17 Questions
Why is the patient's total T4 level elevated, despite being well-maintained on methimazole?
Increased thyroid binding globulin synthesis during pregnancy
What is the treatment of choice for hyperthyroidism in pregnancy, and why?
Thionamide medications, because both radioiodine and surgery should be avoided
Why should methimazole be avoided during the first trimester of pregnancy?
It is a potential teratogen, causing scalp defects, tracheoesophageal fistula, and choanal atresia
What medication is recommended for hyperthyroidism during the first trimester of pregnancy?
Propylthiouracil
Why are patients often switched back to methimazole during the second and third trimesters of pregnancy?
Because propylthiouracil carries a risk of liver failure
What is the primary cause of cardiovascular complications in long-term survivors of Hodgkin lymphoma?
Chemotherapy and/or radiation therapy
What is the effect of radiation therapy on the intimal layer of coronary vessels?
Injury, leading to arterial narrowing typically involving the ostial parts of coronary vessels
What type of cardiomyopathy can result from radiation-induced cardiotoxicity?
Restrictive cardiomyopathy with diastolic dysfunction
What is the effect of anthracycline class of drugs on the heart?
Dose-dependent decline in the ejection fraction, leading to dilated cardiomyopathy
What is a common consequence of radiation-induced cardiotoxicity in the valves?
Valvular abnormalities (mitral or aortic stenosis/regurgitation)
What type of conduction defect can result from radiation-induced cardiotoxicity?
Conduction defects (sick sinus syndrome or variable degrees of heart block)
What is the primary mechanism of radiation therapy-induced cardiovascular complications in long-term survivors of Hodgkin lymphoma?
Diffuse fibrosis in the interstitium of the myocardium, progressive fibrosis of the pericardial layers, injury to the conduction system, and valve damage.
What is the typical site of arterial narrowing in radiation-induced cardiovascular disease?
The ostial parts of coronary vessels.
What is the effect of the anthracycline class of drugs on cardiac function?
A dose-dependent decline in the ejection fraction, leading to dilated cardiomyopathy.
What is a common consequence of restrictive cardiomyopathy in radiation-induced cardiotoxicity?
Diastolic dysfunction.
What is the name of the conduction defect that can result from radiation-induced cardiotoxicity?
Sick sinus syndrome or variable degrees of heart block.
What is the common underlying cause of cardiovascular complications in patients who have received radiation therapy?
Radiation-induced fibrosis and tissue damage.
A patient with hyperthyroidism is being treated with methimazole during pregnancy. How should her treatment be managed? Learn about the effects of methimazole on the fetus and the recommended treatment options for hyperthyroidism during pregnancy.
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