Thyroid Diseases (Management)

Chuchi Oka-Zeh
Mind Map by Chuchi Oka-Zeh, updated more than 1 year ago
Chuchi Oka-Zeh
Created by Chuchi Oka-Zeh over 2 years ago
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Description

Focus on the medications and treatments in managing thyroid based disorders.

Resource summary

Thyroid Diseases (Management)
1 Hyperthyroidism
1.1 High Labs(total T4, free T4, Total T3); LOW lab(TSH)
1.2 Symptoms/Presentation

Annotations:

  • Heat intolerance Tremor Nervousness Goiter Weakness/ Insomnia Frequent bowel movement; diarrhea
1.2.1 Increased Radioactive Iodine Units(RAIU)

Annotations:

  • TSH related Reistance to Pitutiary TH secretion
1.2.1.1 TSH related

Annotations:

  • TSH causes the overprod of T3, T4
1.2.1.2 non TSH related

Annotations:

  • Meds Pituitary resists Thyroid hormone Various thyroid cancers Goiter(due to "fooled gland" thinking that there is  too little T3/T4; there is more than enough).
1.2.1.2.1 Graves Disease

Annotations:

  • This is an autoimmune disease and a common cause of increased RAIU--hyperthyroidism!
1.2.1.2.1.1 Thyroid Storm

Annotations:

  •    —high fever (often >103°F), tachycardia, tachypnea, dehydration, delirium, coma, nausea, vomiting, and diarrhea    
1.2.2 Decreased Radioactive Iodine Units

Annotations:

  • Cancer Inflammatory thyroid Too much outside thyroid intake Meds Food
1.2.2.1 Inflammatory/related to inflammation
1.2.2.2 Cancers
1.2.2.3 Food and medications
1.2.2.3.1 Amiodarone

Annotations:

  • Iodine makes up 37% of the weight. Can cause Type I or Type II  thyroid disease!
1.2.2.3.1.1 Type I

Annotations:

  • This is known as thyrotoxicosis:hyperthyroidism!
1.2.2.3.1.1.1 De-iodinization is lowered-->more t4 and t3 remaining

Annotations:

  • See MedScape Article; but  Amiodarone blocks T4 and T3 from entering the cell and ALSO stops conversion of T4 to T3 in the peripheral/other organ tissues
1.2.2.3.1.1.2 (THYROID DISEASE)
1.2.2.3.1.2 Type II
1.2.2.3.1.2.1 (NO THYROID DISEASE)
1.3 Treatments
1.3.1 SURGERY
1.3.1.1 Meds used pre-surgery

Annotations:

  • For 6 to 8 weeks Iodine is used for 1 to 2 weeks
1.3.2 Radioactive Iodine(I-131)
1.3.2.1 1st Line Conditions

Annotations:

  • Graves' disease Nodules Goiters
1.3.2.2 Contraindications

Annotations:

  • Pregnancy and nursing mothers.
1.3.2.3 Adverse Effects
1.3.2.3.1 related to disease Risk Increasing

Annotations:

  • Thyroid Cancer Cardiovascular Disease Death (Got it? Yes, but sad nevertheless!!)
1.3.2.3.2 related to thyroid

Annotations:

  • radiation thyroiditis  hypothyroidism
1.3.3 Antithyroid Medications
1.3.3.1 Thioamides
1.3.3.1.1 Propylthiouracil(PTU)
1.3.3.1.1.1 Preferred Scenarios

Annotations:

  • Phrase that helps you remember when this should be used  Peter ran a LaP in Th(ialand) La-Lactation P-Pregnancy Th-Thyroid Storm
1.3.3.1.2 Methimazole
1.3.3.1.2.1 Advantages over PTU

Annotations:

