University:
University of Kentucky
Course:
NUR 101 | Academic Orientation and Introduction to Nursing
Academic year:

2023
Views:

65

Pages:

2
Author:

Joseph D.

Nodules: • prevalence ↑ •most begin asymptomatic & are benign • uninodular or multinodular • pts are euthyroid Cold: Hypo Functioning Loit recent growth, consider malignanay Hor: Hyperfunctioning gops "roque" Usually benign Sub clinical Hypothyrodism: TH -TSH; -9 wage, female sex, & dietary iodine Subclinical Hyperthyrodism -TSH; TH & T3 - common pbs >80 4.0.0. Goa's of Therapy: - Normalize TSH Manage symptoms - Achieve optimal TSH levels during pregnancy Drug name Thyroid hormone Approximate dosage equivalent Levothyroxine (14) Drug the SYNTHROID (tab:25,50,75,88,100,112 125,137,150,175,200,300 mmcg) Synthetic 60 meg T4 ELTROXIN (tab:50,100,150,200,300) Inj: 200 mcg/10ml 500mcg/10ml Triodothyronine or licthyronine (13) CYTOMEL (5 mcg, 25 mcg Synthetic 25 to 37:5 mcg 13 Clinical considerations Stabile and predictable Absorption reduced by iron, aluminum-containing products, calcium, PPIs, cholesterol resin and phosphate binders, ralomifene, any, bran, coffee, others. Required multiple daily dosing due to short 1-1/2 [1.5 days); Risk of supraphysiologic 13 levels causing toxicity Desiccated thyroid THYROID (30 mg, 60 mg, 125 mg) Mia of T4 and 13 1 to 1.67 gr Unpredictable ratio of 14 10 13, High 13 levens may cause toxicity Starting Dose (Oral) •Healthy Adult 1.6-1.7 mcg/1kg 1 day Dose 200 meg. Adults >50 4.0.0: Imcg/kg/day is uncommon. Adults cardiac disease or 65 y.o.a.: 12.5-25 mcg/kg/day *Dose Titration (oral) 12-5-25 mcg/day every 4-8 weeks Note: No need for adj. in renal/liver dysfunction Note: Observe w close follow-up trisk to druciop Hyroid function dis onder Typical L-Tyroxine (T4) Dosing Dose (mcg/kg/day) Typical Daily Dose (mcg/day) Age Category Infants <6 months 8-10 25-50 Infants 6-12 months 6-8 50-75 Children 1-5 years 5-6 75-100 Children 6-12 years 4-5 100-150 Children >12 years 2-3 Up to 150 Adults 1.6-1.7 100-150 Elderly <1 12.5-50 Lab Test Monitoring: 6-8 weeks since L-Thyroxine has a half-life of 7 days it will take 5-6 half- lifes to get to steady state (15%) Desicated Thyroid: usually made out of pork, hog & sheep thyroid glands. not recommended due to a wide variation in potency T3+74 proportions vary bluw brands Lo iodine proportions vary blw brands due to impurities allergic ron -T3 can lead to mild thyroid toxic symptoms as it is more potent than Tu - long perio not stable over a period of time - If switching to L-Thyroxine use w75-100 mcg 74/60mg desicated hyroid Pregnancy: Dose may 930-50%. in 1st trim. Reassess TSH qu weeks during first half of pregnancy -Asses TSH a least once during second half - TSH Targets 0-1-2.5 mlU/L 1 tim 0.2-3.0 MIUIL 2n trim 0.3-3.0 mIU/L = 3rd trim Possible Reasons for Lack of Effectiveness: -non-adherance (most common) error in diagnosis (unusual) -impact on abs. due to interaction Leg. iron) potent mech - rapid metabolism (unusual) -resistance (rare) Parenteral Administration: -IV IM Quailabk lolu preferred Dose must be reduced bic abs 9610

Nodules Lecture Note

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