thyroid – Flashcard Test Answers
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What is the list of approved uses of medications called?
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Formulary.
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what is the colloid made of
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Thyroglobulin
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What prevents the transport of iodides
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(1 family, 2 eg) Anions like thiocyanate and perchlorate
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High level of serum iodine results in: (explain)
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Decrease absorption of iodine, due to decrease transcription of NIS (iodine transporter)
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How is iodine added to thyroglobulin
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(1 enzyme that contain _____ and uses ________) Thyroid peroxidase is a heme-containing enzyme that uses peroxide (H2O2) to oxidize iodine
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T4 is called __________, T3 is called __________, which one is more active Which is more secreted
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T3: triiodothyronine is more active/potent, T4 is called thyroxine and is more secreted
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When thyroglobulin needs to be used, it is degrade by (what promotes this)
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Thiol endopeptidases, which is promoted by TSH
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What enzyme is used to recover the iodine from T3 and T4
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Deiodinases
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what enzymes transform T4 in the more active T3 in the peripheral tissue
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Deiodinases
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What are the carrier proteins of T4 and T3
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(3) Which ones bind T3
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What is familial dysalbuminemic hyperthyroxinemia
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(+ importance) Inherited disease where albumin has an increased affinity for T4, it has no importance as the thyroid can compensate by increasing T4 output
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what is important to know about drugs and T3/T4 binding to carriers
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Drugs can increase or decrease affinity (usually can be compensated by thyroid)
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Pituitary responds to free or total T3/T4 levels
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Free
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Iodine deficiency leads to what condition
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Simple non-toxic goiter (goiter due to high TSH)
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Where can one find/eat iodine
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(2) Fish and dairy
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What are two reasons why T3 is more potent than T4
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1.T3 does not bind as well to carrier so, there is more T3 free. 2.T3 does not only bind to surface receptors but also binds to nuclear receptors and can activate transcription
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What is the intracellular thing that T3 binds to
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Thyroid hormone response element
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Other than generic enzymes what genes are affected by T3
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(4) 1.GH, 2.TSH, 3.Myosin, 4.T3 receptor
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Thyroid hormone is involved with those parts of the body
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(7) 1.metabolic rate, 2.body temp, 3.CNS development, 4.cardiac output, 5.glucose metabolism, 6.growth of bones, 7.cholesterol
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What are the 4 causes of infants hypothyroid
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1.Maternal iodine deficiency, 2.Fetal hypopit, 3.Fetal thyroid dysgenesis, 4.Inborn error of thyroid synthesis (1: can be endemic, 3&4 are sporadic)
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Sx of infant hypothyroid
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(4) 1.dwarf, 2.hypothermia, 3.nerve deafness, 4.cretinism (low IQ)
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what are the lab findings in adult hypothyroid
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(2) High TSH, low T4
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what are the 5 causes of adult hypothyroid, which one are goitrous
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1.Hashimotos, 2.Primary failure, 3.Secondary failure (decrease TSH), 4.Tertiary failure (hypothalamus, decrease TSH), 5.degeneration/atrophy. 1&2 are goitrous
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What 2 things happen when a pregnant women has hypothyroid
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1.fetal distress, 2.impaired neuronal development
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What is the most severe Cx of hypothyroid
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(+2~3 Sx) Myxedema coma (hypothermia, unconscious, respiratory distress)
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What are the 3 tx of hypothyroid
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1.Levothyroxine sodium (=T4), 2.Liothyronine sodium (T3), 3.Liotrix (T3 and T4)
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When is liothyronine sodium used
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When you need something more quick acting – myexedema coma (only reason)
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What are the AE of thyroid hormone tx
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(2) 1.osteoporosis 2.cardia problems
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How does thyroid hormone lead to osteoporosis
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Only in post-menopausal women: thyroid hormone activates RANKL, which induces osteoclasts
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Who should be looked over more when txed with thyroid hormone
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Elderly and ppl with heart problems
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How can absorption of thyroid hormone be increased
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(why
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what is hyperthyroid called
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Thyrotoxicosis
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What are the usual lab findings in hyperthyroid
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High T4, low TSH
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what are the causes of hyperthyroid
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(3) 1.Autoimmune/Grave’s, 2.TSH secreting tumors, 3.Constitutive activation of TSH receptors
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what is the most common Sx of hyperthyroid
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1.excessive heat production
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what is the most common Sx of a thyroid storm
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Tachycardia (can lead to coma and then death)
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what are the tx of hyperthyroid
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(13) 1.Surgery, 2.I_131, 3.Propulthiouracil, 4.Methimazole, 5.Thiocyanate, 6.Nitrate, 7.Percholate, 8.PAS, 9.Sulfonamides, 10.Propanol, 11.Diltiazem, 12.Iodide, 13.Sodium Ipodate
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Once surgery is done to remove the thyroid, what else must done with the patient
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Lifelong hormone replacement
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What are the thioureylenes
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(2) What do they do
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Do thioureylenes work immediately
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No as the body can use the stored thyroglobulin
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What are the anions that could be used in hyperthyroid
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(3), why are they not used
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What are the aniline derivatives
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(2) what were they used for
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how does propanol help in hyperthyroid
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Decrease worst Sx (tachycardia)
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How does diltiazem help in hyperthyroid
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Prevent arrhythmias from tachycardia
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What drug should be used with great precaution with hyperthyroid patient
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(not used to tx) Epinephrine, can make the tachycardia worst
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How is Iodine used in tx of hyperthyroid
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For rapid relief, but only last a few days
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AE of iodine for hyperthyroid
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(1 + 1 Cx) GI (including mouth) irritation, that can lead to swelling of larynx and suffocation
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13.Sodium Ipodate is used for
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(+MOA) Rapid anti-hyperthyroid in case of thyroid storm, prevents conversion to T3
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Who gets nodular thyroid disease
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Women
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Malignant %
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10%
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How is nodular thyroid disease dx
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Fine needle aspiraiton
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Two kinds of nodular thyroid disease, which one is related to carcinoma
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Cold: does not uptake iodine (linked to carcinoma), Hot: takes up iodine
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nodular thyroid disease tx
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(2) 1.levothyroxine (decrease TSH), 2.surgery + I_131