  • Less liver issues and works faster.  Top recommended thioamide (The article on Thyroid function testing also made reference to use in patient...saw Real world application )
1.3.3.1.3 Benefits
1.3.3.1.4 Disadvantages
1.3.3.1.4.1 Side Effects
1.3.3.1.4.1.1 SEVERE
1.3.3.1.4.1.1.1 Agranulocytosis
1.3.3.1.4.1.1.2 Hepatitis
1.3.3.1.4.1.2 BENIGN
1.3.3.1.4.1.2.1 Joint Pain
1.3.3.1.4.1.2.2 Fever and Rash
1.3.3.1.4.1.2.3 leukopenia
1.3.3.1.5 USED for 1 (12 months)to 2 YEARS(24 months)
1.3.3.2 Iodides
1.3.3.2.1 Conditions /Indications of Use
1.3.3.2.1.1 Thyroid Storm
1.3.3.2.1.2 Severe Thyroidtoxicosis
1.3.3.2.1.3 Surgery
1.3.3.2.2 Contraindications
1.3.3.2.2.1 Pregnancy
1.3.3.2.2.2 Before use of Radioactive Iodine(RAI)
1.3.3.2.2.3 Nodular Goiters and Adenomas
1.3.4 Beta Blockers

Annotations:

  • Should be used until the more specific anti-thyroid medication effect takes place  The  peripheral T4 to T3 conversion (propranolol, nadolol)   is inhibited.
1.3.4.1 Reasons to Use

Annotations:

  • AKA indications and Uses/Conditions
1.3.4.1.1 management of symptoms
1.3.4.1.2 Works within hours
1.3.4.2 Reasons not to use

Annotations:

  • Also known as contraindications and precautions
1.3.4.2.1 Bronchospasm (severe)
1.3.4.2.2 Heart issues

Annotations:

  • 2nd or 3rd degree heart block Decompensated heart failure
1.3.4.2.3 Alternatives

Annotations:

  • CCBs, beta 2 antagonists and other sympatholytics CAN be used.
2 hypothyroidism
2.1 Treatments
2.1.1 Levothyroxine

Annotations:

  • Synthetic T4(AKA thyroxine)! Multiple brands are available  but these may not be therapeutic equivalent to each other.
2.1.1.1 Drug Interactions
2.1.1.1.1 Decrease T4 absorption

Annotations:

  •    ¡Cholestyramine- Brand Name (Questran) and associated products   ¡Calcium- Brand Names(Phoslo, Eliphos, Phoslyra, and Calphron)   ¡Ferrous sulfate ¡Aluminum hydroxide  ¡Sucralfate- Carafate, Orafate, and ProThelial  
2.1.1.1.2 Increase T4 metabolism

Annotations:

  •    ¡Rifampin- Rifadin  ¡Phenytoin- Dilantin, Phenytek and others ¡Phenobarbital- Lumina  ¡Sertraline-Zoloft
2.1.1.1.3 Pharmacodynamic effects
2.1.1.1.3.1 Warfarin

Annotations:

  • Elevated INR and bleeding risk
2.1.1.1.3.2 Digoxin

Annotations:

  • More digoxin may be needed if using levothyroxine
2.1.1.2 Side Effects
2.1.2 Liothyronine (Cytomel)

Annotations:

  • Not first line Synthetic T3/TriiodothyronineAdvantageous against myxedema coma
2.1.3 Armour Thyroid

Annotations:

  • Think "it varies": -Ratio of hormones varies -The products vary in potency among the brands
2.1.3.1 High allergy potential
2.1.4 Liotrix(Thyrolar)

Annotations:

  • Combination of  Synthetic T4 AND T3 It is predictable and stable NOT dispensed often though
  • Adverse reactions: Rare but clinical pharmacology does note itching, hypersensitivity and a skin rash
2.2 TSH, T4, T3 levels

Annotations:

  • TSH is high T4 and T3 are low. Note Radioactive Iodide Uptake is not used in diagnosis.
2.3 Causes
2.3.1 Primary
2.3.2 Secondary
3 Normal Physiology
3.1 TRH-->TSH-->T4 AND or T3 levels
3.1.1 high T34 or t4--> negative feedback
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