700 - Sys Path > Lecture 9 > Flashcards

Lecture 9 Flashcards

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1
Q

Hypothyroidism

Definition

A
  • Underactivity of the thyroid gland caused by any structural or functional change, resulting in inadequate production of thyroid hormones
  • Dysfunction can occur anywhere along the hypothalamic-pituitary-thyroid axis
  • Very common, especially among older people and women
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2
Q

Causes of Hypothyroidism

For Primary, Secondary, and Tertiary

A
  • Primary
  • Autoimmune (Hashimoto thyroiditis) – most common in North America
  • absence/loss of thyroid parenchyma or hypertrophy of thyroid gland
  • Iodine deficiency – most common worldwide
  • Surgical or radiation-induced ablation of tissue
  • Congenital agenesis/dysgenesis
  • Drugs (lithium, iodides)
  • Secondary
  • Pituitary failure (lesion, tumour)
  • Tertiary (rare)
  • Hypothalamic failure
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3
Q

General Signs and Symptoms of Hypothyroidism

A
  • Most common signs and symptoms include
  • Fatigue
  • Weight gain
  • trouble tolerating cold
  • joint and muscle pain
  • dry skin or dry, thinning hair
  • heavy or irregular menstrual periods
  • fertility issues
  • slowed heart rate
  • constipation
  • depression
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4
Q

General Signs and Symptoms of Hypothyroidism

A
  • Other signs and symptoms include
  • May be mistaken for depression/dementia, especially in older persons
  • Mental slowing, apathy, tiredness
  • Potential goiter
  • Hoarsening of voice
  • Drooping eyelids
  • Pale, puffy face
  • Muscle weakness in extremities
  • Carpal Tunnel Syndrome
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5
Q

Hypothyroidism

Myxedema

A
  • Myxedema is a word used to describes severe
    hypothyroidism
  • It is also used to describe dermatological changes
    seen with severe hypothyroidism
  • Though the mechanism is not fully understood, high levels of TSH lead to the deposition of mucopolysaccharides in the dermis
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6
Q

Hypothyroidism

Complications

A
  • Cardiovascular disease
  • Infertility
  • Myxedema coma (decompensated thyroid)
  • Bradypnea, seizures, LBP, hyponatremia and decreased blood flow to the brain
  • Triggered by physical stress, infection, injury, surgery
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7
Q

Hypothyroidism

Diagnosis

A
  • Thyroid blood panel: TSH, T3, T4, and free T4
  • Often includes antithyroid antibody tests as well
  • Yearly test for people 65+
  • Suggested every 5 years in healthy individuals 35 and up
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8
Q

Hypothyroidism

Treatment

A
  • Hormone replacement
  • often synthetic T4 (Synthroid)
  • Dosage starts low and is gradually increased until TSH levels are WNL
  • May need increased dosage during pregnancy
  • Emergency situations may require IV T3 and T4
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9
Q

Congenital Hypothyroidism

Definition

A
  • Hypothyroidism that develops in infancy or early childhood
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10
Q

Congenital Hypothyroidism

Cause

A
  • Prolonged iodine deficiency
  • Himalayas, China, Africa, and mountainous regions
  • Congenital errors in metabolism and enzyme deficiencies
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11
Q

Congenital Hypothyroidism

Signs and Symptoms

A
  • Stunted physical and mental growth
  • Impaired development of skeletal system and central nervous system
  • Coarse facial features
  • Protruding tongue
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12
Q

Hashimoto’s Thyroiditis

Definition

A
  • Chronic, autoimmune inflammation of the thyroid gland
  • Body is unable to recognize its own thyroid gland/enzymes
  • Antibodies attack and destroy gland
  • Anti-TPO antibodies
  • Anti-Tg antibodies
  • Most common type of thyroiditis and the most common cause of hypothyroidism in North America
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13
Q

Hashimoto’s Thyroiditis

Etiology

A
  • Autoimmune disorder with family predisposition
  • People often have other endocrine disorders
  • Diabetes, underactive adrenals, underactive parathyroid glands
  • People often have other autoimmune disorders
  • Pernicious anemia, RA, Sjögren’s syndrome, systemic lupus erythematosus
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14
Q

Hashimoto’s Thyroiditis

Epidemiology

A
  • 7x more common in women, especially older women
  • Incidence: 0.8 per 1000 per year in men and 3.5 per 1000 per year in women
  • Although the disease may occur in teens or young women, it more often develops in women ages 30 to 50
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15
Q

Hashimoto’s Thyroiditis

Signs and Symptoms

A
  • Usually will have classic hypothyroid SSx
  • May lead to a goiter
  • Fatigue
  • Depression
  • Weight gain
  • Pale, puffy face
  • Bradycardia
  • Cold intolerance
  • Constipation
  • Dry, thinning hair and skin
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16
Q

Hashimoto’s Thyroiditis

Diagnosis

A
  • Physical exam w/ palpable thyroid (physical changes not always palpable)
  • Serum thyroid panel to measure TSH, T3, and T4
  • Serum antibody tests and high inflammatory markers
  • Anti-thyroglobulin and anti-TPO
  • CRP level and ESR
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17
Q

