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NURS 2514 > Chapter 6 Endocrine > Flashcards

Chapter 6 Endocrine Flashcards

1
Q

Where is the Thyroid gland located?

A

Wraps around trachea, just below thyroid cartilage

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2
Q

What is the function of thyroid gland?

A

Produces thyroid hormones (T3 and T4)

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3
Q

What is T4?

A
  • Thyroxine
  • Most abundant thyroid hormones but largely inactive
  • less metabolic effect
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4
Q

where is T4 activate to T3?

A

tissues and liver

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5
Q

What is T3?

A
  • Triidothyroxine

- Active form, greater metabolic effect

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6
Q

What is the tissue in the body that only uses iodine?

A

Thyroid Gland

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7
Q

How many Iodines does T4 and T3 have?

A
  • T4 = 4 iodine 2 tyrosine amino acids

- T3 = 3 iodine 2 tyrosine amino acids

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8
Q

What feedback does thyroid gland regulate to?

A

Negative feedback

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9
Q

What does hypothalamus release?

A

Thyrotropin releasing hormone (TRH)

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10
Q

what does release of TRH causes?

A

causes the anterior pituitary to release TSH

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11
Q

What does Thyroid stimulating hormone (TSH) do?

A

Causes thyroid to produce and secrete Thyroxin (T4)

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12
Q

Who/what releases TSH?

A

Anterior pituitary gland

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13
Q

Activated T3 acts on what? and causes what?

A

Activated T3 acts on cells to increase metabolism

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14
Q

what causes the hypothalamus to stop releasing TRH?

A

When there is an increased levels of thyroid hormones

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15
Q

Explain the regulation of the thyroid gland (Negative feedback)

A
  • Hypothalamus releases TRH which causes the anterior pituitary to release TSH
  • TSH causes thyroid to release T4
  • Activated T3 acts on cells to increase metabolism
  • Increased levels of thyroid hormones cause hypothalamus to stop releasing TRH
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16
Q

TSH is used as a marker for what?

A

TSH is easiest to measure, and used as a marker for thyroid function

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17
Q

Continuum of Thyroid dysfunction (Hyper to Hypo)

A 
-Hyper- 
Thyrotoxicosis 
Hyperthyroidism 
Euthyroid
Hypothyroidism 
Myxedema coma 
-Hypo-
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18
Q

What is goitre?

A

An enlargement of thyroid gland

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19
Q

What is nodule

A

A localized growth of thyroid gland

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20
Q

Is goitre result from hyper or hypo thyroidism?

A
  • Both

- Thyroid cells are stimulated to grow, which may result in hyper or hypo

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21
Q

What causes goitre? (3)

A
  • Elevated levels of TSH ( endemic goitre)
  • Toxic goitre (thyroid grows without TSH stimulation tumour)
  • Goitrogen drugs
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22
Q

What causes elevated TSH ( endemic goitre)?

A
  • Iodine Deficiency
  • Thyroid needs iodine to make T4 and without it the T4 level drops. The Hypothalamus will sense that there is low T4 and will release TRH to try to stimulate the anterior pituitary gland. Anterior pituitary then releases TSH and will continue to release it in order to try to get more T4.
  • too much TSH is the result
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23
Q

What causes toxic goitres?

A
  • Benign tumours in the thyroid gland causing the gland to grow uniformly or through nodules
  • Thyroid grows without TSH stimulations
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24
Q

How do goitrogen drugs cause goitre?

A

They interfere with gland uptake of iodine and can cause low levels of T4 which results in elevated TSH and eventually form goitre.

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25
Q

Goitrogen drugs (4)

A
  • Sulphonamides
  • Salicylates
  • Lithium
  • Amiodarone
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26
Q

Does goitre indicates whats going on with thyroid glands?

A
  • NO

- Needs further assessment

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27
Q

how do we identify if the thyroid nodule is benign or cancerous?

A

Biopsy of tissue is taken

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28
Q

2 types of thyroid nodules

A
  • Functional nodules ( caused by increase TSH)

- Benigh tumours

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29
Q

What is the risk factor of thyroid cancer? and how do we prevents it?

