Term
| 2 types of hormone producing cells |
|
Definition
| follicular and parafollicular cells |
|
|
Term
| cells that produce, store, and release thyroxine (T4) and triidothyronine |
|
Definition
|
|
Term
| major regulator of basal metabolic rate |
|
Definition
|
|
Term
|
Definition
T3 = MIT + DIT
T4 = DIT + DIT |
|
|
Term
| what is the majority of circulating thyroid hormone? |
|
Definition
|
|
Term
| what is the most active form of thyroid hormone? |
|
Definition
|
|
Term
| these cells secrete calcitonin |
|
Definition
|
|
Term
|
Definition
| decrease serum calcium levels through inhibition of osteoclastic activity |
|
|
Term
| what affects calcitonin secretion? |
|
Definition
| serum estrogen and vitamin D levels |
|
|
Term
| solitary thyroid nodules in who has an increased risk of malignancy |
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Definition
|
|
Term
| raising the arms above the head leads to compression of the thoracic outlet inlet and engorgment of the head and neck and a feeling of strangulation |
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Definition
|
|
Term
| when is TSH increased vs decreased |
|
Definition
increased = underactivty (Hashimoto's)
decreased = thyrotoxicosis |
|
|
Term
| what should you do with FHx of MEN-2? |
|
Definition
| screen urine for catecholamines |
|
|
Term
| definitive diagnostic test for thyroid nodules? |
|
Definition
|
|
Term
| what is necessary with an indeterminate FNA |
|
Definition
|
|
Term
| when is a solitary cystic nodule considered resolved? |
|
Definition
| if the fluid has negative cytology and the mass disappears |
|
|
Term
| what is the treatment of solid, benign thyroid nodules? |
|
Definition
| follow up in 3-6m, thyroid hormone PO to suppress tumor growth, re-aspirate if it remains the same size, continue supression meds if it shrinks, surgical excession if it grows |
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|
Term
| treatment of cancerous thyroid nodules |
|
Definition
surgical lobectomy and isthectomy to remove the ipsilateral lobe.
Pathology must confirm the dx.
Total thyroid removal may be needed in a few days. |
|
|
Term
| Can the parathyroid glands be saved with complete thyroid excision? |
|
Definition
| yes, they are autografted into the SCM. |
|
|
Term
| what is the complication of thyroid surgery? |
|
Definition
| recurrent laryngeal nerve injury --> paralysis of the ipsilateral vocal cord --> a weak, breathy voice |
|
|
Term
| bilateral laryngeal nerve injury leads to what? |
|
Definition
| loss of speech and airway control. Requires tracheostomy |
|
|
Term
| what does loss of the external branch of the superior laryngeal nerve lead to? |
|
Definition
|
|
Term
|
Definition
| Graves disease, diffuse toxic goiter |
|
|
Term
| gynecologic cause of hyperthyroidism |
|
Definition
| hyperactive thyroid tissue is found in an ovarian teratoma or dermoid |
|
|
Term
| expected labs in thyroid caused hyperthyroidism? pituitary caused? thyroid antibody caused? |
|
Definition
thyroid = decreased TSH, increased TFT
pituitary = increased TSH
thyroid antibody (IgG) = directed against follicular cells, results in markedly elevated T3&T4. |
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|
Term
| treatment of hyperthyroidism |
|
Definition
medical blockade of the hormone: PTU, tapazole.
