Term
| Define Subclinical hypothyroidism |
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Definition
| Elevated TSH, with normal thyroid levels |
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Term
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Definition
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Term
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Definition
Hashimoto's thyroiditis
Iatrogenic
congenital
Iodine deficiency
Pituitary disorder (secondary hypothyroidism) - TSH low or normal
Hypothalmic (tertiary hypothyroidism - TSH low or normal)
Resistance to thyroid hormone |
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Term
Levothyroxine (T4)
How often should dose adjustments be made?
What is goal of dose adjustments? |
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Definition
Levothyroxine
How often should dose adjustments be made: every 4-6 weeks
What is goal of dose adjustments: Normalize TSH levels |
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Term
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Definition
Liothyronine (T3)
Use - Short term management of patients with thyroid cancer undergoing withdrawal of T4 |
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Term
What is hypothyroidism associated with in pregnancy?
What does lack of TSH suppression in first trimester indicate in hypothyroid woman? |
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Definition
Associated with miscarriage and lower intelligence scores in children of women who had elevated TSH at time of conception.
Lack of TSH suppression in first trimester indicates under treatment with levothyroxine |
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Term
If a woman known to be hypothyroid is taking thyroid replacement therapy, what should she do following a positive pregnancy test?
How often should pregnant women check TSH levels? |
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Definition
Should take two extra tablets per week immediately
Should check TSH level every 8 weeks or 6 weeks after dose adjustment |
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Term
| When do Thyroid levels return to normal in pregnant women? |
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Definition
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Term
| Is thyroid hormone therapy safe in pregnancy and lactation? |
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Definition
| YES safe, and essential to fetal development |
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Term
| What supplement usually given in pregnancy can reduce absorption of levothyroxine? |
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Definition
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Term
| How is Myexedema coma treated? |
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Definition
| Levothyroxine bolus initially, then daily + hydrocortisone + corticosteroids. |
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Term
Define Subclinical Hyperthyroidism
What can it be a risk factor for? |
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Definition
low TSH, normal T4 and T3
Can be a risk factor for A.Fib |
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Term
| Refer to table 2 pg 368 for causes of hyperthyroidism |
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Definition
| Refer to table 2 pg 368 for causes of hyperthyroidism |
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Term
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Definition
| depression, treatment with corticosteroids, some centrally acting meds. |
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Term
When to use radioactive iodine?
When is it contraindicated? |
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Definition
For ablation of thyroid tissue in patient's with Grave's disease, toxic nodules, and goiter
Contraindicated in pregnancy |
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Term
Methimazole (MMI) and Propylthiouracil
What do they do ?
When must they be stopped?
What affect can PTU have?
Some side effects of these agents? |
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Definition
Methimazole (MMI) and Propylthiouracil
What do they do - decrease production of thyroid hormones. PTU also blocks conversion of T4 to T3.
When must they be stopped - 5 days before thyroid scan, RAIU, or treatment with radioactive Iodine.
What affect can PTU have - Make the thyroid resistant to radioactive iodine
Some side effects of these agents - allergy, rash, agranulocytosis, hepatotoxicity and nephrotoxicity |
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Term
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Definition
Hyperthyroidism causes tachycardia and other adrenergic effects.
Nonselective agents such as propranolol can decrease conversion of T4 to T3 |
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Term
Lugol's solution (Iodine)
What does it do?
When is it used? |
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Definition
Lugol's solution (Iodine)
What does it do - blocks production of thyroid hormone
When is it used - Severe hyperthyroidism |
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Term
| When are corticosteroids used in hyperthyroidism? |
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Definition
| Significant opthalmopathy, thyroid storm, or adjuvant in treatment resistant cases |
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Term
| Management of thyroid storm |
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Definition
| Corticosteroids, antithyroid meds, BBs |
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Term
| Most likely hyperthyroidism scenario encountered in pregnancy? |
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Definition
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Term
| Goal free thyroxine and T3 levels in pregnancy? |
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Definition
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Term
| How long should women receiving radioactive iodine wait before conceiving? |
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Definition
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Term
| Which is preferred during pregnancy? MMI or PTU? |
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Definition
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Term
| When should PTU be avoided? |
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Definition
| In kids due to concerns about hepatotoxicity |
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Term
| Radioactive iodine therapy and breastfeeding |
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Definition
| SHOULD BE STOPPED until breastfeeding it stopped |
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Term
| Antithyroid medication side effects and monitoring |
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Definition
| Hepatotoxicity and neutropenia, watch ALT and CBC |
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Term
| What can be used to suppress thyroid in patients with goitre? |
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Definition
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Term
What can be used to treat a multinodular goitre or a hot nodule with associated risk of hypothyroidism?
What can be used to prevent further growth of a benign nodule? What would be the goal TSH in this situation? |
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Definition
What can be used to treat a multinodular goitre or a hot nodule with associated risk of hypothyroidism - Radioactive iodine
What can be used to prevent further growth of a benign nodule? What would be the goal TSH in this situation?
levothyroxine to prevent further growth, TSH goal < 1mU/L but > LLN |
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