A
  • Radiation is risk factor
  • Thyroid is really sensitive to radiation therefore, we have to wear vest with collar on neck to protect thyroid glands.
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30
Q

What is thyroiditis?

A

Thyroiditis is an inflammation of the thyroid gland

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31
Q

what causes thyroiditis? (4)

A
  • Autoimmune - can lead to hypothyroidism (hashimoto’s thyroiditis)
  • Viral infection
  • Bacterial infection
  • Postpartum thyroiditis
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32
Q

Which of the causes of thyroiditis can people usually recover from?

A
  • Viral infection
  • Bacterial infection
  • Postpartum thyroiditis
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33
Q

What is Hashimoto’s thyroiditis

A
  • Thyroid tissues is replaced by fibrous functional tissues

- Permanently changed and can no longer or barely make any thyroid hormones

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34
Q

What is Hyperthyroidism

A

Higher than normal levels of thyroid hormone circulating in blood

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35
Q

What is thyrotoxicosis

A

A group of symptoms caused by excess levels of thyroid hormone (hyper-metabolism)

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36
Q

What causes Hyperthyroidism (5)

A
  • Auto-immune (Graves disease)
  • Toxic nodular goitres/ Thyroid cancer
  • Pituitary tumours
  • Thyroiditis
  • Exogenous iodine ( treatment for endemic goitre)
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37
Q

What is Graves Disease? How does it cause hyperthyroidism?

A
  • Auto-immune

- Antibody mimics TSH and it binds to the TSH receptors causing the thyroid to produce large amount of thyroid hormones

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38
Q

Graves disease is characterized by?

A

Remission and exacerbations, with or without treatment

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39
Q

How does toxic nodular goitre/ thyroid cancer cause hyperthyroidism?

A

Nodule or lump grows on the thyroid gland causing it to become enlarged and produce excess thyroid hormones.
- this is independent of TSH

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40
Q

How does pituitary tumours cause hyperthyroidism?

A

Nodule or lump grows on the pituitary causing it to produce excess TSH which stimulates the thyroid to create more T4 hormones.

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41
Q

How does thyroiditis cause hyperthyroidism?

A

Thyroiditis can cause excess production of hormones.

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42
Q

how does exogenous iodine cause hyperthyroidism

A
  • Too large of dose can increase excess production of hormones.
  • More iodine available to make T4
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43
Q

Clinical manifestations of Hyperthyroidism - CNS (7)

A

Anxiety, very alert, nervous, depression, insomnia, irritable, heat intolerance

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44
Q

Clinical manifestations of Hyperthyroidism - CVS (6)

A
  • increase CO
  • Increase HR
  • Afib
  • SVT (supra ventricular tachycardia)
  • PVCs ( premature ventricular contractions)
  • Cardiac hypertrophy
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45
Q

What does fast metabolism do in sympathetic system?

A
  • SNS is sensitive to fast metabolism
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46
Q

Clinical manifestations of Hyperthyroidism - respiratory (2)

A
  • Tachypnea

- Eventually muscle wasting can cause dyspnea

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47
Q

Clinical manifestations of Hyperthyroidism - GI (4)

A
  • increase appetite
  • weight loss
  • increase BS (bowel sounds)
  • Diarrhea
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48
Q

Clinical manifestations of Hyperthyroidism - musculoskeletal (3)

A
  • fatigue
  • muscle weakness
  • osteoporosis ( rapid bone reabsorption)
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49
Q

Clinical manifestations of Hyperthyroidism - others (2)

A
  • exophthalmos - autoimmune

- Goitre - due to high TSH

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50
Q

What is exophthalmos?

A

Autoimmune attack which affects soft tissue behind eyes causes inflammation and edema which pushes the eyes forward
-> risk of injury due to eyelids cannot protect bulging eyes

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51
Q

What is the complication of Hyperthyroidism?

A

Thyroid Crisis ( Thyroid Storm)

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52
Q

When is thyroid crisis most likely to occur?