Subtotal or total thyroidectomy
Radioiodine ablatio of active thyroid tissue: potassium iodide or Lugol's solution. |
|
|
Term
|
Definition
| nervous, restless, emotional lability, rapid speech, fine tremor, tachycardia, palpitations, arrhythmias, dyspnea, lid lag, proptosis, exopthalmos, increased sweating, fatigue, weakness, hair loss, leg swelling, pretibial myxedema |
|
|
Term
| when is thyroidectomy chosen over meds? |
|
Definition
| pregnancy, pts that wish to become pregnant, med non-compliance, iodine allergy, and refusal for ablation |
|
|
Term
| solitary thyroid tumor that produces excess thyroid hormone. Malignancy is rare. |
|
Definition
|
|
Term
| how does a toxic adenoma appear on thyroid scan? |
|
Definition
|
|
Term
| treatment of a thyroid adenoma |
|
Definition
| pre-op prep with propranalol or a thionamide. Surgical excision via lobectomy |
|
|
Term
| who is thyroid cancer more common in, men or women? |
|
Definition
|
|
Term
| what is the dual carcinogenic role of radiation in thyroid cancer? |
|
Definition
| disrupts cellular DNA and induces chronic TSH stimulation by damaging the production of thyroid hormone |
|
|
Term
| painless thyroid nodule and hoarseness |
|
Definition
|
|
Term
| in thyroid cancer what does a cold nodule mean? |
|
Definition
| low levels of tracer uptake, minimal function (%5 = malignant) |
|
|
Term
| in thyroid cancer what does a hot nodule mean? |
|
Definition
| increased uptake of tracer = benign |
|
|
Term
| what is used to dx thyroid cancer? |
|
Definition
| TFT, thyroid U/S, FNA, radionuclide thyroid scan |
|
|
Term
| thyroid cancer that is aggressive with increased malignancy, poor prognosis, surgery is done for palliative airway relief |
|
Definition
|
|
Term
| survival rate of anaplastic thyroid cancer |
|
Definition
|
|
Term
| type of thyroid cancer seen as part of MEN2A or 2B, autosomal dominant inheritance, early mets to cervical nodes |
|
Definition
|
|
Term
| treatment for medullary thyroid cancer |
|
Definition
| total thyroidectomy, lymph node dissection |
|
|
Term
| thyroid cancer that is common in iodide-deficient areas, tumors invade via hematogenous spread |
|
Definition
| follicular thyroid cancer |
|
|
Term
| common sites of mets from follicular thyroid cancer |
|
Definition
| brain, bone, lungs, and liver |
|
|
Term
| most common thyroid malignancy in the US |
|
Definition
|
|
Term
| type of thyroid cancer that grows slowly and spreads via lymph, usually has an excellent prognosis, associated with exposure to ionizing radiation |
|
Definition
|
|
Term
| treatment of papillary thyroid cancer? |
|
Definition
| total thyroidectomy produces less recurrence |
|
|
Term
| what supplies blood to the parathyroid glands? |
|
Definition
| multiple branches of the inferior thyroid arteries |
|
|
Term
| venous drainage of the parathyroid gland is via? |
|
Definition
| internal jugular, subclavian, innominate veins |
|
|
Term
| function of the parathyroid glands? |
|
Definition
| regulate calcium homeostasis with vitamin D, magnesium, and calcitonin |
|
|
Term
|
Definition
| cardiac and neuromuscular conduction, catalyzes many cellular processes, is an essential part of the skeleton. |
|
|
Term
|
Definition
directly increase calcium resorption in proximal convoluted tubule --> PO3 clearance.
Directly mobilizes calcium from bone via osteoclast activation and bone resorption.
Directly increases GI absorption of calcium via stimulation of vitamin D production |
|
|
Term
| who is hyperparathyroidism more common in, men or women? |
|
Definition
|
|
Term
| 90% of hyperparathyroidism arises from what? The other 10% arise from what? |
|
Definition
| 90% from a single hyperfunctioning adenoma. 10% from MEN I or II disease. |
|
|
Term
| risk factors for hyperparathyroidism |
|
Definition
| childhood radiation therapy (head and neck), + FHx of MEN disease |
|
|
Term
| pathophys of primary hyperparathyroidism |
|
Definition
| excess PTH --> increased calcium and decreased phosphate = osteoperosis, bony mineral loss, panreatitis, PUD, nephrolithiasis, HTN, gout, pseudogout |
|
|
Term
| pathophys of secondary hyperparathyroidism |
|
Definition
| with renal disease, increased phosphate --> depression of serum calcium levels --> PTH stimulation by hyperplastic glands |
|
|
Term
| pathophys of tertiary hyperparathyroidism |
|
Definition
| seen in ESRD and dialysis patients. |
|
|
Term
| sxs of hyperparathyroidism |
|
Definition
| bones, stones, abdominal groans, psychic moans, and fatigue overtones |
|
|
Term
| dx of hyperparathyroidism |
|
Definition
| PE - unremarkable. Labs = persistent hypercalcemia, increased serum PTH, increased alk phos with bony disease (malignancy) |
|
|
Term
| treatment of hyperparathyroidism |
|
Definition
tumor location by US, CT, or nuclear scan.
pre-op Tc-sestamibi scanning and intra-op rapid PTH immunoassay.
Surgical excsision |
|
|
Term
| strength of evidence behind potential benefits of parathyroid surgery |
|
Definition
strongest: improved bone health, improved sense of well being and quality of life, reduction in risk of kidney stones.
Intermediate: improvement in musclar and skeletal complaints, impovement in abdominal complaints.
