Chapter 40 Part I Flashcards by Fatima Avila

INFO
-What are T3 & T4 regulated by?

TSH from the pituitary gland –> TSH tells the thyroid to make T3 & T4

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INFO
-What do T3 & T4 do?

Regulate metabolism & growth and development

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HYPOTHYROIDISM
-What is this?
-What can it be?

-Not enough T3 & T4
-Congenital or acquired

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HYPOTHYROIDISM: Etiology & Pathogenesis
-Most cases of hypothyroidism are primarily due to what?

intrinsic dysfunction of the thyroid gland

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HYPOTHYROIDISM: Etiology & Pathogenesis
-What is the most common cause of acquired hypothyroidism?
-What is this also known as?
-It is characterized by what?

-lymphocytic thyroiditis
-Hashimoto or autoimmune thyroiditis
-an enlarged thyroid gland

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HYPOTHYROIDISM: Etiology & Pathogenesis
-What are other causes of acquired hypothyroidism?

Radiation of the thyroid gland
Surgical removal of thyroid tissue
Iodine deficiency

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HYPOTHYROIDISM: Etiology & Pathogenesis
-What is iodine required for?
-What does iodine decifiency lead to? Explain this.
-What ends of happening?

-for T3/T4 formation
-lack of T3/T4 & stimulates TSH secretion; without iodine, no production of T3/T4)
-Increased TSH causes thyroid cells to secrete LARGE amounts of thyroglobulin, which leads to a GOITER

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HYPOTHYROIDISM: Etiology & Pathogenesis
-What is a goiter?
-What does it present in?

-Enlarged thyroid
-hyperthyroid, hypothyroid, euthyroid

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HYPOTHYROIDISM: Clinical Manifestations
-What two things are decreased?

Basal metabolic rate & appetite

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HYPOTHYROIDISM: Clinical Manifestations
-Do they experience wieght gain or weight loss?

Mild/moderate weight gain

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HYPOTHYROIDISM: Clinical Manifestations
-In terms of cardiac problems, what do they experience?

-Bradycardia
-Narrowed pulse pressure

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HYPOTHYROIDISM: Clinical Manifestations
-What kinds of neurological symptoms are experienced?

Weakness
Lethargy
depression
Difficulty with concentration/memory

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HYPOTHYROIDISM: Clinical Manifestations
-What happens to the skin/hair & bowel movements?

Cold intolerance
Enlargeed thyroid
dry skin
Constipation
Loss of eyebrow

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HYPOTHYROIDISM: Clinical Manifestations
-What two things are elevated?

Serum cholestrol & triglycerides

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HYPOTHYROIDISM: Clinical Manifestations
-What happens to menstruation?

Menstruation irregularity

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HYPOTHYROIDISM: Diagnosis
-What is the diagnosis of primary hypothryroidism?

Elevated TSH –> sensitive indicatory of thyroid HYPOactivity

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HYPOTHYROIDISM: Diagnosis
-What is the diagnosis of secondary hypothyroidism?

Low TSH

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HYPOTHYROIDISM: Diagnosis
-Low levels of T3 & T4 may not occur until when?

Later in the disease course

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HYPOTHYROIDISM: Treatment
-What is the goal of treatment?

Return of euthyroid (normal) state

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HYPOTHYROIDISM: Treatment
-How should treatment be?
-Resolution of symptoms occurs how long?
-You want to be careful of what?

-SLOW
-over weeks
-overtreatment

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HYPOTHYROIDISM: Treatment
-What is the mainstay of therapy?
-What does it do?

-Oral levothyroxine
-Replaces supplement hormone production

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HYPOTHYROIDISM: Myxedema
-What is this
-When does it occur in?

-Life-threatening hypothyroidism
-In severe or prolonged thyroid deficiency

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HYPOTHYROIDISM: Myxedema
-Patients appear with what?

-Generalized, non-pitting edema
-Decreased LOC
-HYPOtension
-HYPOthermia

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HYPOTHYROIDISM: Myxedema
-What may these patients have a history of?

-Precipitating events –> trauma, sepsis, medication

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**HYPERTHYROIDISM**: *Etiology & Pathogenesis* -When does this happen?

When the thyroid gland makes TOO MUCH thyroid hormone

**HYPERTHYROIDISM**: *Etiology & Pathogenesis* -What are the 3 types of mechanisms in which this occurs?

1. Thyroid follicular cell **hyper**function with INCREASED synthesis & secretion of T3 and T4 2. Thyroid follicular cell destruction with release of preformed T3 & T4 3. Ingestion of excessive thyroid hormone

**HYPERTHYROIDISM**: *Etiology & Pathogenesis* -What is an example of thyroid follicular hyper function? -Why is this important?

-Graves disease -It is the most common cause of hyperthyroidism

**HYPERTHYROIDISM**: *Etiology & Pathogenesis* -What are 2 examples of thyroid follicular cell destruction

1. Hashimoto thyroiditis 2. Subacute thyroiditis

**HYPERTHYROIDISM**: *Clinical Manifestations* -What are they?

-Exopthalmos: bulging eyes -Tachycardia, palpitations, angina -Weight **LOSS** -Heat intolerance -Sleeplessness, nervousness

**HYPERTHYROIDISM**: *Diagnosis* -What is the best indicator of this?

Undetectable TSH

**HYPERTHYROIDISM**: *Diagnosis* -What will be elevated?

T3 & T4

**HYPERTHYROIDISM**: *Diagnosis* -Which study can confirm the diagnosis of Graves disease? -What does it exclude the presence of?