A

Most likely to happen in chronic or untreated hyperthyroidism

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53
Q

What is Thyroid Crisis

A
  • It is a rare complication where hyperthyroidism symptoms are intensified
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54
Q

Thyroid Crisis is triggered by? (3)

A
  • illness
  • Trauma
  • Surgery
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55
Q

Thyroid Crisis is characterized by (14)

A
  • Severe tachycardia
  • heart failure
  • shock
  • fever
  • agitation
  • delirium
  • nausea
  • vomiting
  • diarrhea
  • hyperthermia
  • restlessness
  • seizure
  • abdominal pain
  • coma
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56
Q

During thyroid crisis, why is the heart and nerve more sensitive to SNS?

A

due to more binding sites for epinephrine and norepinephrine are present

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57
Q

What is the treatment for Thyroid Crisis?

A

Thyroid levels must be reduced and other symptoms managed with medical therapy

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58
Q

Does thyroid Crisis requite immediate medical treatment?

A

yes

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59
Q

What are the treatment of hyperthyroidism (4)

A
  • Drug therapy
  • Radioactive iodine therapy
  • Surgical therapy
  • Nutritional Therapy
60
Q

What is Radioactive iodine therapy?

A
  • Treatment for hyperthyroidism

- ingested capsule that Destroys part of the thyroid tissue and cells

61
Q

What is Surgical Therapy? When is it done?

A
  • Treatment for hyperthyroidism
  • Removing part of thyroid gland
  • Done when patient no longer respond to drugs
62
Q

Nutritional Therapy

A
  • Treatment for hyperthyroidism
  • Increase calorie diet, high in protein, mineral and vitamins
  • avoid high fibre foods because it can stimulate GI more
63
Q

What is the difference between goitre and nodule?

A
  • Goitre is enlargement of the thyroid gland while nodule is localized growth of thyroid gland.
64
Q

Why does a person with hyperthyroidism complain of fatigue?

A

Due to high metabolism. The body works extra to reach demand therefore it results in fatigue. SNS is also sensitive so our body goes into SNS stimulation which causes more fatigue

65
Q

Hypothyroidism

A

Lower than normal levels of thyroid hormone circulating in the blood

66
Q

what are the causes of hypothyroidism? (7)

A
  • Congenital hypothyroidism
  • Auto-immune ( Hashimotos Thyroiditis)
  • Pituitary disease
  • Hypothalamic dysfunction
  • Iodine deficiency
  • After surgical removal of thyroid gland
  • Medications: Amiodarone, Lithium
67
Q

What is congenital hypothyroidism

A

Born without the ability to produce adequate amounts of thyroid hormones

68
Q

What is Autoimmune (Hashimoto’s Thyroiditis)

A

Antibodies attack on thyroid gland which results in functional thyroid tissue replaced by fibrous tissue that is not capable of sensitizing hormones.

69
Q

How does pituitary disease and hypothalamic dysfunction cause hypothyroidism?

A

Both affects the negative feedback loop affecting thyroid from getting stimulated normally = low TSH

70
Q

How does Iodine deficiency cause hypothyroidism?

A

Cannot make T4 without iodine

71
Q

How does surgical removal of thyroid gland cause hypothyroidism

A

If too much is removed then the thyroid gland is unable to produce adequate amount of hormones.

72
Q

How does medications such as Amiodarone and Lithium cause hypothyroidism?

A

Amiodarone - Contains iodine which causes thyroid to make less T4 ( Thyroid gland get used to high levels of iodine that normal amount of iodine is not going to work anymore then it will result in low production)
Lithium - Blocks hormone production

73
Q

Clinical Manifestations of Hypothyroidism - CNS (6)

A
  • Fatigue
  • lethargy
  • Depression
  • memory loss
  • cold intolerance
  • Slow speech
74
Q

True or false: Onset of hypothyroidism symptoms is noticed right away

A

false: onset of symptoms may be unnoticed for months to years

75
Q

Clinical Manifestations of Hypothyroidism - CVS (4)

A
  • bradycardia
  • Heart blocks
  • Anemia
  • increase LDL (risk for cardiovascular)
76
Q

