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Endocrine 2
second half of endocrine lecture
60
Physiology
Graduate
07/15/2009

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Term
TSH levels increase, what is your thyroid gland doing?
Definition
Cleaving thyroid hormones from thyroglobulin, increased iodide pump activity, increased iodination of tyrosin (forms T3 & T4), increased size, number, and activity of cells
Term
What is TSH also known as?
Definition
Thyrotropin, an anterior pit. hormone
Term
Causes of hyperthyroid?
Definition
toxic goiter, graves, thyrotoxicosis, thyroid storm
Term
New onset hyperthyroid can manifest as?
Definition
a-fib, this is when docs usually order treatment regimens (to reduce risk of stroke)
Term
Pt is restless, face flushed, skin moist, tachycardic, has an increased cardiac output, fatigue, insomnia, "wide-eyed stare", wt loss, what is cause?
Definition
hyperthyroid
Term
Thyroid function tests show what in hyperthyroid?
Definition
elevated T3/T4, low TSH
Term
Goiter is caused by
Definition
(anything that can cause a reduction in thyroid hormone output)drugs, defect in thyroid hormone synthesis, iodine deficincy
Term
Are thyroid hormone levels in goiter normal or abnormal, why?
Definition
normal, thyroid gland tissue has enlarged enough to compensate for the low output
Term
goiter tx
Definition
thyroxine (improves in 3-6 mons), surgery
Term
hypothyroidism mostly starts as
Definition
thyroiditis, then progressive deterioration to a fibrous gland with diminished or absent hormone production
Term
leading cause of hyperthyroid
Definition
graves (females 20-40)
Term
activation of the cAMP system in the thyroid gland produces what?
Definition
stimulates growth and output of T3/T4
Term
graves triad
Definition
exophthalmos, hyperthyroidism, dermopathy (lumpy reddish skin on legs/feet)
Term
treatment of graves includes
Definition
proplythiouracil and methimazole cause interference of hormone formation (euthyroid in 6-8 weeks), iodide inhibits hormone release (storage increases) EFFECT IS IMMEDIATE use for storm or emergency, propranolol inhibits B effects AND reduces T4 to T3 conversion, radioactive iodine if all else fails high 80-98% remission(may cause hypoth), surgery
Term
complications of subtotal thyroidectomy.....oops
Definition
hypothyroid, hemmorage with trach compression, recurrent laryngeal nerve and superior laryngeal nerve (motor) damage (what may these cause?), inadvertent removal of parathyroid (hypoCa+)
Term
prep for thyroidectomy
Definition
euthyroid 6-8 weeks, potassium iodide7-14 days prior to reduce hormone relase and vascularity, B blockers
Term
pregs considerations for hyperthyroid
Definition
no radioactive iodine (goiter in infant) or propranolol (intrautering growth retardation), antithyroid drugs do not cross placents (preffered tx), thyroidectomy only choice if durgs dont work
Term
thyroid stizzorm
Definition
life threatining exacerbation of hyperthyroid (triggers-trauma, infection, illness, surgery)
Term
life threatening symptoms of storm
Definition
severe dehydration, CV instability, tachy, anxiety, LOC changes, excessive heat production
Term
storm tx
Definition
cooling blanket, ice packs,cool humid O2, IV hydration, glucose, B blockers, dexamethasone, antithyroid drugs, vasopressors (direct acting why?)
Term
a pt with a thyroid tumor that extends into sternum is at risk for what?
Definition
airway obstruction/collapse when you paralyze or decerase their muscle function (airway muscles and neg pressure were holding airway open against the tumor pressure)
Term
myxedema coma symptoms
Definition
hypothermia (most common), delerium, hypoventilation, dilutional hypernatremia, bradycardia, treat with IV thyroxine or triiodothyronine
Term
myxedema comma, emergency or back of the line?
Definition
emergency
Term
parathyroid hormone controls what two electrolytes
Definition
Ca+ and phos
Term
parathyroid hormone depends on what to regulate its activity?
Definition
serum Ca+ levels (low causes an increased release of hormone and high supresses its release
Term
parathyroid hormone does what to Ca+ and phos levels
Definition
it regulates, GI absorbtion, renal tubule reabsorbtion/filtration and bone release/uptake
Term
renal PTH effects
Definition
increases Ca reabsorbtion in late distal convoluted tubule and collecting tubule, and it increases excretion by lowering the serum threshold for phosphate (the threshold is the cutoff at which the proximal tubule stops reabsorbing phos)
Term
hyperparathyroidism
Definition
mostly caused by a benign tumor, 90% (metastatic causes a very rapid increase in Ca+ levels)
Term
hyperparathyroid symptoms
Definition
HALLMARKS= increased serum and ionized Ca+, vomiting and dehydration (early)
Term
bone disease in hyperparathyroid?
