Hyperthyroidism

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Adverse events of thioamides

CNS - fever, HA, paresthesias General - Rash, arthralgia, urticari GI - jaundice, hepatitis Hematologic - agranulocytosis, leukopenia, bleeding

List the different type of hyperthyroidism

1. Graves' disease (most common) 2. Toxic multinodular goiter (MNG), toxic adenoma, and exogenous thyroid hormone ingestion

Three primary ways of treating hyperthyroidism.

1. Surgery 2. Radioactive iodine (RAI) (tx of choice in most common forms!) 3. Antithyroid (thioamide) drugs

Patient instructions for iodides

1. dilute w/water or fruit juice to improve taste 2. Notify MD if fever, skin rash, metallic taste, throat swelling, or burning of the mouth occur

What comprises Lugol's solution?

5% iodine and 10% potassium iodide. Delivers 6.3 mg iodine per drop

Define thyroid storm

A life-threatening sudden exacerbation of hyperthyroidism. Sx: fever, tachycardia, delirium, and coma

Definition of hyperthyroidism

AKA thyrotoxicosis. Clinical syndrome where the tissues are exposed to high levels of thyroid hormone. More common in women (3 in 1,000 women occurrence)

Drugs that may cause hyperthyroidism.

Amiodarone Iodine

Graves' dx pathophys

Autoimmune disease in which thyroid-STIMULATING antibodies are produced. They mimic TSH on thyroid tissue.

Identify adjunctive tx for hyperthyroidism

Beta blockers CCbs (control tachycardia)

Iodide mechanism of action

Blocks hormone release and inhibits thyroid hormone synthesis

How is hyperthyroidism diagnosed?

Elevated T3/T4 in the presence of decreased TSH.

Brand SSKI

Generic Saturated solution of potassium iodide (1 g/mL - delivers 38 mg iodine / drop)

Brand Tapazole

Generic methimazole

Brand PTU

Generic propylthiouracil (given in 8 hour intervals)

Brand Lugol's solution

Generic strong iodine solution

Signs and symptoms of hyperthyroidism.

Heat intolerance Weight loss Weakness Palpitations Anxiety Tremor Tachycardia Moist, warm skin Weakness Eyelid lag

When a pt taking thioamides should speak to their MD.

If they have fever, sore throat, unusual bleeding, rash, ab pain, or yellowing of skin.

Monitoring of thioamides

Improvement of hyperthyroidism Perform thyroid function tests - s/sx of agranulocytosis

Thioamide drug interactions

Increases warfarin's effect

Iodide drug interaction

Lithium potentiates the antithyroid effect of iodides

List the iodides

Lugol's solution SSKI

Monitoring of iodides

Monitor for adverse events and improvement in s/sx of hyperthyroidism.

Thioamide MoA

PTU and methimazole inhibit thyroid hormone synth by preventing the incorporation of iodine into iodotyrosines & by inhibiting the coupling of monoiodotyrosine and diiodotyrosine to form T4 and T3. PTU also inhibits conversion of T4 to T3 peripherally.

List the thioamide medications

Propylthiouraci Methimazole (They have no permanent effect on the thyroid)

Which medication is preferred in hyperthyroidism in pregnancy?

Propylthiouracil (RAI contraindicated)

Adverse reaction of iodides

Rash, salivary gland swelling, metallic taste, burning of the mouth, GI distress, hypersensitivity, goiter

Toxic adenomas and MNGs pathophys

These are masses of thyroid tissue that secrete thyroid hormones independent of pituitary control.

Iodides place in therapy

Used when rapid reduction in thyroid hormone secretion desired (in thyroid storm), or to decrease glandular vascularity prior to thyroidectomy

RAI stands for

radioactive iodine


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