USMLE Internal Medicine Review 12 07 Additional Medical Measures

USMLE Internal Medicine Review 12 07 Additional Medical Measures

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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 12 07 Additional Medical Measurese Below

 

Begin 12 07 Additional Medical Measures Transcription

Now looking at some supplemental medical measures in the treatment of Graves’ disease in conjunction with antithyroid drugs, radioactive iodine or thyroidectomy. During the acute phase of thyrotoxicosis, propanolol is a helpful therapeutic agent.

Propranolol belongs to which class of agents?

  • Propranolol is a beta-adrenergic blocking agent or a beta blocker.

Propranolol 10-40mg q6h will help control which 3 conditions associated with thyrotoxicosis? Just name them please.

  • Propranolol 10-40mg q6h will help control atrial fibrillation, hypertension, and tachycardia associated with thyrotoxicosis. Propranolol is withdrawn gradually as serum Thyroxine levels return to normal. Adequate nutrition including multivitamin supplements is essential for Graves’ disease patients.

And restricted barbiturate use can aid in accelerating T4 metabolism with the agent Phenobarbital being helpful in which 2 ways? Just list them.

  • Phenobarbital may be helpful both for its sedative effect and in lowering T4 levels.

Which drug has been shown to inhibit both thyroid hormone synthesis and release and peripheral conversion of T4 to T3?

  • Ipodate sodium, also called Iopanoic acid, 1g daily. Ipodate sodium leaves the gland saturated with Iodide and should not be used before I131 therapy or with antithyroid drugs.

Which anion exchange resin agent lowers serum T4 by binding it in the gut?

  • Cholestyramine 4g po tid.

Student doctor please pause the tape and summarize additional medical measures used in the treatment of Graves’ disease in conjunction with the 3 major modelities: antithyroid drug therapy, radioactive iodine therapy and thyroidectomy. Please include Propranolol, nutrition, Phenobarbital, Ipodate sodium, and Cholestyramine.

  • During the acute phase of thyrotoxicosis the bête blocker Propranolol is a helpful therapeutic agent. Propranolol 10-40mg q6h will help control atrial fibrillation, hypertension, and tachycardia associated with thyrotoxicosis. Propranolol is withdrawn gradually as serum Thyroxine levels return to normal. Adequate nutrition including multivitamin supplements is essential for Graves’ disease patients. Restricted barbiturate use, particularly Phenobarbital is helpful both for its sedative effect and in lowering T4 levels. Ipodate sodium or Iopanoic acid 1g daily has been shown to inhibit both thyroid hormone synthesis and release and peripheral conversion of T4 to T3. Ipodate sodium leaves the gland saturated with Iodide and should not be used before I131 therapy or with antithyroid drugs. Cholestyramine 4g po tid is an anion exchange resin agent which lowers serum T4 by binding it in the gut.

A choice of therapy for Graves’ disease varies with the nature and severity of the illness but a few treatment guidelines are fairly well recognized. I’ll give a series of patient specifics. Please respond with which of the major 3 options you feel is best suited: The 3 treatment modalities are antithyroid drug therapy, radioactive iodine therapy and surgical thyroidectomy.

If large doses of antithyroid drugs are required for control there is an allergic reaction to these agents or the gland does not shrink in response to therapy.

Which of the 3 treatment modalities is best?

  • Radioactive iodine would be the treatment of choice.

And if there is prompt response to early antithyroid drug therapy and the thyroid gland begins to shrink?

  • Long term antithyroid drug therapy with or without concurrent Levothyroxine therapy.

And what are 2 indications for thyroidectomy as the treatment of choice for Graves’ disease?

  • Thyroidectomy is the treatment of choice for Graves’ disease if the thyroid gland is larger than about 150g or is multinodular or if the patient wishes to become pregnant soon.

Student doctor please pause the tape and summarize a few guidelines for selecting the treatment of choice for Graves’ disease, among the 3 major options: antithyroid drug therapy, radioactive iodine therapy and thyroidectomy.

  • Generally speaking if there is prompt response to early antithyroid drug therapy and the thyroid gland begins to shrink, Long term antithyroid drug therapy with or without concurrent Levothyroxine therapy is the treatment of choice for Graves’ disease. If large doses of antithyroid drugs are required for control there is an allergic reaction to these agents or the gland does not shrink in response to therapy, radioactive iodine is probably the best choice.

And if the thyroid gland is larger than about 150g or is multinodular or if the patient wishes to become pregnant soon, thyroidectomy is the preferred treatment for Graves’ disease.

****END OF TRANSCRIPTION****

 

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