Review Question - QID 213359

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Graves Disease Treatment Pharmacologic QID: 213359 (M1.OMB.19.1)

QID 213359 (Type "213359" in App Search)

A 31-year-old woman presents to her primary care physician with a 2-week history of diarrhea. She says that she has also noticed that she is losing weight, which makes her feel anxious since she has relatives who have suffered from anorexia. Finally, she says that she is worried she has a fever because she feels warm and has been sweating profusely. On physical examination she is found to have proptosis, fine tremor of her hands, and symmetrical, non-tender thyroid enlargement. Which of the following types of enzymes is targeted by a treatment for this disease?

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Catalase

1/174

Cyclooxygenase

7/174

Kinase

4/174

Peroxidase

84%

147/174

Phosphatase

7/174

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This patient who is experiencing weight loss, hyperthermia, anxiety, tremor, and diarrhea with symmetrical, non-tender thyroid enlargement most likely has Graves disease. Graves disease can be treated with thionamides that inhibit the thyroid peroxidase enzyme.

Graves disease can be treated with beta-blockers, glucocorticoids, thiocyanate, thionamides, and radioactive iodine. Beta blockers are used to block adrenergic overactivation in patients with excessive thyroid hormone function and are used symptomatically to prevent heart palpitations. Glucocorticoids are similarly used to symptomatically reduce exophthalmos. The other 3 drug classes are primarily used to ablate the excessive production of thyroid hormone. Thiocyanate inhibits the sodium iodide symporter located on the basolateral membrane of thyroid epithelial cells. Thionamides inhibit the key enzyme thyroid peroxidase that is responsible for the organification of thyroid hormone. Finally, radioactive iodine is used to ablate overactive thyroid tissue.

Incorrect Answers:
Answer 1: Catalase is an enzyme that is involved in immune cell function. This enzyme is defective in various immunodeficiencies but is not targeted during Graves disease.

Answer 2: Cyclooxygenase is inhibited by non-steroidal anti-inflammatory drugs and these drugs would be used to treat subacute thyroiditis; however, they are not used to treat Graves disease.

Answer 3: Kinases are inhibited downstream of second messenger pathways in the adrenergic system; however, they are not directly targeted by beta blockers.

Answer 5: Phosphatases such as alkaline phosphatase can be low in conditions such as hypophosphatasia; however, they would not be targeted by any of the drugs used to treat Graves disease.

Bullet Summary:
Graves disease can be treated with beta-blockers, glucocorticoids, thiocyanate, thionamides, and radioactive iodine.

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