Endocrine 3 Flashcards
A patient with untreated hyperthyroidism and atrial fibrillation presents for emergency surgery. What is the BEST intervention at this time?
a. amiodarone
b. esmolol
c. propylthiouracil
d. delay surgery until a euthyroid state is achieved
b. esmolol
Medical management for hyperthyroidism includes
thionamides (propylthiouracil)
beta-blockers (propranolol)
potassium iodide
radioactive iodine
Surgical treatment for hyperthyroidism includes
subtotal or total thyroidectomy
Complications of surgery for hyperthyroidism include
hypothyroidism
hemorrhage
tracheal compression
hypocalcemia
recurrent laryngeal nerve injury
Elective surgery should be
delayed until the patient is euthyroid
Successful medical management of hyperthyroidism may require
upwards of 6-8 weeks
If the patient has a goiter, you should
choose the most conservative airway management (e.g. awake intubation)
_________ should be titrated carefully in the patient with hyperthyroidism because there’s an increased incidence of ___________ & ____________
titrate NMBs; myasthenia gravis and myopathy
__________due to resection of parathyroid glands most commonly occurs _________after surgery
hypocalcemia; 24-48 hours
Hypocalcemia can lead to
laryngospasm
muscle spasm
hypotension
prolonged QT interval
mental status changes
The treatment for hypocalcemia is
IV calcim
__________ & ____________ indicate hypocalcemia
Chvostek’s sign & Trousseau’s sign
Under anesthesia, thyroid storm can mimic
MH
pheochromocytoma
neuroleptic malignant syndrome
light anesthesia
Don’t give ___- to treat hyperpyrexia in a patient with thyroid storm because it can dislodge T4 from plasma proteins
aspirin
Remember the four B’s when treating the patient with thyroid storm:
block synthesis (methimazole, carbimazole, PTU, potassium iodide)
block release (radioactive iodine, potassium iodide)
block T4 to t3 conversion (PTU, propranolol, glucocorticoids)
block beta receptors (propranolol, esmolol)
Thionamides require
6-7 weeks to achieve a euthyroid sate
Serious side effects of thionamides include
hepatitis
agranulocytosis
Thionamides include
propylthiouracil
methimazole
carbimazole
Potassium iodide needs to be given
10 days before surgery
radioactive iodine can cause
hypothyroidism
Contraindications to radioactive iodine include
pregnancy
breast feeding mothers
Emergency surgery in the setting of hyperthyroid warrants administration of
a beta-blocker
potassium iodide
glucocorticoids
PTU should be started at this time
A goiter can cause
tracheal deviation or tracheomalacia
Exophthalmos increases the risk of
corneal abrasion
Signs and symptoms of thyroid storm include
fever >38.5 degrees C
tachycardia/tachyarrhythmias
HTN
CHF
shock
confusion and agitation
N/V
Additional treatments for thyroid storm include
cardiopulmonary support
active cooling measures
tylenol for fever
glucocorticoids
All of the following are anesthetic considerations for myxedema EXCEPT:
a. restrictive lung disease
b. low cardiac output
c. hypernatremia
d. impaired drug metabolism
c. hypernatremia
How should you proceed with surgery for hypothyroidism?
mild to moderate hypothyroidism okay to proceed with elective surgery
severe hypothyroidism should cancel
Patients with hypothyroidism are at risk for
airway obstruction due to a large tongue, swollen vocal cords, and goiter
______________ function is common with hypothyroidism
decreased adrenal function
Hypotension unresponsive to catecholamines can be treated with _________ in hypothyroidism
corticosteroids
Patients may be more sensitive to ___________ with hypothyroidism
the effects of neuromuscular blockers
What happens to the hemodynamics of the patient with hypothyroidism?
hypodynamic–> decreased HR, SV, contractility, cardiac output, and baroreceptor responsiveness
Hemodynamic support for hypothyroidism is best provided with
sympathomimetics that improve myocardial performance (not phenylephrine)
Medical management of hypothyroidism includes thyroid hormone is replaced with
synthetic T4 (levothyroxine)
The initial response to therapy for hypothyroidism is
natriuresis and decreased TSH
Patients with hypothyroidism are at risk of
aspiration due to delayed gastric emptying
Clinical features of primary hyperparathyroidism include: (select 2)
a. pathologic fractures
b. laryngospasm
c. myocardial depression
d. shortened QT interval
a. pathologic fractures
d. shortened QT interval
What two hormones act antagonistically to regulate the ionized Ca2+ level
calcitonin and PTH
Calcitonin and PTH affect Ca2+ regulation in the
bone, intestine, and kidneys
PTH is produced in the
parathyroid gland (chief cells)
What is the effect of parathyroid hormone on ionized calcium and phosphate
increases ionized calcium
decreases serum phosphate
Calcitonin is produced in the
thyroid gland (C cells)
What effect does calcitonin have on ionized calcium and serum phosphate?
decreases ionized calcium and increases serum phosphate
The most common cause of hypercalemia is
primary hyperparathyroidism
The most common cause of primary hyperparathyroidism is
parathyroid adenoma
The best treatment for parathyroid adenoma is
surgical resection of the parathyroid glands
Secondary hyperparathyroidism is caused by
something that stimulates the parathyroid glands to increase PTH output (the glands themselves are normal)
The most common cause of secondary hyperparathyroidism is
chronic kidney disease
Hypoparathyroidism causes
hypocalcemia
The most common cause of primary hypoparathyroidism is
iatrogenic gland removal during thyroidectomy
Treatment of primary hypoparathyroidism includes
supplementation of Ca2+
vitamin D
Mg2+
