Edocrine Flashcards
Thyroid- Metabolism
- Thyroxine (T4)
- Triiodothyronine (T3)
- Both increase metabolism
Thyroid- Calcium Regulation
•Calcitonin -Reduces calcium •If Ca++ in Blood is too high •Bones absorb Ca++ •Reduces Ca++ in blood •May produce hypocalcemia -Complication
Disorders of Thyroid Gland
•Excess hormone •Hyperthyroidism -Overactive •Thyrotoxicosis -Excessive blood levels -Graves disease •Thyroid Storm -Most severe thyrotoxicosis -Hypermetabolic state! •Deficient hormone •Hypothyroidism -Low levels •Myxedema -Most severe hypothyroidism
Hyperthyroidism- Thyrotoxicosis
Grave’s Disease
•Autoimmune -Overproduction of thyroid hormones •Overdose -Synthroid -Accidental? Intentional? •⬆️ Metabolism; exaggerated growth •S/S -Protrusion of the eyeballs •Exophthalmus -Altered movement of eyelid and orbit -Goiters
Extreme Hyperthyroidism
Thyroid Storm
•Extreme Metabolism -Severe Sinus Tachycardia or Atrial •Fibrillation -Hyperthermia (104 degrees) and heat intolerance -Restless, agitation, delirium, tremors -Heart failure and shock -Flushed, moist skin, weight loss -Bounding pulses with wide pulse pressures -Diarrhea, polyuria •Medication Clues •Beta Blockers •Radioactive iodine -Decreases thyroid levels -Outpatient setting •Antithyroid agents -MMI or Thaimazole (Methimazole) -PTU (Propylthiouracil)
Thyroid Storm Tx
•Cardiovascular complications that arise
-Rapid heart rate
•Supportive-protocols
-ABC’s
-Fluid resuscitation
-Beta blockers, calcium channel blockers
-Steroids
Hypothyroidism
•Thyroid deficiency- not life threatening
•Iron deficiency- rare in US
-Iron needed to produce thyroid hormone
•Congenital
-Newborns typically screened
•Autoimmune
-Hashimoto’s Disease- most common
•Destruction of thyroid cells by immune system
-Numerous other autoimmune causes
•Pituitary disorders, infections, trauma, vascular
•TSH
Myxedema Coma
Extreme Hypothyroidism
•Crisis form of hypothyroidism •Decline mental status •Winter months •Women >60 •Levothyroxine (Synthroid) •Hypothermia- when no accidental cold exposure exists •Hypoglycemia- when not Insulin dependent •Coma •Bradycardia, bradypnea •Hypotension •Weak, sluggish •Hair loss •Weight gain, edema •Constipation •Dry, coarse skin •Tx: supportive -Rare
Parathyroid
•Parathyroid hormone (PTH) •Increases blood calcium levels -Antagonist to calcitonin[thyroid gland] •Bones release calcium •Kidneys re-absorb calcium into blood •Enhances absorption of calcium in intestines •Complication -May cause hypercalcemia
Pituitary
•Diabetes insipidus (DI)
-“To pass through” + “weak, watery”
-Lack of ADH or kidneys resistant to ADH action
•Loss of water in kidneys > loss of sodium
-Hypernatremic dehydration
•Central DI - lack IDH
-Pituitary tumor/ surgery
•Nephrogenic DI - resistant ADH
-Medications, sickle cell, electrolyte problems
S/S of Hypernatremia
- Polydipsia, polyuria, nocturia, dehydration
- Muscle spasms, hyperreflexia
- Altered mentation, confusion, coma
- Support ABC’s
- Fluid replacement NS or LR
- Definitive treatment- in hospital
- Desmopressin for Central DI
Adrenal Glands-Cortex
•Corticosteroids -Cortisol •Release glucose glycogen from liver (glucogen-like) •Lipids from adipose •Anti-inflammatory effects -Aldosterone •Kidneys reabsorb sodium and water
Adrenal Glands- Medulla
Epic and norepi release
Cushing’s Disease
•Overproduction of cortisol •Buffalo hump •Moon face •Abdomen -Pendulous/ stretch marks •Increased facial hair -Hirsutism •Cushing’s: is GUSHING cortisol
Adrenal Insufficiency
Addison’s Disease
•Deficient cortisol or aldosterone or both
•Autoimmune, TB or HIV, genetic, trauma, chemo
•Pituitary or hypothalamic disorders
•Long-term steroid therapy- sudden cessation of use
•Cortisol
-Stress hormone
-Mimics glucagon
•Aldosterone
-Blood pressure
-Water balance- reabsorption of water and sodium
-Excrete potassium
•Patient’s cortisol doesn’t ADD UP
