60 Questions
What is the mechanism of action of radioactive iodine in thyroid treatment?
It becomes concentrated in the thyroid gland and destroys thyroid cells, leading to hypothyroidism
How are patients treated for signs of thyroid storm after radioactive iodine treatment?
Treated with beta-blockers
When is thyroid hormone replacement started after stopping antithyroid medications?
4 to 18 weeks after stopping antithyroid medications
What is the principal test for monitoring thyroid function after radioactive iodine treatment?
Free T4
How do antithyroid medications work in the treatment of thyroid disorders?
By inhibiting stages in thyroid hormone synthesis
Why is propylthiouracil recommended during the first trimester of pregnancy?
Due to teratogenic effects of methimazole
What happens if antithyroid medications are discontinued before therapy is complete?
Relapse within 6 months
What are the two forms of pharmacotherapy available for treating hyperthyroidism?
Radioactive iodine and antithyroid medications
Why is radioactive iodine therapy contraindicated during pregnancy?
It crosses the placenta
What precaution should women of childbearing age take before administration of radioactive iodine?
Undergo a pregnancy test
How long should women avoid conceiving following radioactive iodine treatment?
At least 6 months
What is the goal of radioactive iodine therapy (131I)?
To eliminate the hyperthyroid state with the administration of sufficient radiation in a single dose
What conditions can radioactive iodine be used to treat?
Toxic adenomas, toxic multinodular goiter, and most varieties of thyrotoxicosis
Why is breast-feeding prior to radioactive iodine treatment contraindicated?
Due to potential radiation exposure to the infant
What is the usual dosage for propylthiouracil?
200 mg every 6 hours
How does propylthiouracil affect thyroid hormone production?
It inhibits thyroid hormone production
What is the only contraindication to propylthiouracil?
Known hypersensitivity reaction to the medication
What has the FDA issued a BLACK BOX WARNING for regarding propylthiouracil?
Risk of severe liver injury and acute liver failure
How should patients take propylthiouracil?
Around the clock in evenly divided doses
What is a reported adverse effect of propylthiouracil?
Signs of hypothyroidism
With whom is close monitoring necessary when using propylthiouracil?
Older adults and patients with hepatic impairment
How long may it take for therapeutic effects of propylthiouracil to become apparent?
1 to 2 weeks
Which of the following is NOT a side effect that should be monitored when taking propylthiouracil?
Muscle strength
What should patients be educated about when taking propylthiouracil?
The signs and symptoms of acute liver failure
Which medication is recommended for all patients with symptomatic hyperthyroidism?
Propranolol
What is the main action of propranolol in the treatment of hyperthyroidism?
It blocks beta-adrenergic receptors.
Why should methimazole be used cautiously by women of childbearing age?
It increases the risk of fetal abnormalities.
What is a disadvantage of using radioactive iodine therapy for hyperthyroidism?
Risk of developing hypothyroidism
When should propranolol be tapered and discontinued in the treatment of hyperthyroidism?
Once the patient becomes euthyroid
Which of the following is used for short-term treatment of hyperthyroidism to inhibit the release of thyroid hormones?
Strong iodine solution
Which of the following is a common cause of hypothyroidism?
Autoimmune disease
What is a common symptom of hypothyroidism?
Fatigue
What happens when thyroid hormone levels are too low?
Body's processes start slowing down
Which of the following is a symptom of hypothyroidism?
Dry skin
What can happen to menstrual periods in women with hypothyroidism?
They can become heavy or irregular
What is a potential effect of hypothyroidism on hair?
Thinning hair
What is a possible effect of hypothyroidism on body weight?
Weight gain
What is a symptom commonly associated with hypothyroidism?
Depression
What can happen to the heart rate in hypothyroidism?
Slowed heart rate
What is a potential effect of hypothyroidism on the face?
Puffy face
What is the primary goal of managing Graves’ disease?
Minimize extrathyroidal manifestations such as ophthalmopathy
How is thyrotoxicosis typically diagnosed?
High serum level of thyroxine (T4) and triiodothyronine (T3) and a low serum level of TSH
What is a potential consequence of thyroiditis?
Permanent hypothyroidism
What is the most widely used treatment for hyperthyroidism in the United States?
Radioactive iodine therapy
What is a significant risk associated with surgical removal of the thyroid for treating hyperthyroidism?
Risks and expense associated with thyroid surgery
Which medication is used alone to treat hyperthyroidism, as part of the preoperative preparation for thyroidectomy, and in the treatment of thyroid storm?
Propylthiouracil (PTU)
What has the FDA issued a BLACK BOX WARNING for regarding propylthiouracil?
Severe liver injury resulting in death or acute liver failure
What is the principal test for monitoring thyroid function after radioactive iodine treatment?
Thyroid stimulating hormone (TSH) levels
When is propylthiouracil contraindicated?
In the first trimester of pregnancy
What is the traditional treatment for the common forms of hyperthyroidism?