Clinical Manifestations of Hypothyroidism - Respiratory(3)

A
  • lower respiratory rate
  • Sleep apnea
  • SOB on exertion
77
Q

Clinical Manifestations of Hypothyroidism - GI (3)

A
  • Loss of appetite
  • Weight gain
  • constipation
78
Q

Clinical Manifestations of Hypothyroidism - Musculo (2)

A
  • muscle fatigue

- muscle cramps

79
Q

Clinical Manifestations of Hypothyroidism - renal

A
  • low GFR due to decrease in renal blood flow ( fluid retention)
80
Q

Clinical Manifestations of Hypothyroidism - others (2)

A
  • myxedema

- goitre due to increase in TSH

81
Q

what is myxedema?

A

due to accumulation of polysaccharides in the connective tissue of the skin which draws water
- puff face, periorobital edema, mask expression

82
Q

what is the complication of hypothyroidism?

A

Myxedema Coma ( extremely low metabolic state)

83
Q

When can myxedema coma occur?

A

Can occur due to chronic, untreated hypothyroidism

84
Q

What are the triggers for myxedema coma? (4)

A
  • drugs ( opioids, barbiturates, tranquilizers)
  • infection
  • exposure to cold
  • trauma
85
Q

Myxedema coma is characterized by? (5)

A
  • lethargy
  • coma
  • hypothermia
  • hypotension
  • hypoventilation
86
Q

What to do dor myxedema coma?

A
  • Medical emergency
  • vital signs must be supported
  • thyroid hormones replaced ( IV )
87
Q

How does amiodarone cause problems with thyroids?

A

Amiodarone can lead to inhibition of T4 and T3 entry into the peripheral tissues. Both amiodarone and its principle metabolite may have direct cytotoxic effects on the thyroid follicular cells, leading to a destructive thyroiditis

88
Q

Adrenal glands consist of?

A

Medulla and cortex

89
Q

Medulla secretes what?

A

Catecholamines

90
Q

what are the example of catecholamines

A

Epinephrine and noripheneprine

91
Q

What does cortex secretes

A

Secretes >50 steroid hormones, collectively known as “corticosteroids”

92
Q

what are the 3 corticosteroids? and give examples

A

1) glucocorticoids - cortisol
2) mineralcorticoids - aldosterone
3) Androgen

93
Q

what is the function of glucocorticoids? (3)

A
  • Helps maintain blood glucose
  • Anti-inflammatory that suppress the immunity
  • Support of action that helps body respond to stress
94
Q

what is the function of mineralcorticoids

A
  • maintenance of fluid and electrolyte balance.

- Acts on renal tubules to increase reabsorption of sodium and excretion of potassium

95
Q

What is the function of androgen (2)

A
  • Secrete in small amounts to stimulate pubic and hair axillary hair growth
  • Controls sex drive in females
96
Q

Regulation of adrenal gland is through what feedback?

A

Negative feed back

97
Q

Adrenal gland regulation is controlled by?

A

Hypothalamus - anterior pituitary

98
Q

How does Regulation of the adrenal glands work?

A

1) Hypothalamus releases corticotropin releasing hormone (CRH) which stimulates anterior pituitary
2) anterior pituitary releases adrenocorticotropic hormone (ACTH)
3) Adrenals produce corticosteroids

99
Q

Difference between physiological effect vs pharmacologic effect

A

Physiological - occurs at low levels

Pharmacologic - occurs at high levels

100
Q

what is physiologic effect of glucocorticoids

A
  • Occurs at low levels
  • release of cortisol from normal adrenal glands
  • Admin of low dose
101
Q

what is pharmacologic effect of glucocorticoids

A
  • Occurs at high levels
  • Excessive secretion of cortisol (Cushing’s syndrome)
  • admin of large doses to treat disorders unrelated to adrenal dysfunction ei. inflammation, cancer, asthma etc.
102
Q

What is Cushing’s syndrome?

A

A group of symptoms caused bu excess levels of corticosteroids (particularly glucocorticoids)

103
Q

what are the causes of Cushing syndrome?

