Term
| TSH levels increase, what is your thyroid gland doing? |
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Definition
| Cleaving thyroid hormones from thyroglobulin, increased iodide pump activity, increased iodination of tyrosin (forms T3 & T4), increased size, number, and activity of cells |
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Term
| What is TSH also known as? |
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Definition
| Thyrotropin, an anterior pit. hormone |
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Term
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Definition
| toxic goiter, graves, thyrotoxicosis, thyroid storm |
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Term
| New onset hyperthyroid can manifest as? |
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Definition
| a-fib, this is when docs usually order treatment regimens (to reduce risk of stroke) |
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Term
| Pt is restless, face flushed, skin moist, tachycardic, has an increased cardiac output, fatigue, insomnia, "wide-eyed stare", wt loss, what is cause? |
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Definition
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Term
| Thyroid function tests show what in hyperthyroid? |
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Definition
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Term
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Definition
| (anything that can cause a reduction in thyroid hormone output)drugs, defect in thyroid hormone synthesis, iodine deficincy |
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Term
| Are thyroid hormone levels in goiter normal or abnormal, why? |
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Definition
| normal, thyroid gland tissue has enlarged enough to compensate for the low output |
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Term
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Definition
| thyroxine (improves in 3-6 mons), surgery |
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Term
| hypothyroidism mostly starts as |
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Definition
| thyroiditis, then progressive deterioration to a fibrous gland with diminished or absent hormone production |
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Term
| leading cause of hyperthyroid |
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Definition
|
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Term
| activation of the cAMP system in the thyroid gland produces what? |
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Definition
| stimulates growth and output of T3/T4 |
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Term
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Definition
| exophthalmos, hyperthyroidism, dermopathy (lumpy reddish skin on legs/feet) |
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Term
| treatment of graves includes |
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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 |
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Term
| complications of subtotal thyroidectomy.....oops |
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Definition
| hypothyroid, hemmorage with trach compression, recurrent laryngeal nerve and superior laryngeal nerve (motor) damage (what may these cause?), inadvertent removal of parathyroid (hypoCa+) |
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Term
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Definition
| euthyroid 6-8 weeks, potassium iodide7-14 days prior to reduce hormone relase and vascularity, B blockers |
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Term
| pregs considerations for hyperthyroid |
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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 |
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Term
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Definition
| life threatining exacerbation of hyperthyroid (triggers-trauma, infection, illness, surgery) |
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Term
| life threatening symptoms of storm |
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Definition
| severe dehydration, CV instability, tachy, anxiety, LOC changes, excessive heat production |
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Term
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Definition
| cooling blanket, ice packs,cool humid O2, IV hydration, glucose, B blockers, dexamethasone, antithyroid drugs, vasopressors (direct acting why?) |
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Term
| a pt with a thyroid tumor that extends into sternum is at risk for what? |
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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) |
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Term
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Definition
| hypothermia (most common), delerium, hypoventilation, dilutional hypernatremia, bradycardia, treat with IV thyroxine or triiodothyronine |
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Term
| myxedema comma, emergency or back of the line? |
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Definition
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Term
| parathyroid hormone controls what two electrolytes |
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Definition
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Term
| parathyroid hormone depends on what to regulate its activity? |
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Definition
| serum Ca+ levels (low causes an increased release of hormone and high supresses its release |
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Term
| parathyroid hormone does what to Ca+ and phos levels |
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Definition
| it regulates, GI absorbtion, renal tubule reabsorbtion/filtration and bone release/uptake |
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Term
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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) |
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Term
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Definition
| mostly caused by a benign tumor, 90% (metastatic causes a very rapid increase in Ca+ levels) |
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Term
| hyperparathyroid symptoms |
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Definition
| HALLMARKS= increased serum and ionized Ca+, vomiting and dehydration (early) |
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Term
| bone disease in hyperparathyroid? |
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Definition
| osteitis fibrosa cystica (positioning can be problamatic) |
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Term
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Definition
| released from thyroid gland, weakly antagonizes PTH, promotes Ca+ bone deposition |
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Term
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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 |
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Term
| adrenal medulla secretes what |
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Definition
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Term
| what adrenal cortex zone is responsible for aldeosterone, and responds to potassium concentration |
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Definition
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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? |
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Definition
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Term
| 4 stimuli that cause release of aldosterone, and from what part of the cortex? |
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Definition
| K concentration & angiotension II (both increase) Na concentration (decreases), ACTH from ant. pit. |
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Term
| what two ions are responsibile for the symptoms in hyperaldesteronism and what are there levels? |
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Definition
| hyperNa, and hypoK causes headache, HTN, and metabolic acidosis |
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Term
| why would spironolactone work for hyperaldesteronism? |
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Definition
| it antagonizes aldesterone in the collecting tubule, preventing Na reabsorption and K excretion |
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Term
| why do patients on steroids have a rise in serum glucose? |
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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 |
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Term
| what increases the release of ACTH from the ant. pit. which causes increased levels of cortisol? |
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Definition
| any type of STRESS (hot/cold, surgery, infection, trauma, sympathetic drugs, etc) |
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Term
| what is cortisol's role in catecholamines? |
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Definition
| maintains synthesis, synthesizes B receptors and regulates the receptor responsiveness, contributes to vascular permeability, tone, and cardiac contractility |
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Term
| why is cortisol used for inflammation? |
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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) |
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Term
| where is ACTH released from? |
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Definition
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Term
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Definition
| hyperglycemia, weight gain, water retention, HTN, hypoK, telangiectasis, moonface, buffalo hump, |
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Term
| what cancerous tumor can cushings be associated with? |
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Definition
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Term
| what is the number one cause of hypothalmic-pituitary axis dysfunction? |
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Definition
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Term
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Definition
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Term
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Definition
| an autoimmune destruction of the adrenal glands, causing decreased glucocorticoids, mineralocorticoids, or androgens |
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Term
| what steroid dose puts a patient at risk for hypothalamic-pit. axis supression? |
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Definition
| greater than 5mg for more than two weeks in the previous 12 months |
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Term
| suggested hydrocortisone dose for a patient with axis depression |
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Definition
| 100mg every 8 hours started the evening prior to surgery |
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Term
| how long does it take a patients adrenals to recover after steroid therapy? |
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Definition
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Term
| patients who had been taking less than 5 mg of prednisone a day should have what considerations prior to surgery |
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Definition
| no axis supression should occur, so they should get their normal dose prior to surgery, no supplimentation required |
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Term
| what airway considerations are present in a patient with acromegaly? |
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Definition
| huge epiglottis and tounge, increased mandible length, masses in pharynx, abnormal chord movement and hoarseness, cricoarytenoid joints may be stretched, stridor, and dyspnea |
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Term
| release of hormones from what 2 endocrine glands is regulated exclusively by nerve activity? |
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Definition
| adrenal medulla, post pit. |
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Term
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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 |
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Term
| lab values for hypothyroidism |
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Definition
| low t3/t4 with increased TSH (primary), low t3/t4 with low TSH (secondary) |
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Term
| most common cause of primary hypothyroidism |
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Definition
| radioactive ablation or surgery of gland (hashimotos is idiopathic and 2nd most common cause) |
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Term
| symptoms of hypothyroidism |
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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 |
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Term
| cardiac changes with increased t3/t4 |
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Definition
| decreased svr, volume retention, increased contractility, tachy |
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Term
| LONG TERM hyperthyroidism can have what cardiac effects |
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Definition
| poor cardiac contractility, low CO, s=sx of heart failure (s3 & pulm. congestion) |
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