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Class 3 Thyroid Flashcards

1
Q

What does the thyroid gland regulate?

A

Metabolic rate

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2
Q

No thyroid gland will decrease metabolic rate by how much? Excess can raise metabolic rate by how much?

A
  • Decrease 40-50%

- Increase 60-100%

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3
Q

Where is the thyroid located and how much does it weigh?

A
  • Below the larynx, anterior and on each side of trachea

- 15-20 grams

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4
Q

Name the 4 hormones produced by the thyroid?

A
  • Thyroxine (T4)
  • Triiodothyronine (T3)
  • Reverse T3 (rT3)
  • Calcitonin
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5
Q

Thyroid gland is made up of what type of cells?

A

-Cubodial epithelial cells which surrounds a colloid matrix

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6
Q

What is required for thyroid hormone synthesis?

A

-Iodine

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7
Q

What two thyroid hormones are most important metabolic control?

A

T4, and T3

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8
Q

How are T4 and T3 different?

A
  • Thyroid secretes 93% T4 compared to 7% T3

- T3 is more potent and cleared more rapidly

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9
Q

Explain how thyroid hormone is released?

A
  • TRH is released by the hypothalamus
  • TRH causes the release of TSH by the Pituitary
  • TSH causes the release TH
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10
Q

What happens to T4 in the tissues?

A

Converted to T3

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11
Q

99% of TH is bound to what?

A

-Protein (TGB and Albumin)

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12
Q

TH activates what two intracellular processes?

A
  • Gene transcription

- Protein and enzyme production

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13
Q

The increase in gene transcription and protein/enzyme production by TH does what?

A

-Increase the metabolic rate

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14
Q

TH increases the size and number of __________.

A

Mitochondria

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15
Q

In general the TH effect what 3 things

A
  • Metabolism

- Growth and development

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16
Q

How does TH stimulate carbohydrate metabolism?

A
  • Increase uptake of glucose

- enhances glycolsis and insulin secretion

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17
Q

How does TH stimulate fat metabolism?

A
  • Mobilize lipids
  • Decrease fat stores
  • Decrease cholesterol
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18
Q

How does TH effect vitamins?

A

-Increase the need for vitamins

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19
Q

TH can decrease body weight, what can counter act that?

A

-TH increases appetite

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20
Q

How does TH effect Beta and alpha adrenergic receptors?

A
  • Increases Beta

- Decreases Alpha

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21
Q

How does TH effect CV?

A
  • Increased blood flow
  • Increased CO
  • Increased Heart rate
  • Increased respiration
22
Q

How does TH effect CNS?

A
  • Increased mentation
  • Increased Anxiety
  • Increased Neurosis
23
Q

Sleep effects of TH

A

-exhaustive / excitable effects (tired but can’t sleep)

24
Q

Endocrine effects of TH

A

-Increases secretion, and need for hormones

25
Reproductive effects of TH
- Lack of TH causes loss of libido - Excess LH causes impotence - Inconsistent menstrual changes
26
What are the causes of primary hypothyroidism?
- Hashimoto's ****** - surgical removal - Inadequate iodine - Radiation - Lithium
27
What is primary, secondary, and tertiary hypothyroidism?
- T3 T4 are not produced (most common) - TSH not being released from pituitary - Inadequate TRH from hypothalamus
28
Hypothyroidism in infancy leads to what 2 things?
- Mental retardation | - growth deficits (cretinism)
29
Most severe form of hypothyroidism is called what?
-myxedema coma
30
High levels of TBG do what to T4
-Decrease T4
31
Are TSH levels high or low in primary hypothyroidism?
High, pituitary attempt to stimulate more release.
32
Synthroid is what? Armour Thyroid contains what?
- Synthetic T4 | - T3 and T4
33
Problems associated with Hypothyroid and anesthesia?
- Hypotension - Hypothermia - Hypoventilation - Hyponatremia - Hypoglycemia - Lethargy - Bradycardia - CHF - Gastroparesis
34
Anesthetic management with hypothyroid?
- Possible crash on induction - Ketamine used frequently - Volatile agents not recommended - A-Line / PA cath - Panc/Roc have vagolytic / sympathomimetic effects
35
What is thyroiditis? What does it do?
- Inflammation of thyroid | - Does not produce more TH, but will release most of it stores.
36
Thyrotoxicosis is what?
-Over supply of TH in the tissues
37
What is the most common cause of hyperthyroid?
-Graves disease
38
How does graves disease work?
- Autoantibodies activate TSH receptor - Causes goiter - Stimulates TH synthesis, secretion and thyroid growth
39
How do beta blockers help hyperthyroidism?
- Beta blockade treats tachycardia, tremors, palpations, anxiety and heat tolerance - D-isomer inhibits conversion of T4 to T3
40
How do you treat hyperthyroid?
- Antithyroid drugs (Methimazole and PTU) - Beta blockers - Radioactive iodine (ablates thyroid tissue) - Surgery
41
S/S of thyroid storm?
- Hyperthermia - tachycardia - dysrythmias - CHF - Shock
42
Causes of thyroid storm
- Surgery - Infection - trauma - Toxemia - DKA
43
Name drugs used to treat hyperthyroid in anesthesia?
- Sodium iodide - Cortisol - PTU
44
Hyperthyroid anesthesia considerations
- Check airway (goiter) - Treat hyperdynamism (propanolol) - Antithyroid drugs - Correct volume and electrolyte problems
45
What things should be resolved prior to elective surgery involving hyperthyroid?
- Tremor - Heat intolerance - nervousness - Murmurs - Pulse pressure - NSR
46
Thyroidectomy preop concerns
- Thyroid hormone status | - Airway status
47
What should be done intraop for thyroidectomy?
-Neuro monitoring with nim tube or dragonfly
48
Post of thyroidectomy concerns
- RLN damage - SLN Damage - Hematoma / bleed - Hypocalcemia - Tracheomalacia (tracheal softening that collapse with inspiration)
49
RLN damage signs
- Unilateral = hoarseness | - Bilateral = aphonia, stridor, aspiration
50
SLN damage signs
-Abnormal voice in high pitches
51
What causes hyocalcemia after thyroidectomy? When? and what can happen?
- Removal of parathyroid glands - 24-72 hours post op - Weakness, tetany, laryngospasm, CV collapse

Personal Endo (6 decks)

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