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What are the sx of hypothyroidism?
- Cold intolerance
- Constipation
- Lethargy
- Brittle hair
- Facial puffiness
- Wt gain (despite decreased appetite)
- Impaired memory
- Confusion
- Increased cholesterol and TG
- Decreased deep tendon reflexes
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What are the sx of hyperthyroidism?
- Heat intolerance
- Increased bowel movements
- Warm skin, excess sweating
- Nervousness, emotional lability
- Fine, thin hair
- Wt loss (despite increased appetite)
- Palpitations, tachycardia
- Dyspnea
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What are the trends for lab values in hyperthyroid disease?
- TSH
- Total T4
- Free T4
- Total T3
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What are the trends for lab values in hypothyroid disease?
- TSH
- Total T4
- Free T4
- Total T3
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What is the normal range of TSH?
0.5-4.7 mIU/mL
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What is the normal range for Free T4?
0.8-1.8 ng/dL
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What is the normal range for Total T4?
4.5-10.9 mcg/dL
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What is the normal range for Total T3?
60-181 ng/dL
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What is the dosing for Levothyroxine?
- 50mcg x 1mo, then 100mcg
- 25mcg x 1mo, titrate by 25mcg (Elderly)
- Normal maintenance dose = 1.7 mcg/kg/d
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How should Levothyroxine be administered?
- On an empty stomach 30min before or 1h after the 1st meal of the day
- separate from calcium, iron, and caffeine by 2hrs
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How should Levothyroxine be monitored?
- TSH and T4 q 6wks after initiation
- Goal TSH is 0.5-3.5 mIU/mL
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What are the disadvantages of T3?
- Short half-life
- Cost
- Higher risk of cardiotoxicity
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What are the SE of Levothyroxine?
- Cardiac issues
- Osteoporosis
- Increased fracture risk
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What is subclinical hypothyroidism?
- Normal T4 with elevated TSH
- Treat if TSH > 10 mIU/mL
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What medications might interact with levothyroxine or thyroid disorder?
- Warfarin:
- disorder causes slower clotting factor metabolism (need more warfarin)
- levothyroxine causes decreased drug metabolism (need less warfarin)
- Digoxin
- Insulin
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What medications can cause hypothyroidism?
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What are the sx of a myxedema coma?
- hypothermia
- delerium
- coma
- bradycardia
- large tongue
- puffy face
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How do you treat myxedema?
- T3 or Combo
- Hydrocortisone
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What is the tx for hyperthyroidism?
- Surgery
- Radioactive Iodine
- Methimazole (MMI)
- Propylthiouracil (PTU)
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What are the SE of MMI and PTU?
- Rash
- GI
- Fevers
- Altered smell (MMI)
- Hepatitis (PTU)
- Agranulocytosis
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What is the adjunct therapy for hyperthyroidism sx?
- Propranolol (blocks T4 conversion to T3)
- Clonidine
- Diltiazem
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