Definition
osteitis fibrosa cystica (positioning can be problamatic)
Term
calcitonin
Definition
released from thyroid gland, weakly antagonizes PTH, promotes Ca+ bone deposition
Term
hypoparathyroid symptoms
Definition
like hypo Ca+, circumoral parasthesia, nuronal muscular irritability, tetany, chvosteks (facial twitching with taping on mandible angle) trousseaus (carpopedal spasm after three minutes of ischemia courtesy of a tourniquet) and laryngo/broncho spasms manifesting as inspiratory stridor and wheezing
Term
adrenal medulla secretes what
Definition
epi, norepi
Term
what adrenal cortex zone is responsible for aldeosterone, and responds to potassium concentration
Definition
zonus glomerulosa
Term
if a patient had an anterior pit tumor that caused a hypersecretion of the hormone ACTH, what zone of the adrenal cortex would be effected?
Definition
zonus fasciculata
Term
4 stimuli that cause release of aldosterone, and from what part of the cortex?
Definition
K concentration & angiotension II (both increase) Na concentration (decreases), ACTH from ant. pit.
Term
what two ions are responsibile for the symptoms in hyperaldesteronism and what are there levels?
Definition
hyperNa, and hypoK causes headache, HTN, and metabolic acidosis
Term
why would spironolactone work for hyperaldesteronism?
Definition
it antagonizes aldesterone in the collecting tubule, preventing Na reabsorption and K excretion
Term
why do patients on steroids have a rise in serum glucose?
Definition
cortisol causes mobilization of amino acids from muscle cells for gluconeogenesis, they increase the glucose production from fat and carbs, they also inhibit the uptake of glucose into the cells
Term
what increases the release of ACTH from the ant. pit. which causes increased levels of cortisol?
Definition
any type of STRESS (hot/cold, surgery, infection, trauma, sympathetic drugs, etc)
Term
what is cortisol's role in catecholamines?
Definition
maintains synthesis, synthesizes B receptors and regulates the receptor responsiveness, contributes to vascular permeability, tone, and cardiac contractility
Term
why is cortisol used for inflammation?
Definition
stabelizes lysosome membranes, decreases capillary permeability, decreases WBC phagocytosis and migration, supresses lymphocyte reproduction, stops fever (reduces the release of interleukin 1 from WBC)
Term
where is ACTH released from?
Definition
ant. pit.
Term
cushings symptoms
Definition
hyperglycemia, weight gain, water retention, HTN, hypoK, telangiectasis, moonface, buffalo hump,
Term
what cancerous tumor can cushings be associated with?
Definition
oats cell
Term
what is the number one cause of hypothalmic-pituitary axis dysfunction?
Definition
steroids
Term
who had addisons?
Definition
JFK
Term
addisons is.....
Definition
an autoimmune destruction of the adrenal glands, causing decreased glucocorticoids, mineralocorticoids, or androgens
Term
what steroid dose puts a patient at risk for hypothalamic-pit. axis supression?
Definition
greater than 5mg for more than two weeks in the previous 12 months
Term
suggested hydrocortisone dose for a patient with axis depression
Definition
100mg every 8 hours started the evening prior to surgery
Term
how long does it take a patients adrenals to recover after steroid therapy?
Definition
6-12 months
Term
patients who had been taking less than 5 mg of prednisone a day should have what considerations prior to surgery
Definition
no axis supression should occur, so they should get their normal dose prior to surgery, no supplimentation required
Term
what airway considerations are present in a patient with acromegaly?
Definition
huge epiglottis and tounge, increased mandible length, masses in pharynx, abnormal chord movement and hoarseness, cricoarytenoid joints may be stretched, stridor, and dyspnea
Term
release of hormones from what 2 endocrine glands is regulated exclusively by nerve activity?
Definition
adrenal medulla, post pit.
Term
stages of inflammation?
Definition
tissur release of chemiclas (histamine, bradykinin, prostaglandins, etc.), local vasodilation (erythemia), capillary leakage (edema), interstitial clotting (factor leakage which walls off area), granulocytes and monocytes move in
Term
lab values for hypothyroidism
Definition
low t3/t4 with increased TSH (primary), low t3/t4 with low TSH (secondary)
Term
most common cause of primary hypothyroidism
Definition
radioactive ablation or surgery of gland (hashimotos is idiopathic and 2nd most common cause)
Term
symptoms of hypothyroidism
Definition
fatigue, listlessness, apathy, slowed speech, dull intelect, cold intolerance, decreased sweating, wt gain, large tounge, hoarse voice, pariorbital edema, vent dysrythmias, brady, inc. svr, reduced contractility and baroreceptor fxn, pericardial and pleural effusions, decreased ventilatory response to hypoxia and hyprecarbia, illeus (bowel obstruct), uterine bleeding
Term
cardiac changes with increased t3/t4
Definition
decreased svr, volume retention, increased contractility, tachy
Term
LONG TERM hyperthyroidism can have what cardiac effects
Definition
poor cardiac contractility, low CO, s=sx of heart failure (s3 & pulm. congestion)
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