Too much of a good thing
What drugs are in the thionamides class for treatment of hyperthyroidism?
What is propylthiouracil (PTU) and methimazole (Tapazole)?
Another way to lower circulating thyroid hormone levels is administration of high doses of ____________. This drug binds to thyroid hormone in the gastrointestinal tract inhibiting their enterohepatic circulation.
What is cholestyramine?
The risk for hepatotoxicity is higher with this thionamide?
What is propylthiouracil?
Which therapy options for hyperthyroidism can result in permanent hypothyroidism?
What is radioactive iodine and surgery?
Which agents are recommended for symptom control for thyrotoxicosis associated with thyroiditis?
What is propranolol 80-160mg/d and nadolol 80-160mg/d?
titrate to HR <90 bpm
A 28 yo AAF has been recently diagnosed with Graves' disease. She is 8 weeks pregnant and needs to start therapy today. Which antithyroid medication do you initiate?
What is propylthiouracil?
In thyroid storm, inorganic iodine preparations should be given after what drugs?
PTU or methimazole (2-3 hours after successful inhibition of thyroid hormone synthesis)
______ are used with radioactive iodine in thyroid storm to blunt and delay rise in antibodies to the TSH receptor, thyroglobin, and thyroid perioxidase while reducing T4 and T3 concentrations?
What is corticosteroid (dexamethasone, hydrocortisone)?
1 grain of desiccated thyroid is equivalent to _____ mcg of levothyroxine (T4)?
What is 100 mcg?
Metallic taste, burning mouth/throat, sore throat/gums, gastrointestinal upset/diarrhea are associated with this therapy used to acutely inhibit thyroid hormone release and quickly achieve euthyroid state?
What is Lugol's solution or SSKI (potassium iodide saturated solution)?
Patients treated with methimazole take _____ weeks to become euthyroid compared to treatment with propylthiouracil which takes ______ weeks
What is 3-8 weeks, 3-4 weeks?
This effect has been used as a treatment principle for treatment of thyroid storm, by infusing large amounts of iodine to suppress the thyroid gland.
What is the Wolff-Chaikoff effect?
This anticonvulsant (also used for bipolar) can decrease levels of levothyroxine and higher doses may be needed at initiation.
What is carbamazepine?
This drug is a synthetic T4:T3 in 4:1 ratio.
What is Liotrix (Thyrolar, Euthyroid)?
These are patient counseling points for which agent of choice for Graves' disease?
Sit while urinating, flush toilet x2 with lid down. For 5 days avoid long trips & public transportation, For 7 days minimize close contacts with other people, keep dishes & clothes separate (wash immediately), For 10 days: avoid pregnant women. Do not breast-feed or become pregnant for 6 months.
What is radioactive iodide (RAI 131)?
Hyperthyroidism can ______ warfarin levels thereby _______ INR.
What is increase, increasing?
Patients allergic to iodine can use _______ 300mg q6h as an alternative since it impairs thyroid hormone release.
What is lithium?
_________ _______ is the most important modifiable risk factor in a patient with thyroid eye disease (Graves' orbitopathy).
What is smoking cessation?
Hypothyroidism can ______ warfarin levels thereby _______ INR.
What is decrease, decreasing?
Total body stores of iodine remain increased for up to ____ months after discontinuation of amiodarone.
What is 9 months?
Patient treated on methimazole 5mg BID has labs that returned back with free T4 levels at 2.5ng/dL (0.76-1.46). How would you adjust the methimazole dose?
What is increase dose up to 20 mg/d?
A 40 yo male patient presented to the ED w/a temp of 102.2F and perfuse sweating. He complained of a "racing heart" (HR 124 bpm) and was having nausea with 3 episodes of vomiting in the past 24 hours. The patient's wife stated that he has "not been himself- he's been moody and irritable." While in the ED it was discovered that the patient was in atrial fibrillation. The patient's wife also stated he was previously taking methimazole 10mg daily, however he ran out of refills and had not taken medication in 3 weeks. A TSH was drawn and returned <0.1 mIU/L.
Recommend a treatment regimen for this patient (hint there are FOUR agents):
What is
propranolol
propylthiouracil* (or methimazole)
iodine (SSKI)
hydrocortisone (or dexamethasone)
*may be given IV
A 43-year-old woman has received a diagnosis of Graves disease. She is reluctant to try ablative therapy and wants to try oral pharmacotherapy first. She is anxious and always feels warm when others say it is too cold. What would be considered the best drug for initial treatment of her condition?
TSH: 0.22 mIU/L (0.5-4.5mIU/L)
Free T4: 3.2 ng/dL (0.8-1.9 ng/dL)
Methimazole
This drug (which treats tuberculosis by blocking RNA transcription) can cause increased conjugation and biliary excretion of thyroid hormone resulting in hypothyroidism.
What is rifampin?
Amiodarone metabolism in the liver releases approximately ____ mg of inorganic iodine into the systemic circulation per 100mg amiodarone ingested.
What is 3 mg?