-24-hour radioactive iodine uptake study -thyroid neoplasms

**HYPERTHYROIDISM**: *Treatment* -What do you use to block acute symptoms?

Beta-blockers

**HYPERTHYROIDISM**: *Treatment* -What is used to block thyroid hormone production?

-Antithyroid drugs, thionamides (propylthiouracil, methomiazole)

**HYPERTHYROIDISM**: *Treatment* -What are two other things?

-Radioactive iodine treatment -Surgery

**HYPERTHYROIDISM**: *Treatment* -What does radioactive iodine treatment do?

Destroys part of thyroid for Graves disease

**HYPERTHYROIDISM**: *Treatment* -What can be surgically removed? -What is this for?

-Thyroid gland -tumors

**HYPERTHYROIDISM**: *Treatment* -How is a pituitary adenoma treated?

Surgically

**HYPERTHYROIDISM**: *Thyroid Storm* -What is this? -What does that mean? -What is it trigged by?

-Life-threatening thyrotoxicosis -excessive amounts of thyroid hormones released into circulation -stress, infection, trauma, or thyroid manipulation during surgery

**HYPERTHYROIDISM**: *Thyroid Storm: Clinical Manifestations* -What is elevated? -They present with extreme what?

-temperatures, tachycardia, arrythmias, CHF -restlessness, agitation, & psychosis

**HYPERTHYROIDISM**: *Thyroid Storm: Treatment* -What kind of management is used & why?

Aggressive management to achieve metabolic balance

**HYPERTHYROIDISM**: *Thyroid Storm: Treatment* -What is the typical treatment?

Antithyroid drugs FOLLOWED by iodine administration

**HYPERTHYROIDISM**: *Thyroid Storm: Treatment* -What is given to alleviate cardiac symptoms?

Beta-blockers

**HYPERTHYROIDISM**: *Thyroid Storm: Treatment* -What kind of therapies should be used? (3)

1. Antipyretic therapy 2. Fluid replacement 3. Surgical removal of tumors

**HYPERTHYROIDISM**: *Thyroid Storm: Treatment* -What can occur if this is left untreated?

It is fatal

**HYPERCORTISOLISM** -What is this?

TOO MUCH cortisol

**HYPERCORTISOLISM** -What is Primary Hypercortisolism? -Example?

-Disease of the **adrenal cortex** -Adrenal tumor

**HYPERCORTISOLISM** -What is Secondary Hypercortisolism?

HYPERfunction of anterior pituitary ACTH-secreting cells

**HYPERCORTISOLISM** -What is Tertiary Hypercortisolism?

HYPOthalamic dysfunction or injury --> increased stimulation of pituitary

**HYPERCORTISOLISM** -What is Cushing disease?

term ONLY used for excess cortisol production caused by **PITUITARY** hyper stimulation of the adrenal cortex

**HYPERCORTISOLISM** -What is Cushing Syndrome?

Term used to describe ANY other reason for hypercortisolism

**HYPERCORTISOLISM**: *Clinical Manifestations* -How does the body appear?

-Moon face: round face & flushed cheeks -Weight gain in abdomen -thin extremities -Cervical fat pad

**HYPERCORTISOLISM**: *Clinical Manifestations* -What occurs with the capillaries? -What about muscles?

-Capillary friability -Decreased muscle mass & muscle weakness

**HYPERCORTISOLISM**: *Clinical Manifestations* -What happens to the skin?

-THIN SKIN -Purple striae & ecchymosis over abdomen, arms, & thighs

**HYPERCORTISOLISM**: *Clinical Manifestations* -What happens to sugar?

Glucose intolerance --> HYPERglycemia

**HYPERCORTISOLISM**: *Diagnosis* -What is measured?

ACTH

**HYPERCORTISOLISM**: *Diagnosis* -Primary HYPERcortisolism is what?

-adrenal -LOW ACTH

**HYPERCORTISOLISM**: *Diagnosis* -What is secondary hypercortisolism?

-pituitary -HIGH ACTH

**HYPERCORTISOLISM**: *Diagnosis* -What is increased?

Plasma cortisol

**HYPERCORTISOLISM**: *Diagnosis* -What can you use? (2)

1. 24-hour urinary free cortisol levels 2. Dexamethasone suppression test

**HYPERCORTISOLISM**: *Diagnosis* -What does the dexamethasone suppression test do?

Differentiates between pituitary causes & ectopic causes

**HYPERCORTISOLISM**: *Treatment* -What is treatment based on?

Etiology

**HYPERCORTISOLISM**: *Treatment* -What is the goal of treatment?

To normalize hormone secretion

**HYPERCORTISOLISM**: *Treatment* -What do you do if this is from excess drug use?

Exogenous dose reduction

**HYPERCORTISOLISM**: *Treatment* -What do you do if this is a pituitary disease?

Transsphenoidal hypophysectomy & laser ablation

**HYPERCORTISOLISM**: *Treatment* -What do you do if there's an adrenal tumor?

Unilateral adrenalectomy & radiation

**HYPERCORTISOLISM**: *Treatment* -What are chemotherapeutic agents used for?

To block cortisol production

Chapter 40 Part I Flashcards

Disorders of Endocrine Function (67 cards)