endocrine Flashcards
hpa
TRH stimulates TSH then regulates thryoid gland to make T3 and T4
T3/T4 sensed by hypothalamas- increases TRH- then more TSH
negativ feedback: if thyroid hormone is too high- they inhibit BOTH HYPOTHALAMS AND PITUATRY tsh secretion!!
CRH
CRH is in hypo then ACTH made at pitutary gland and then ADRNEAL gland makes CORTISOL
GNRH
GNRH i hypothalm, FSH AND LH BY pitutary and OVARIES MAKES ESTROGEN, progesterone and small amount of teststerone, and in men- stimulates testes to produces TESTOSTERONE!
secondary disorders
secondary and tertiary disrodes have LABS IN THE SAME DIRECTION
primary disorders
labs in opposite directs if the problems is the target organ!!
TSH
best thyroid function test- initial test for suspected thyroid disease
also used to follow patients on thyroid hormone
LOW TSH—DECREASE DOSE OF LEVo
high tSh: increase dose of leveo
Free t4
ordered when tSh is abnormal
hashimoto’s ab
antithyroid peroxidase AB
anti thyroglobulin AB
grave’s disease ab
thyrodi sitmulating RECEPTOR ab
free t3
used to diagnosed hyperthyroidsim when TSH is low and T4 is STILL NORMAL!
normal ft4 and elevated tsh
subclinical hypothyroidism
low TSH plus normal FT4
subclinical hyperthyroidism
radioactive test
diffuse : grave’s disease or TSH secreting pitutary adnormal
decreased utake: THyROIDITIS- hypothyorid
hot nodule: toxic adnoema
multiple nodules: toxic multinodular goiter
cold nodules: rule out malig
subclinical hypothyroid
levothyroixine- if patient develops hyperlipid, or tsh too high
hypothyroid
cold intolerance, weight gain, dry thickened skin, loss of outer 1/3 eyebrow, goiter, nonpitting edema! sluggish, depression, decreased DTR, consti, anorexia, bradycardia, decresaed cardiac output, moenorrhagia, hypoglycemia
hyperthyroidism
HEAT intolerance, weight loss, skin warm, most, alpecia, goiter, hyperactivity, anxiety, inervous, diarrhea, hyperdefecation, tachy, plapitation, high output heart failure, no periods, hyper GLYCEMIA
euthyroid sick syndrome
surgery, malig, sepsis, cardiac- decreased t3/t4- but t3 ABNORMALLY LOW, decreased TSH too
thyroid storm
usually ater surgery, truama, infection, illness, preg
palpitations, tachy, atrial fibb, high fever, nausea, vomiting, psychosis, tremors
Propylthioracil or methimazole@!!!- ptu prevents peripheral conversation of t4 into t3.
BETA BLOCKRES!!! IV sodium iodide
IV GLUCOCORTICOSTEROIDS!!!- NO ASPIRIN!!!- COOLING BLANKETS!!!
myexdema crissis
bradycardia, coma, hypothermia, hypoventilation, hypotensive, hypoGLYCEMIC, hypoNATREMIA IV SYNTHROID (levo_, passive warming. DONT WARM THEM SO FAST!, normal saline
grave’s
pretibial myxedema!!- non pitting- pink to brown plques on shin
diffuse uptake!- radioactive iodine- MC therapy!!!
toxic multinodular goiter
patchy aras of both increased and decreased uptake= radioactive iodine!
methimazle: and ptu: AGRANULOCYSOIS!!! hepatitis
PTU preferred in pregnancy
medication induced
AMIODARONE- hypothryoidsim , OR LITHIUM!!!!!!
levothyroroxine
synthetic T4!!!!- monitor TSH every 6 week intervals!!!
thryoid nodules
most in women are BENIGN = follicular adenoma or cysts!!!
men and children - most likely malig- papillary CANCER MC in Women
asymptomatic.
most patients ARE EUTHyroid
benignnodules: follicular ADENOMA!!!!!
FNA with biopsy- best test to evaluate!
cold nodules- suspicious for malig