Hashimoto’s Thyroiditis

Treatment

A
  • No specific Tx for the autoimmune reaction
  • Most develop hypothyroidism
  • Lifelong hormone replacement (Synthroid)
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18
Q

Massage and Hashimoto’s Thyroiditis

A
  • No contraindications
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19
Q

Iodine Deficiency

Iodine

A
  • Thyroid contains most of body’s iodine, it is an essential component of T4 and T3
  • Found in ocean/sea water
  • Through evaporation and rain, iodine enters soil near sea
  • In North America, table salt is fortified with iodine
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20
Q

Iodine Deficiency

A
  • Rare in North America, d/t table salt fortification
  • Risk factors: high altitudes, far from sea
  • Deficiency causes goiter, as thyroid tries to “capture” more iodine
  • Can result in:
  • Hypothyroidism d/t inability to make T4 and T3
  • Hyperthyroidism d/t increase incidence of diffuse and nodular goiter => autonomous growth and fxn may occur => toxic goiter/hyperthyroidism
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21
Q

Iodine Deficiency

Diagnosis

A
  • Serum thyroid hormone tests
  • high TSH, low T3/T4
  • Urine iodine test
  • Thyroid ultrasound
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22
Q

Iodine Deficiency

Treatment

A
  • Oral iodine supplementation
  • And/or obtain through diet
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23
Q

Massage and Iodine Deficiency

A
  • No contraindications
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24
Q