Weakest: improved blood pressure, reduced risk of diabetes, reduced risk of early death from CVD |
|
|
Term
| hyperparathyroid post op complications |
|
Definition
hypocalcemia
tx = calcium supplementation (PO, IV) |
|
|
Term
|
Definition
| perioral numbness, paresthesias, carpopedal spasm, seizures |
|
|
Term
| tapping on the facial nerve --> facial muscle spasm |
|
Definition
|
|
Term
| where is the pituitary gland located? |
|
Definition
|
|
Term
| where is the pituitary gland located? |
|
Definition
|
|
Term
| MC visual defect from pituitary tumors |
|
Definition
|
|
Term
| what CN are near the pituitary gland? |
|
Definition
| 3,4,5,6 and the carotid arteries |
|
|
Term
| anterior pituitary hormones |
|
Definition
| prolactin, GH, FSH, LH, ACTH, thyrotropin |
|
|
Term
| posterior pituitary hormones |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
headache
girls = irreg. menses, amenorrhea, galactorrhea.
boys = gynecomastia, sexual dysfunction |
|
|
Term
| how do you dx a prolactinoma? |
|
Definition
| serum prolacin > 300, MRI |
|
|
Term
| treatment of prolactinoma |
|
Definition
| trial of bromocriptine, transphenoidal resection |
|
|
Term
| overproduction of GH, almost exclusively from a pituitary adenoma, hallmark = bony overgrowth |
|
Definition
|
|
Term
|
Definition
| diaphoresis, fatigue, headache, voice changes, arthralgias, malocclusion |
|
|
Term
| how do you dx acromegaly? |
|
Definition
| increased GH levels not suppressed by insulin challenge, insulin resistance, MRI |
|
|
Term
|
Definition
| resection, RT, bromocriptine |
|
|
Term
| sxs of FSH and LH hypersecretion |
|
Definition
| headache, visual field changes, |
|
|
Term
| dx and tx of FSH, LH hypersecretion |
|
Definition
dx = increased hormone levels
tx = surgical resection |
|
|
Term
| what are the adrenal glands divided into? |
|
Definition
|
|
Term
| what are the adrenal cortex hormones? |
|
Definition
| glucocorticoids (cortisol), mineralocorticoids (aldosterone), sex steroids (testosterone) |
|
|
Term
|
Definition
| catecholamines (epinephrine, norepinehprine, dopamine) |
|
|
Term
| precursor of glucocorticoids and mineralocorticoids |
|
Definition
|
|
Term
| what is cortisol secreted in response to? |
|
Definition
| ACTH from the pituitary via CRF from hypothalamus, hypovolemia, hypoxia, hypothermia, hypoglycemia |
|
|
Term
| cortisol stimulates __________ and inhibits ______________. |
|
Definition
| stimulates glucagon release and inhibits insulin release |
|
|
Term
| complications of exogenous glucocorticoids |
|
Definition
| supress immune system, impair wound healing, block inflammatory cell migration, inhibit antibody production, inhibit histamine release, inhibit collagen formation, inhibit fibroblast function |
|
|
Term
| what is aldosterone secretion controlled by? |
|
Definition
RAS.
Renal hypoperfusion or hyponatremia --> juxtaglomerular cells secrete renin --> cleaves angiotensin to angiotensin I --> cleaved to AG II |
|
|
Term
|
Definition
| vasoconstriction --> aldosterone secretion --> distal tubule reabsorbs sodium --> water retention |
|
|
Term
|
Definition
|
|
Term
| what is Cushing's Disease? |
|
Definition
| overproduction of cortisol |
|
|
Term
| what is the etiology of Cushing's Syndrome? |
|
Definition
| small cell carcinoma of the lung and carcinoid tumors of teh bronchi/gut |
|
|
Term
|
Definition
| wt gain, easy bruising, lethargy, weakness |
|
|
Term
| how do you dx Cushing's Disease? |
|
Definition
| 24 hr urine collection, dexamethasone suppression test |
|
|
Term
| treatment of Cushing's Disease |
|
Definition
| remove the source of cortisol production, pituitary = resection, adreanl = adrenalectomy, adrenal carcinoma = resection |
|
|
Term
| what percent of pheochromocytomas are malignant? |
|
Definition
|
|
Term
| what do pheochromocytomas produce? |
|
Definition
|
|
Term
| what are the sxs of a pheochromocytoma? |
|
Definition
| headahce, tachycardia/palpitations, anxiety, diaphoresis, chest/abd pain, nausea |
|
|
Term
| triggers of a pheochromocytoma? |
|
Definition
| physical exertion, tyramine containing foods, succinylcholine, propranalol |
|
|
Term
| how do you dx a pheochromocytoma? |
|
Definition
| urine analysis for catecholamines & metanephrines & vanilylmandelic acid (VMA), CT scan, MRI, nuclear medicine scan |
|
|
Term
| treatment of pheochromocytoma |
|
Definition
surgical removal.
avoid hypertensive crisis in the OR by alpha blockade with phenoxybenzamine (first) followed by beta blockade with phentolamine |
|
|
Term
|
Definition
| Parathyroid hyperplasia, Pancreatic islet cell tumors (usually gastrinomas), anterior Pituitary adenoma (commonly a prolactinoma) |
|
|
Term
|
Definition
| medullary thyroid carcinoma, pheochromocytoma, parathyroid hyperplasia |
|
|
Term
|
Definition
| medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas |
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