NU553 Unit 4 Thyroid and Parathyroid Physiology: Hormones, Regulation, and Disorders Advanced Pharmacology and Pharmacotherapeutics Exam 2
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What is the most common cause of primary hyperparathyroidism?
A single benign adenoma
Which hormones are produced by the thyroid gland that regulate metabolism?
Thyroxine and triiodothyronine
Why is levothyroxine the first line treatment for hypothyroidism?
It mimics physiologic hormone production and provides stable levels
What is the most common cause of hypothyroidism in iodine sufficient regions?
Hashimoto thyroiditis
When should thyroid stimulating hormone be rechecked after starting levothyroxine?
6 to 8 weeks
What is the mechanism of action of antithyroid drugs like methimazole and propylthiouracil?
They inhibit thyroid peroxidase
What hormone is released by the hypothalamus to stimulate the pituitary in the thyroid axis?
Thyrotropin releasing hormone
What is the approximate half life of thyroxine?
7 to 10 days
Which thyroid hormone is more biologically active?
Triiodothyronine
What is the recommended starting levothyroxine dose in ischemic heart disease?
12.5 to 25 micrograms daily
Which supplements interfere with levothyroxine absorption?
Calcium and iron
How does pregnancy affect levothyroxine dosing?
Dose increases by 20% to 50%
Why is liothyronine not preferred for routine hypothyroidism treatment?
Short half life causes fluctuations
How does parathyroid hormone affect bone?
Increases calcium resorption
Why are beta blockers used in hyperthyroidism?
To control adrenergic symptoms
What lab pattern is seen in secondary hypothyroidism?
Low thyroid stimulating hormone and low free thyroxine
How should levothyroxine be taken for best absorption?
On an empty stomach before meals
What medication can treat primary hyperparathyroidism if surgery is not an option?
Cinacalcet
What is the hallmark lab pattern of hypoparathyroidism?
Low calcium and low parathyroid hormone
Which antibodies are elevated in Hashimoto thyroiditis?
Thyroid peroxidase and thyroglobulin antibodies
What element is required to synthesize thyroid hormones?
Iodine
What defines subclinical hypothyroidism?
Elevated thyroid stimulating hormone with normal free thyroxine
What is the most common cause of hyperthyroidism in the United States?
Graves disease
What lab pattern is seen in primary hyperparathyroidism?
High calcium with normal or high parathyroid hormone
Why is methimazole preferred over propylthiouracil after the first trimester?
Lower risk of hepatotoxicity
What condition presents with severe hyperthyroid symptoms and instability?
Thyroid storm
What symptoms suggest agranulocytosis from antithyroid drugs?
Fever sore throat malaise
What is the definitive treatment for primary hyperparathyroidism?
Parathyroidectomy
What is the average levothyroxine maintenance dose?
1.6 micrograms per kilogram
What eye finding is associated with Graves disease?
Exophthalmos
What lab pattern is seen in overt hyperthyroidism?
Low thyroid stimulating hormone and high free thyroxine
What is the intravenous levothyroxine dose used in myxedema coma?
300 to 500 micrograms
What condition presents with hypothermia and central nervous system depression in hypothyroidism?
Myxedema coma
What do parathyroid glands regulate?
Calcium homeostasis
How does cinacalcet lower calcium?
Increases sensitivity of calcium receptors
Which antibody is associated with Graves disease?
Thyroid stimulating immunoglobulin
What is the half life of triiodothyronine?
About 24 hours
What are the main treatments for hyperthyroidism?
Antithyroid drugs radioactive iodine or surgery
Which antithyroid drug is preferred in the first trimester of pregnancy?
Propylthiouracil
What is the first line therapy for hypothyroidism?
Levothyroxine
What lab pattern is seen in overt hypothyroidism?
High thyroid stimulating hormone and low free thyroxine
How should levothyroxine dosing change when switching to intravenous?
Reduce to 50% to 70%
What serious adverse effect must be reported with antithyroid drugs?
Agranulocytosis symptoms
What are common side effects of cinacalcet?
Nausea and vomiting
How does parathyroid hormone increase calcium absorption in the gut?
Activates vitamin D
What skin finding is seen in long standing hypothyroidism?
Myxedema
How does levothyroxine affect warfarin therapy?
Increases bleeding risk
Why is thyroid stimulating hormone used as a screening test?
Highly sensitive to hormone changes
Which antithyroid drug is preferred after the first trimester?
Methimazole
What is the function of deiodinases?
Convert thyroxine to triiodothyronine
What serious adverse effect of antithyroid drugs involves low white blood cells?
Agranulocytosis
Why should levothyroxine brands not be switched?
Variable bioavailability
Which hormone from the pituitary stimulates the thyroid?
Thyroid stimulating hormone
What are the symptoms of myxedema coma?
Hypothermia altered mental status cardiovascular instability