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Therapeutics - Thyroid/Parathyroid
Thyroid, Parathyroid
32
Pharmacology
4th Grade
10/13/2010

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Cards

Term
What is Graves disease?
Definition

Causes hyperthyroidism

autoimmune condition due to production of abnormal immunoglobulin- TRAB thyroid antibodies which bind to thyroid receptor (mimicking TSH)

Term
What is treatment of choice in mild goitre?
Definition
Thionamides: propylthiouracil, methimazole, carbimazole
Term
What is the mechanism of action of thionamides - propylthiouracil, methimazole, carbimazole?
Definition

Prevent thyroid synthesis by inhibiting the oxidation binding of iodide and its coupling to tyrosine

Decrease TRAB antibody levels

Term
Why is carbimazole preferred over other thionamides?
Definition

Cheaper and less toxic than propylthiouracil

Single dose improves adherance

 

Term
When is propylthiouracil preferred over carbimazole?
Definition

During pregnancy; carbimazole cause congenital skin defects (aplasia cutis)

Give smaller doses of PTU, <300mg

Term
What are most common adverse effects of thionamides?
Definition

Pruritic maculopapular skin rash

hepatitis

less common AE:

hypothromboinaemia

agranulocytosis

Term
What should be monitored while taking thionamides?
Definition

LFTs

skin reactions

 

Term
When is radioactive iodine (RAI) indicated to treat hyperthyroidism?
Definition

Post adolescent patients

Graves ophthalmopathy

History of thyroid surgery

Toxic nodular goitre

Old people with cardiac disease


Term
What is the most commonly used RAI
Definition
I-131
Term
What is the half life of I-131?
Definition
8 days
Term
What is pretreatment for RAI therapy?
Definition

Carbimazole for 1 month to deplete the gland of stored hormones.

OR

B-Blockers before and after RAI to prevent exacerbation of thyrotoxicosis

Term
How long should before carbimazole should be ceased before RAI therapy?
Definition
4 days
Term
How long before RAI therapy should Propylthouracil be ceased?
Definition
1 week
Term
After what time can the maximum benefits of RAI treatment be seen?
Definition
3-4 months
Term
What is given to patients 3-5 days before surgery to reduce thyroid vascularity?
Definition
KI tablets OR lugol's iodine
Term
When is thyroidectomy indicated?
Definition

large goitres

when RAI and thionamides are C/I

respiratory distress

swallowing difficulties

Term
How is amiodarone induced thyroxicosis treated?
Definition

high doses of glucocorticoids

prednisolone 20-25mg bd

Term
What are the causes of hypothyroidism?
Definition

congenital

autoimmune (Hashimoto's)

drug induced/post operative

iodine deficiency

viral infection

Secondary: hypopituitarism/hypothalmic disease

 

Term
How is primary hypothyroidism diagnosed?
Definition

clinical assessment with thyroid hormones and TSH levels

low free T4 and T3, high TSH

Term
How is secondary/tertiary hypothyroidism diagnosed?
Definition

clinical assessment with thyroid hormones and TSH levels

low free T4, low TSH

Term
What are the symptoms of hypothyroidism?
Definition

Dry, flaky skin; yellow complexion

Dry, thinning hair

Puffy face and eyes

Slow speach/poor memory/depression

deepening, gruffness in voice

Increased serum LDL, macrocytic anaemia

Weight gain, decreased appetite

Bradycardia, cardiac enlargement

Term
How is hypothyroidism treated?
Definition

thyroxine (T4)

 

Term
What are adverse effects of thyroxine long term treatment?
Definition

osteoporosis

atrial fibrillation

Term
What is Myxoedema Coma?
Definition

Severe, untreated hypothyroidism

Loss of conciousness and hypothermia

Requires hospitalisation

Term
How is Myxoedema Coma treated?
Definition

Initial treatment with liothyronine (isomer of T3) 25mcg IV infusion

With or without loading dose of thyroxine 0.5-1mg oral

Also, fluid/electrolytes and glucocorticoid admin. maintained

Term
What does the hyperparathyroidism cause?
Definition
increase PTH -> bone mass loss -> hypercalcaemia
Term
What are possible primary causes of hyperparathyroidism?
Definition

adenomas

neoplasms

Term
What are possible secondary causes of hyperparathyroidism?
Definition

hypocalcaemia

hyperphosphataemia

chronic renal failure

metabolic disorders causing decreased Vit d

Term
What are the pentad of symptoms associated with hyperparathyroidism?
Definition

Painful bones - arthralgias

Abdominal groans - N/V, anorexia

Psychic moans - OCD, depression

fatigue overtones

Kidney stones

 

Term
What is the treatment for symptomatic primary hyperparathyroidism
Definition
parathyroidectomy
Term
What are the symptoms of hypoparathyroidism?
Definition

Musculoskeletal: twitching, tingling, hyperreflexia

Extrapyramidal symptoms

Paranoia

Arrhythmias, increased QT interval

Dry scaly skin

Term
What is the treatment for hypoparathyroidism
Definition

Daily intake of 1000-2000mg of Ca2+

Vitamin D

Maybe phosphate binder

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