A
  • Causes are divided in to two groups: ACTH independent and ACTH dependent
104
Q

what are 2 causes of ACTH dependent Cushing Syndrome

A

1) Pituitary adenoma (Secretes ACTH) - 68% of non-iatrogenic
2) Non-pituitary tumour (Secretes ACTH) - 15% of non-iatrogenic

105
Q

what does non-iatrogenic means?

A

not related from taking medications

106
Q

How does Pituitary adenoma secrete ACTH and cause cushings

A

Pituitary have an abnormal growth which can cause increase in ACTH to be secreted which causes increase in cortisol

107
Q

How does Non-pituitary tumour secrete ACTH and cause cushing’s

A

Tumour outside pituitary gland that increase the secretion of ACTH causes rise in cortisol level. Common spots are in the lungs

108
Q

what are 2 causes of ACTH independent Cushing Syndrome

A

1) adrenocortical tumour (secretes cortisol) - 17% of non-Iatrogenic
2) Iatrogenic administration of exogenous glucocorticoids (for inflammation) ( most common)

109
Q

How does adrenocortical tumour cause cushing’s syndrome

A

adrenal glands have tumour which causes it to secrete excess amounts of corticosteroids (cortisol)

110
Q

How does iatrogenic administration of exogenous glucocorticoid cause cushings?

A

High intake of exogenous glucocorticoids increase levels of cortisol in blood

111
Q

Clinical manifestations of Cushing syndrome -Glucocorticoids (9)

A
  • Moon face
  • Buffalo hump
  • Supraclavicular fat pad
  • Thin extremities with muscle atrophy (catabolic effect)
  • Thin skin and subcutaneous tissues ( catabolic effect)
  • Purple striae ( catabolic effect)
  • Pendulous abdomen
  • Ecchymosis resulting from easy bruising
  • slow wound heal
112
Q

Clinical manifestations of Cushing syndrome - Mineral corticosteroids

A
  • Increase in BP

- Weight gain

113
Q

Clinical manifestations of Cushing syndrome - Androgen

A
  • acne
  • thinning of hair
  • Increased body and facial hair
114
Q

Cushing syndrome according to cause - effects of cortisol

A
  • Central obesity
  • muscle wasting and fatigue
  • hyperglycaemia/ insulin resistance
  • osteoporosis
  • Thin skin with striae, easily bruised
  • Impaired immune response and opportunist infection.
115
Q

Cushing syndrome according to cause - effects of mineral corticoids (2)

A
  • hypokalemia

- hypertension

116
Q

Cushing syndrome according to cause - effects of androgens(4)

A
  • Increase body hair/ masc hair line
  • acne
  • menstrual irregularities/ infertility
  • Hirsutism ( abnormal hair growth in women)
117
Q

Name 3 things that are “broken down” by high levels of cortisol in cushing’s syndrome(3)

A
  • muscle
  • bones
  • skin
118
Q

Why would we be concerned about a skin tear in a patient with cushings syndrome?

A

because they are immunosuppressive therefore, skin tear can increase the risk for infection.

119
Q

What is adrenal insufficiency?

A

a rare condition caused by decreased levels of corticosteroids.

120
Q

What does PRIMARY adrenal insufficient cause means? list 4

A
  • primary means that the problem is in the adrenal glands and the negative feedback is still working ( low cortisol, Increase ACTH)
    1) auto-immune - Addison’s disease
    2) tuberculosis
    3) CMV infection
    4) Adrenal Tumour
121
Q

What does SECONDARY adrenal insufficient cause means? list 2

A
  • Pituitary gland is the problem ( low cortisol, low ACTH)
    1) Pituitary disease
    2) Administration of exogenous corticosteroids
  • Body detects corticosteroids so pituitary gland doesn’t make as much ACTH to prompt the adrenal gland to make more.
122
Q

Addison’s disease clinical manifestations- symptoms causes: Increased levels of ACTH

A
  • Hyperpigmentation to face, hands, over joints and in skin folds
123
Q

Addison’s disease clinical manifestations- symptoms causes: Reduced aldosterone level

A
  • Hyponatremia
  • Dehydration and hypotension
  • Hyperkalemia
  • Metabolic Acidosis
124
Q

Addison’s disease clinical manifestations- symptoms causes: reduced cortisol levels

A
  • decrease blood sugar between meals ( hypoglycemia)
  • weakness and fatigue
  • Decrease tolerance to stress
125
Q

What is addisonian crisis?

