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Hypothyroidism
High TSH and low T3 and T4
Cold, Pale, Puffy, overweight, lethargy, decrease HR and T, cold intolerance
can cause myxedma, and cretinism (kids-MR and growth failure)
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Hyperthyroidism
Low TSH high T3 and T4
often caused by Graves disease
can cause thyrotoxic crisis if under extreme stress (surgery, infection ect.)- very high fever, tachycardia, coma, HF
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Tx for Hypothyroidism
Liothyronine (Cytomel)- T3 faster than levothyroxine but shorter hlaf life
Levothyroxine (Synthroid, Levithroid, Levoxyl)- t4 that converts to t3 in body
ADR: rare if overdose=hyperthyroidism symptoms
Interactions: many, warfarin-increases=bleeding
take in am on empty stomach-take for life
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Tx of Hyperthyroidism
- blocks t4, t3
- Propylthiouracil (PTU)-ADRS: agranuloctyosis, hypothyroidism, can use in preggos
- Methimazole (Tapazole)- longer half life, dont use in pregnancy, slower onset
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Propranolol (Inderal)
- use for hyperthyroidism and throtoxic crisis- to decrease HR
- non selective beta blocker
- dont effect t3 or t4
ADRs: Bronchoconstriction- concern w/asthma
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Glucocorticoids ADRS
- Adrenal suppression (if stopped abruptly)
- Growth retardation in kids
- Cataracts/glaucoma
- Peptic Ulcer disease
- Cushings syndrome
- osteoporosis
- Hyperglycemia
- Leukocysosis
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Acute adrenal insufficiency/ Adrenal Crisis
- D/t abrupt withdrawl of long term tx (>10 days)-taper
- can be d/t addison's disease
risks: hypoglycemia, and cardiocadcular collapse
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Osteoporosis
Tx with Bisphonates: Alendronate (Fosamax), Risedronate (Actonel)
- ADRs: esophagitis- if cant sit or stand 30 mins dont give ,
- Musculoskeletal pain, jaw necrosis, bone fx
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