Antithyroid drugs, radioactive iodine, and surgery
What is the main treatment for hypothyroidism?
Administration of synthetic thyroxine pills
Which condition can lead to hypothyroidism?
Viral thyroiditis
What is the lifelong replacement therapy for hypothyroidism?
Levothyroxine therapy
What are the symptoms of hyperthyroidism?
Heat intolerance, palpitations, anxiety
What is the purpose of levothyroxine therapy?
To replace the hormone the thyroid can no longer make
What is the risk associated with opioid analgesics and sedating drugs for people with hypothyroidism?
Respiratory depression and myxedema coma
What is the goal of levothyroxine therapy?
To maintain TSH levels within a narrow range
What is the preferred method for diagnosing hyperthyroidism?
Blood tests measuring thyroid hormone and TSH levels
What is the recommended way to take levothyroxine?
On an empty stomach
What is the risk associated with radioactive iodine treatment for hyperthyroidism?
Development of hypothyroidism
Study Notes
Treating Hyperthyroidism with Propylthiouracil
- Therapeutic effects of propylthiouracil may take 1 to 2 weeks to become apparent, but achieving a euthyroid state could take 6 to 8 weeks.
- Adverse effects should be monitored, including heart rate, peripheral pulses, lung sounds, heart sounds, speech, emotional status, rest periods, weight, constipation, skin changes, CNS depression, gastric irritation, fever, sore throat, and white blood count for leukopenia.
- Patients should be educated about the signs and symptoms of acute liver failure and seek immediate medical treatment if these symptoms occur.
- Patient teaching guidelines for propylthiouracil include periodic tests of thyroid and liver function, avoiding seafood or iodized salt, taking the drug at regular intervals, reporting adverse effects, consulting a healthcare provider before taking over-the-counter drugs, monitoring pulse and weight, and seeking medical attention for rash symptoms.
- Methimazole is similar to propylthiouracil and should be used cautiously by women of childbearing age due to the risk of fetal abnormalities during the first trimester.
- Strong iodine solution and saturated solution of potassium iodide are short-term treatments for hyperthyroidism, used to inhibit the release of thyroid hormones.
- Sodium iodide 131I is a radioactive isotope used for diagnostic tests of thyroid function and therapeutic treatment of hyperthyroidism and thyroid cancer.
- Disadvantages of using radioactive iodine therapy include the development of hypothyroidism and delayed therapeutic benefits.
- Propranolol is recommended for all patients with symptomatic hyperthyroidism, particularly in older adults with resting heart rates over 90 beats/min or with a history of cardiovascular conditions.
- Propranolol blocks beta-adrenergic receptors to control symptoms of hyperthyroidism such as tachycardia, palpitations, excessive sweating, tremors, and nervousness.
- Propranolol is useful for controlling symptoms during the delayed response to thioamide drugs and radioactive iodine, before thyroidectomy, and in treating thyrotoxic crisis.
- Propranolol should be tapered and discontinued when patients become euthyroid and definitive treatment has controlled hyperthyroid symptoms.
Hypothyroidism and Hyperthyroidism: Causes, Diagnosis, and Treatment
- Hypothyroidism can be caused by Hashimoto’s disease, congenital hypothyroidism, surgical removal of the thyroid, radiation treatment, and certain medications.
- Symptoms of hypothyroidism develop slowly and can go unnoticed for months or years.
- There is no cure for hypothyroidism, and most patients have it for life, but some exceptions exist, such as viral thyroiditis or thyroiditis after pregnancy.
- Hypothyroidism is treated by replacing the hormone the thyroid can no longer make, typically with synthetic thyroxine pills.
- Certain medications and conditions, such as amiodarone, interferon alpha, lithium, and iodine levels, can lead to hypothyroidism.
- Surgical removal of part or all of the thyroid can result in hypothyroidism, and radiation treatment for hyperthyroidism often leads to hypothyroidism.
- Treatment for hypothyroidism involves the administration of synthetic thyroxine, such as levothyroxine, which should be taken on an empty stomach.
- Levothyroxine therapy is for life and requires routine laboratory testing to review thyroid-stimulating hormone (TSH) levels.
- Levothyroxine rarely causes adverse effects when administered at appropriate doses.
- Replacement therapy for hypothyroidism is lifelong, and no clear-cut guidelines exist regarding duration of antithyroid drug therapy.
- People with hypothyroidism are at risk of respiratory depression and myxedema coma with opioid analgesics and sedating drugs.
- Hyperthyroidism can be diagnosed through blood tests measuring thyroid hormone and TSH levels, and symptoms include heat intolerance, palpitations, anxiety, fatigue, weight loss, and irregular menses in women.
Test your knowledge on the treatment of hyperthyroidism with propylthiouracil and related medications. This quiz covers therapeutic effects, adverse effects monitoring, patient teaching guidelines, and other treatment options for hyperthyroidism management.
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