A

life threatening emergency caused by insufficient adrenal hormones or a sudden sharp decrease in these hormones.

126
Q

What are the causes of Addisonian crisis?(5)

A

Stressors like:

  • infection
  • trauma
  • surgery
  • Psychological distress
  • sudden withdrawal of corticosteroid hormone therapy.
127
Q

What are the symptoms of addisonian crisis? (10)

A
  • hypotention
  • hypoglycemia
  • hyponatremia
  • hyperkalemia
  • fever
  • weakeness
  • confusion
  • nausea
  • vomiting
  • diarrhea
128
Q

What to do on addisonian crisis?

A
  • Support vitals

- Give corticosteroids IV

129
Q

Compare and contrast cushing syndrome to addison’s disease

A

Cushing - too much cortisol

Addisons - too little

130
Q

Explain why hyperpigmentation occurs in Addison’s

A
  • Increase in ACTH binds to melanocytes receptors causing hyperpigmentation
131
Q

Why can we never discontinue exogenous glucocorticoids suddenly?

A

Because it can result in addisonian crisis due to decrease size of adrenal glands

132
Q

Where is the posterior pituitary gland?

A

This gland is an extension of the hypothalamus

133
Q

what hormones does posterior pituitary gland release

A

1) oxytocin

2) Antidiuretic Hormone (ADH)

134
Q

What does ADH do?

A

ADH (vasopressin) regulates fluid volume by stimulating water reabsorption in renal tubules

135
Q

What is Syndrome of Inappropriate ADH (SIADH)

A

ADH released despite low or normal serum osmolality

136
Q

what does low osmolality or high osmolality means?

A 
Low = Blood is more diluted 
High= blood is more concentrate
137
Q

What is the cause of SIADH (4)

A
  • brain injury/ tumours
  • infections (meningitis)
  • small cell lung ca ( secretes ADH)
  • Drug induced ( seizure meds, antidepressants, opiates)
138
Q

SIADH clinical manifestations (1 others) ( brain 5) , ( GI 3) , (Muscles 3)

A
  • Fluid retention = decrease urine output and increase body weight
  • Symptoms are primary related to decrease in NA+
    1) Muscle cramps, twitching and weakness
    2) Vomiting, abdominal cramping, anorexia ( GI related)
    3) Lethargy, confusion, headache, seizure, coma (Brain)
139
Q

What is Diabetes Insipidus?

A

group of conditions associated with a deficiency in production or secretion of ADH or with a decreased renal response to ADH

140
Q

What causes Diabetes insipidus (3)

A

1) Central (neurogenic) - Problem with brain
2) Nephrogenic - ADH acts on kidneys/ kidneys not responding
3) Primary ( psychogenic) - excess water intake

141
Q

Clinical Manifestations of DI (9)

A
  • “dying of Thirst”
  • Polydipsia
  • Abrupt Polyuria
  • Fatigue
  • Constipation
  • Weight loss
  • Dehydration
  • Decreased LOC, seizure, shock, coma
  • Hypernatremia
142
Q

What is the role of ADH in the body?

A

Reabsorb water in the renal Tubes

143
Q

When is ADH released normally?

A

When osmolality is high ( blood is concentrated)

144
Q

How do kidneys respond to ADH?

A

By reabsorbing water at the renal tubes

145
Q

What are the symptoms of hyponatremia

A
  • Changes in LOC - confusion, seizure, coma, lethargic
  • Muscle cramps, twitching, weakness
  • Vomiting, abdominal cramp and anorexia
146
Q

What are symptoms of hypernatremia (4)

A
  • Decrease LOC
  • seizure
  • Shock
  • coma

NURS 2514 (11 decks)

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