NR 565 Final Exam Study guide

Labs used to diagnose Hyo/hyper thyroidism TSH, T3, T4, free T3 and T4 Timeframe for re-check of labs after starting levothyroxine Retest serum TSH in 6-8 weeks and after any dosage change Hypothyroidism (Hashimotos) - S/S - Abnormally high levels of TSH is HYPO hypothyroidism - Pale, puffy, expressionless - Skin is cold and dry - Hair is brittle, and hair loss occurs - Heart rate and temp are low - Lethargy, fatigue, intolerance to cold Hyperthyroidism (Graves disease) - Heartbeat is rapid and strong & dysrhythmias and angina may occur - CNS is stimulated, resulting in nervousness, insomnia, rapid thought flow, rapid speech - Skeletal muscles may weaken and atrophy - Metabolic rate is raided, resulting in increased heat and body temp - Appetite is increased, weight loss occurs exophthalmos Normal TSH levels 0.6-6 T3 levels 80-220 T4 levels 4.5-12.5 radioactive iodine destroys the thyroid gland -used for hyperthyroidismTreatment of Thyroid storm - PTU - High doses of iodine solution - Methimazole is given to suppress thyroid function synthesis and first line for hyperthyroidism - Beta blockers is given to reduce heart rate - Sedation, cooling and giving glucocorticoids and IV fluids Methamazole (Tapazole) - First line drug for hyperthyroidism - Avoided in first trimester of pregnancy Results of not treating hypothyroidism during pregnancy - Permanent neuropsychological deficits Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself) - Beta blockers suppress tachycardia - Non radioactive iodine - Exophthalmos can be treated with oral glucocorticoids Drug/Food/Supplement interactions with levothyroxine - Calcium, iron, antacids, magnesium - Should be taken on an empty stomach -- can take levo an hour later - Phenytoin, carbamazepine, rifampin, Sertraline, and phenobarbital accelerate levothyroxine - Warfarin can be enhanced - Thyroid hormones increases cardiac responsiveness to catecholamines, thereby increasing the risk for catecholamine induced dysrhythmias How to confirm a diagnosis prior to beginning treatment - Fasting plasma glucose 126mg/dL - Random plasma glucose 200mg/dL - Oral glucose tolerance test 2-h plasma glucose 200 - Hemoglobin A1C 6.5& or higher