USMLE Internal Medicine Review 12 08 Treatment of Complications of Graves’ Disease

USMLE Internal Medicine Review 12 08 Treatment of Complications of Graves’ Disease

On these “Gold Standard Internal Medicine Facts” pages you will find Free:

  • USMLE Audio Review files from our “Gold Standard USMLE Reviews”
  • Transcriptions of those files
  • And videos (as they become available)

The idea is that you can review for the USMLE online by:

  • Listening to the Audio
  • Following along with the transcription
  • Or by watching the video (if available)

If you like what you here, you can purchase the entire Gold Standard Foundations of Medicine MP3 Audio USMLE review for your iPhone, iPod, or computer here.

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 08 Treatment of Graves’ Disease Below

 

Begin 12 08 Treatment of Graves’ Disease Transcription

We’ll deal quickly with treatment of complications of Graves’ disease. And then finish up with brief descriptions of other forms of thyrotoxicosis. Thyrotoxic crisis or thyroid storm is the most serious complication of Graves’ disease and requires vigorous management.  Which agent and dose is most helpful in controlling arrhythmias associated with Graves’ disease? Propranolol 1-2mg slowly intravenously or 40-80mg po q6h.

And which calcium blocking agent is effective in the presence of severe heart failure or asthma and arrhythmia?

  • Cautious IV administration of Verapamil 5-10mg may be effective in this setting.

Which 3 treatment measures are indicated for heart failure associated with Graves’ disease? Just list them please.

  • Digitalis, diuretics and oxygen are indicated for heart failure treatment.

And which antithyroid agent helps in the treatment of thyroid storm by blocking hormone synthesis?

  • Propylthiouracil 250mg q6h.

What is the alternative for patients who cannot take medication by mouth?

  • Methimazole 25mg q6h by rectal suppository or enema.

What are the 2 options for agents to retard hormone release after administration of antithyroid drugs?

  • Hormone release is retarded by sodium iodide 1g IV over 24 hours or saturated solution of potassium iodide 10 drops bid.

The combination of propranolol and propylthiouracil along with which additive agent ads in treatment by partially blocking conversion of T4 to T3? The additive agent hydrocortisone hemisuccinate 50mg IV q6h.

Supportive therapy for thyroid storm includes a cooling blanket and which type of analgesic to help control fever?

  • Acetaminophen. Aspirin binds to TBG and frees up more Thyroxine so is probably contraindicated.

Fluids, electrolytes and proper nutrition are important in treating thyroid storm and what is probably the best choice for a sedative agent?

  • Phenobarbital because it accelerates inactivation of T3 and T4.

Lastly, it’s essential to treat the underlying disease process that may have precipitated the thyroid storm. The treatment measures may include antibiotics, anti-allergy drugs or post-operative care among others.

Student doctor please pause the tape and summarize the treatment of thyrotoxic crisis of thyroid storm as a serious complication of Graves’ disease. Please include Propranolol, Verapimil, Propylthiouracil, and Methimazole, Sodium and Potassium Iodide, Hydrocortisone Hemisuccinate, supportive therapy, Phenobarbital, and treatment for associated heart failure or other underlying disease.

  • Thyrotoxic crisis or thyroid storm is the most serious complication of Graves’ disease and requires vigorous management. Propranolol 1-2mg slowly IV or 40-80mg po q6h is most helpful in controlling arrhythmias, associated with Graves’ disease. Cautious IV administration of Verapamil 5-10mg may be effective in the presence of severe heart failure or asthma and arrhythmia. Specific treatment measures indicated for heart failure associated with thyroid storm of Graves’ disease include Digitalis, diuretics and oxygen. Propylthiouracil 250mg po q6h helps in the treatment of thyroid storm by blocking hormone synthesis. For patients who cannot take medication by mouth, Methimazole 25mg q6h by rectal suppository or enema is a good alternative. Two agents which retard hormone release after administration of antithyroid drugs are sodium iodide 1g IV over 24 hours or saturated solution of potassium iodide 10 drops bid. The combination of Propranolol and Propylthiouracil along with the additive Hydrocortisone Hemisuccinate 50mg IV q6h ads in treatment by partially blocking conversion of T4 to T3. Supportive therapy for thyroid storm includes a cooling blanket and acetaminophen to help control fever. Aspirin is not a good choice because it binds to TBG and frees up more Thyroxine. Fluids, electrolytes and proper nutrition are important in treating thyroid storm. Probably the best choice for a sedative agent is Phenobarbital because it accelerates inactivation of T3 and T4. It’s essential to treat the underlying disease process that may have precipitated the thyroid storm. Treatment measures may include antibiotics, anti-allergy drugs, post-operative care or others.

****END OF TRANSCRIPTION****

 

Want More USMLE Step 1 Review Facts?

boardprep.net

Leave a Reply