rd trimester in gestational Hyperthyroidism?
- Propylthiouracil is preferred in 1st trimester
- Propylthiouracil is preferred in 2nd/3rd if it was used during the 1st. If it was not used in the 1st then Methimazole is preferred in 2nd/3rd trimester
What 2 drugs are utilized for the management of Thyroid Storm?
- Propylthiouracil
- Propranolol
What is the starting dose of Levothyroxine for older adults with cardiovascular disease?
12.5-25mcg/day
What disease is the most common cause Hyperthyroidism?
Graves disease
What is the clinical presentation of Hypothyroidism?
Everything slows down (constipation, lethargy, fatigue, weakness, low BP/HR, etc.)
What is the drug of choice for Pediatric patients 5 years old or older?
Methimazole
What is it called when the thyroid is removed?
Bonus 50pt:
What are the two different types of it?
- Thyroidectomy
(subtotal thyroidectomy/ total thyroidectomy)
What 3 drug classes decrease the absorption of Levothyroxine?
Bonus 50pt:
Name the specific drugs that belong to the classes
- PPI/H2RA (omeprazole, pantoprazole, famotidine)
- Antacids (calcium salts)
What is the Clinical presentation of Hyperthyroidism?
- Everything speeds up (increased BP/HR/appetite/diarrhea/etc)
- Goiter
- exophthalmos
What disease is the most common cause of "spontaneous" Hypothyroidism?
Hashimotos Disease
What is the preferred treatment for Pediatric patients less than 5 years old?
Bonus 100pt:
What should be avoided in pediatric patients less than 5 years old?
- Thyroidectomy preferred
- Avoid the use of radioactive iodine
What are the 2 treatment plans for Graves disease?
- Radioactive Iodine (first option)
- Surgery (second option)
What drug interferes with lab assays when testing for Hyperthyroidism?
Bonus 50pt:
When should the drug be stopped so it does not mess with the lab assay?
- Biotin
- Biotin should be stopped 2 days before assay
What are the 6 clinical presentations of Thyrotoxicosis?
Bonus 100pt:
explain what each clinical presentation is.
- Exophthalmos
- Goiter
- Lid Lag
- Clubbed Fingers
- Onycholysis
- Pretibial Myxedema
What are the 3 primary causes of Hypothyroidism?
Bonus 100pt:
What are the 2 secondary causes of Hypothyroidism?
Primary:
- iodine deficiency
- iatrogenic hypothyroidism
- hashimotos disease
Secondary:
- disorder of the pituitary gland
- Hypothalamic Hypothyroidism
What is the drug of choice for Hypothyroidism in pregnant patients?
Bonus 150pt:
Describe the dosing changes associated with the drug of choice for hypothyroidism in pregnant patients.
Levothyroxine
- there should be a 20-30% dose increase at the start of pregnancy, then the dose should be reverted back to what they were taking before pregnancy 6-8 weeks after giving birth
What is the primary Adjunctive therapy used with Thionamides?
Propranolol for symptom management
What 4 medications/medication types can cause hypothyroidism?
- Tyrosine Kinase Inhibitors
- Amiodarone
- Interferon Alpha
- Lithium