Hyperthyroidism

Definition

A
  • Over activity of the thyroid gland that leads to high levels of thyroid hormone
  • Affects ~1% of population
  • 10x more common in women, more common in those over 60
  • MC cause: Grave’s disease
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25
# Hyperthyroidism Causes of Hyperthyroidism
* Grave’s disease is most common cause * Autoimmune hyperthyroid disease * Toxic thyroid nodules (Plummer’s disease) is the second most common * Thyroid gland nodules that secrete TH w/o stimulation * Thyroiditis * Inflammation of thyroid gland * Eventual hypothyroidism d/t depletion of hormones * Potential to return to normal function * Inflammation d/t toxic substances or radiation * Overactive pituitary gland (rare)
26
# Hyperthyroidism General Signs and Symptoms of Hyperthyroidism
* weight loss * increased HR and BP, arrhythmias * Hyperhidrosis * feeling of nervousness/anxiety * higher body temperature * Tremors * Frequent BM and diarrhea * Uncontrolled hyperthyroidism can lead to a thyroid storm * High blood pressure * High fever * Vomiting/diarrhea * MI
27
# Hyperthyroidism Diagnosis
* suspected based on SSx * Thyroid blood panel: TSH, T3, T4, and free T4 * Often includes antithyroid antibody tests as well * Primary: low TSH, high T3 and T4 * Pituitary: high TSH, high T3 and T4 * Depending on the cause, may use imaging to scan the thyroid
28
# Hyperthyroidism Treatment
* **Beta-blockers** * Slows HR, thus controlling BP, tremors, and anxiety * **Anti-thyroid drugs** * Inhibit production of thyroid hormone * **Radioactive iodine (po)** * Destroys part of thyroid gland w/o effecting the body as a whole * Not given to pregnant/nursing women * Crosses placenta and breastmilk, destroys infant thyroid * May set off radiation alarms for several weeks
29
# Hyperthyroidism Treatment ct’d
* Thyroidectomy * Candidates: young; large goiter; drug allergy * Often results in hypothyroidism and lifelong hormone replacement
30
# Hyperthyroidism Complications
* If untreated, places undue stress on heart and other organs * CHF, stroke, renal failure
31
# Grave’s Disease Definition
* Overproduction of thyroid hormone due to autoimmune stimulation of the thyroid gland * Anti-TSH receptor antibodies that stimulate the thyroid * Most common cause of hyperthyroidism in North America
32
# Grave’s Disease Etiology
* Autoimmune disorder with family predisposition * People often have other endocrine disorders * Diabetes, underactive adrenals, underactive parathyroid glands * People often have other autoimmune disorders * Pernicious anemia, RA, Sjögren's syndrome, systemic lupus erythematosus
33
# Grave’s Disease Epidemiology
* 4x more common in women * Affects about one in 200 people * Although the disease may occur at any age, it more often develops in over 30 years old
34
# Grave’s Disease Signs and Symptoms
* Will have classic hyperthyroid SSx * weight loss * increased HR and BP, arrhythmias * Hyperhidrosis * feeling of nervousness/anxiety * higher body temperature * Tremors * Frequent BM and diarrhea
35
# Grave’s Disease Signs and Symptoms Specific to Grave’s Disease | Myxedema
* Because TSH stimulates fibroblasts * Deposition of excessive connective tissue components leading to edema * Commonly occurs on the shins (pretibial myxedema) * Puffiness around eyes * When occurring behind the eyes, leads to exophthalmos
36
# Grave’s Disease Signs and Symptoms Specific to Grave’s Disease | Exophthalmos
* Forward protruding eyes and the presence of staring
37
# Grave’s Disease Diagnosis
* Serum thyroid panel to measure TSH, T3, and T4 * Serum antibody tests and high inflammatory markers * Anti-TSH receptor antibodies * CRP level and ESR
38
# Grave’s Disease Treatment
* No specific Tx for the autoimmune reaction * Beta-blockers * Antithyroid medications * Reduction of iodine in the diet * Possible thyroidectomy
39
Massage and Grave’s Disease
No contraindications
40
# Thyroid Cancer Definition
* malignant tumour of the thyroid gland
41
# Thyroid Cancer Etiology
* The most significant risk factor is exposure to radiation, especially during childhood
42
# Thyroid Cancer Epidemiology
* 53,990 new cases and 2060 cancer deaths per year in the US * Women are 3x more likely to develop
43
# Thyroid Cancer Signs and Symptoms
* The most common sign is a solitary nodule on the anterior throat * Dysphagia * Hoarseness * Neck pain
44
# Thyroid Cancer Diagnosis
* Imaging and biopsy used to confirm diagnosis
45
# Thyroid Cancer Treatment
* Surgical excision of the tumour or of the thyroid * Will require lifelong HRT with thyroid hormone * Chemotherapy, radiation, radioactive iodine may all be used
45
# Thyroid Cancer Prognosis
* Localized (only in the thyroid): 100% 5-year survival rate * Regional (cancer has spread to nearby lymph nodes: 98% 5-year survival rate * Distant (metastasis to other organs): 54% 5-year survival rate
46
Massage and Thyroid Cancer
* No contraindications
47
# Diabetes Mellitus
* Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia
48
# Diabetes Mellitus Two Main Types
* Type I diabetes mellitus is caused by autoimmune destruction of pancreatic beta cells leading to insulin deficiency * Type II diabetes mellitus is caused by insulin resistance and is related to metabolic syndrome
49
# Diabetes Mellitus Type I Definition
* Autoimmune destruction of the pancreatic beta cells leading to the absence of insulin and therefore hyperglycemia * One of the MC chronic disease in childhood * Can be onset in childhood or adulthood * More common in childhood * Genetics play a role but less so than in type II diabetes
50
# Diabetes Mellitus Type I Etiology
* Autoimmune destruction of the pancreatic beta cells leading to absolute insulin deficiency * Genetics play a role but less so than in type II diabetes
51
# Diabetes Mellitus Type I Epidemiology
* Approximately 300,000 Canadians have type 1 diabetes
52
# Diabetes Mellitus Type I Signs and Symptoms | m/c s&s
* Most common signs and symptoms * polydipsia, polyuria, polyphagia * weight loss * Opportunistic infections like candidiasis, acute visual disturbances
53
# Diabetes Mellitus Type I Diabetic Ketoacidosis
* Severe polydipsia, polyuria, weight loss + acidosis * Acidosis presents as fruity smelling breath, possible neurologic findings (drowsiness, lethargy) * SSx evolve rapidly over 24hr period
54
# Diabetes Mellitus Type I Diagnosis
* Fasting glucose (on more than one occasion) * Random glucose * OGTT * Insulin or C-peptide * Testing for autoantibodies * HbA1c
55
# Diabetes Mellitus Type I Treatment
* Continual glucose monitoring with insulin therapy * Patient education – hypoglycemia SSx, CGM, blood glucose monitoring
56
Massage and Diabetes Mellitus Type I
* Local contraindications around areas of insulin injection and glucose monitor/insulin pump
57
# Diabetes Mellitus Type II Definition
* The development of insulin resistance due to long standing metabolic syndrome * Characterized by hyperglycemia due to insulin and can result in the progressive loss of insulin secretion from the pancreatic beta cells * More common than type I diabetes
58
# Diabetes Mellitus Type II Etiology
* Strong genetic role in etiology * DMII often found accompanied by other signs of metabolic syndrome * HTN * Dyslipidemia (elevated TG, lowered HDL) * Central obesity
59
# Diabetes Mellitus Type II Signs and Symptoms
* Asymptomatic (40%) * Common SSx (which are d/t hyperglycemia): * Polyuria * Polydipsia * Nocturia * Acanthosis nigricans * HTN, dyslipidemia * DMII very rarely can present as DKA
60
# Diabetes Mellitus Type II Diagnosis
* Fasting glucose (on more than one occasion) * Random glucose * OGTT * Insulin or C-peptide * Testing for autoantibodies * HbA1c
61
# Diabetes Mellitus Type II Complications
* Cardiovascular disease * Nerve damage in periphery * Other nerve damage * Arrhythmias, digestive upset, ED * Kidney disease * Eye damage * Skin conditions * Slow healing
62
# Diabetes Mellitus Type II Treatment
* Healthy eating * Regular exercise * Weight loss * Possibly, diabetes medication or insulin therapy * Metformin * Sulfonylureas (glyburide) * Advanced disease may require insulin therapy
63
Massage and Diabetes Mellitus Type II
* No contraindications unless patient is using insulin or has a glucose monitor (local contraindications)
700 - Sys Path
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