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Pharm Thyroid
KYCOM Block 11
44
Pharmacology
Graduate
10/19/2013

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Cards

Term
explain thyroid hormones from ingestion of iodine to T3/4 production and storage (7 steps)
Definition
1. ingest iodine
2. TSH stimulates iodine uptake and hormone production
3. iodine active transport into thyroid
4. activated with THYROID PEROXIDAZE (using Hb and H2O2)
5. monotyrostol and diiodotyrosyl are produced
6. THYROID PEROXIDASE links AA making T3 and T4 in a 1:4 ratio
7. T3 and T4 are stored in thyroglobulin
Term
explain thyroid hormone release from thyroglobulin to arrival at the tissues (7 steps)
Definition
1. thyroglobulin fuses with lysoosme

2. proteolytic enzymes break it into...
- monotyrosyl and dioxotyrosyl which stay in thyroid
- T3/T4 which go into blood
- excess iodine which stays in thyroid

3. T3/4travel in blood on thyroxine binding globulin and albumin

4. T3/4 are released at tissues
Term
what motifications occur to T3/4 at the tissues (2)
Definition
diodinase enzymes remove 5' outer ring...

- 5-DI and 5-DII turn T4 to T3 (41% of T3)

- 5-DIII turns T4 into reverse T3
Term
where are T3 and T4 degraded
Definition
liver
Term
what are the differences in T3 and T4 elimination
Definition
T3 is eliminated in 2 d due to increased protein binding increasing hald life

T4 is eliminated in 6-7d
Term
how does iodine regulate thyroid hormone production
Definition
decreased iodine decrease thyroid hormones which stimulate TSH causing thyroid hypertrophy (gioter) and selective T3 formation
Term
how does the production of thyroid hormone reulate itself
Definition
it doesnt

it stops TSH production but increases thyrotropin releasing hormone (TRH) production which cancel
Term
what is the difference in tissue binding and activity of T3 and T4
Definition
T3 binds with 5x higher affinity

T4 binds with lower affinity
Term
what are the 6 areas in general thyroid hormones affect
Definition
growth and development
basal metabolic rate
released when cold to regulate body temp
heart
CNS
cholesterol metabolism
Term
how does the thyroid effect growth and development (5)
Definition
differentiation and myelination of cnS

potentiation of GH, PTH, and calcitonin
Term
in what organs does the thyroid hormone effect on basal metabolic rate have the most effect (4)
Definition
heart, muscle, liver, kidney
Term
what changes do thyroid hormones cause in the heart (4)
Definition
sensitize it (synergistic)
increase CO, HR, contractility
Term
what effects do thyroid hormones have on the CNS
Definition
sensitize catecholamine receptors (synergistic)
Term
what does thyroid hormone do to cholesterol metabolism
Definition
stimulates metabolism of cholesterol to bile acids

important! lack can cause hypercholesterolemia
Term
what is the name for adult hypothyroidism
Definition
myexedema
Term
what is the name for child hypothyroidism
Definition
cretinism
Term
what are the 9 signs of child hypothyroidism
Definition
impaired growth
mental retardation
pot belly
dwarfism
lethargy
hypothermia
slow HT
poor appetite
death if untreated
Term
what are the 8 signs of adult hypothyroiodism
Definition
pallid expression
blank expression
dry skin
brittle nails
weakness
reduced CO
fatigue
cold intolerence
Term
what are two diseases of hyperthyroidism
Definition
graves and plummers disease
Term
what are 7 characteristics of graves disease
Definition
diffuse toxic goiter
exophthalmos: big eyes
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure
Term
what are 4 causes of graves disease
Definition
autoimmune: IgG bind to TSH receptor

chorionic: placental secretion of TSG stimulates receptors in pregnancy
Term
what are 6 signs of plummer's disease
Definition
toxic nodular goiter
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure
Term
what are 5 general signs of hyperthyroidism
Definition
hot moist skin
forced rapid heart beat
angina
arrhythmia
heart failure
Term
what are the 3 treatments for hyperthyroidism
Definition
surgical removal of thyroid
local radiation with radioactive iodine
anti thyroid agents
Term
what causes a thyroid storm (7)
Definition
complication of hyperthyroidism triggered by stress, thyroid surgery, trauma, diabetic ketoacidosis, labor, heart disease, radioactive iodine
Term
what are the 7 treatments of a thyroid storm
Definition
fluids
anti-pyretics
cooling blankets
propylithiouracil in large doses
iodates
B blockers and Ca can control tachyarrhytima
dexamethasone
Term
what are the three thyroid hormone drugs, what hormone is each
Definition
desiccated thyroid - T3 and T4
levothyroxine - T4
liothyroxine - T3
Term
what are the advantages of using liothyronlne over levothyroxine (4)
Definition
liothyroline does not have to be converted for full potential, fast onset, good absorption, good when someone has problem with T4 to T3 conversion enzyme
Term
what is the clinical use for thyroid hormones (3)
Definition
hypothyroidism
non-toxic goiter
replacement therapy
Term
what are the contraindications to thyroid hormones (3)
Definition
acute MI

increase anticoagulant effects

reduce digitalis effects
Term
what are the 3 side effects or problems with desiccated thyroid
Definition
antigenic because it comes from pork

highly variable biological activity

religous objections to treatment
Term
what are the two anti-thyroid or thiroureylenes
Definition
propylthiouracil and methimazole
Term
MOA of anti-thyroids
Definition
stop iodiniation of throsyl in thyroglobulin

block thyroid peroxidae inhibiting coupling reaction

prophylthiouracil- blocks conversion of T3 to T4
Term
what are the three side effects of anti-thyroids
Definition
agranulocytosis

marrow aplasic (improves on DC)

secreted into breast milk
Term
what can anti-thyroids be used to treat (7)
Definition
graves disease
small goiters
mild hyperthyroidism

deplete thyroid hormone before radiation hyperthyroidism in elderly

after radiation

prethyrodectomy- prevent surge in surgery

thyroid storm - prophylthiouracil due to T3 to T4 ability
Term
iodine MOA
Definition
saturated potassium iodide prevents thyroid hormone release

inhibits hormone synthesis by decreasing TSG and blcking its action (wolff chickoff effect)
Term
4 side effects of iodine
Definition
rebound hyperthyroidism

angioedema

hypersensitivity

iodism
Term
what is iodism, what are 7 signs
Definition
chronic intoxication of iodine

burning bouth, throat, eyes, headache, productive cough, gastric irritation, skin lesions
Term
what are the three uses of iodine
Definition
reduce vascularity and increase gland firmness

thyroid storm prevention

pre surgery
Term
MOA radioactive iodine
Definition
gets trapped in thyroid and B-rays destory parenchyma
B-rays only destory bad tissue
Term
what are three side effects of radioactive iodine
Definition
cannot use in pregnancy

delayed hypothyroidism

chromosomal abberations (cannot use in kids and pregnancy)
Term
what is the half life of radioactive iodine
Definition
8d
Term
what is the use of radioactive iodine
Definition
safe after surgery
Term
what is another name for radioactive iodine
Definition
iodine 131
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