Endocrine and Neuromuscular Flashcards
What are causes of hyperthyroidism?
intrinsic causes, Graves, thyroiditis, extra-thyroid
What is dysphagia?
difficulty swallowing or sensation that food is stuck in the throat
What are intrinsic causes of hyperthyroidism?
toxic multi-nodular goiter, adenoma
What are extra-thyroid causes of hyperthyroidism?
iatrogenic, iodine, TSH tumor, carcinoma
Which is the active form - T4 or T3?
T3
Is more T4 or T3 secreted?
T4 (90%)
T4 and T3 are a product of what two things? (simplified)
iodine and tyrosine
What’s the difference between thyrotoxicosis and thyroid storm?
thryotoxicosis is any disorder of increased thyroid hormone concentration; thyroid storm is whe a patient’s metabolic, thermoregulatory and CV compensatory mechanisms fail
What are symptoms of thyroid storm?
hyperpyrexia, tachycardia, supraventricular arrhythmias, CHF, increased risk of stroke, possible hepatic failure
What can precipitate thyroid storm?
trauma/thyroid manipulation/surgery, withdrawing anti-thyroid drugs, iodinated drugs (radioiodine therapy, iodinated contrast dye, amiodarone), CVA, CHF, PE, pregnancy, DKA, infection, bowel infarction
What drugs block periperal T4-T3 conversion?
PTU, propanolol, glucocorticoids such as Decadron and hydrocortisone, thiopental decreases T4-T3 conversion
Which NSAID is preferred for the treatment of fever associated with hyperthyroid conditions? which is not and why?
Tylenol preferred; ASA is bad choice because it increases the amount of free thyroid hormone
How does one treat the stormy stormy thyroid?
propanolol (for tachychardia, anxiety, tremor, T4-T3 inhibition), Decadron (to reduce thyroid secretion and inhibit T4-T3 conversion), PTU/methimazole, NaI/KI, cooling, Tylenol, catecholamine depleting drugs (reserpine or guanethidine)
Insult to the parathyroid would result in what electrolyte disturbance?
hypocalcemia (may manifest up to 96 hrs later)
What are the typical symptoms of myasthenia gravis?
fluctuating muscle weakness: eyes (ptosis, diplopia), bulbar (dysarthia, dysphagia, difficulty chewing), possible limb weakness, respiratory (dyspnea esp in supine)
What is the pathoph of myasthenia gravis?
caused by antibody to T-cell and blockade of nicotinic ACh receptors of motor endplate
85% of MG patients have pathologic alterations of what gland?
thymus
What are NMB considerations for MG?
sensitive to non-depolarizing, resistant to depolarizing
What are NMB considerations for Lambert-Eaton?
sensitivity to depolarizing and non-depolarizing
Which disease features a presence of antibodies to ACh receptors?
MG
What is the effect of anticholinesterases on Lambert-Eaton syndrome?
no effect
What is the effect of reserpine?
antipsychotic and antihypertensive
What is nadolol?
non-selective beta-blocker
Why is ASA not a good drug for treating thyroid storm?
it promotes the release of thyroid hormone from its carrier protein
What induction agent decreases peripheral conversion of T4-T3?
thiopental
Why is dexamethasone used to treat thyroid storm?
reduces thyroid secretion and inhibits T4 –> T3 conversion
In regards to the course of surgery, when in thyroid storm most likely to occur?
6-18hrs post-op
