Endocrine deck 2

Question 1

What is Hyperthyroidism

Answer 1

condition of excessive levels of thyroid hormones. This overabundance of thyroid hormones results in a hypermetabolic state. The incidence is higher in women than in men. Older age and smoking are risk factors

Question 2

what diagnostic test is used in hyperthyroidism?

Answer 2

24-hour radioiodine uptake scan

Question 3

24-hour radioiodine uptake scan

Answer 3

Cannot use in pregnant patients
used to test for hyperthyroidism
measure the amount of radioactive iodine that is taken up by the thyroid gland after oral administration.

presence of uptake usually indicates that there is new hormone synthesis. No uptake indicates a destroyed or inflamed thyroid gland,

Question 4

A Normal or High Radioiodine Uptake in a 24-hour radioiodine uptake scan could indicate what problems?

Answer 4

• Graves disease
• Thyroid adenomas/toxic multinodular goiter
• Excessive iodine

Question 5

A Near-Absent Radioiodine Uptake in a 24-hour radioiodine uptake scan could indicate what problems?

Answer 5

• Thyroiditis
• Excess thyroid hormone replacement
• Ectopic production

Question 6

symptoms of hyperthyroidism in older patients

Answer 6

Older patients tend to have predominant cardiovascular manifestations such as tachycardia or atrial fibrillation, dyspnea, and edema

Question 7

Clinical manifestations of hyperthyroidism

Answer 7

hormone levels are increased and so are all the clinical manifestations (e.g., tachycardia, hypertension, anxiety, and diarrhea), with the exception of weight loss.

Question 8

What is thyroid storm and what causes it?

Answer 8

Medical emergency- sudden worsening of hyperthyroid symptoms

Can be from long time untreated hyperthyroid or precipitated by infection, surgery or stress

Question 9

What are the symptoms of a thyroid storm?

Answer 9

high temperature (e.g., 104 to 106° F), tachycardia (> 140 beats per minute), decreased mental alertness, abdominal pain, and an exaggeration of any hyperthyroid manifestations (Table 10-6). Additional complications of hyperthyroidism include cardiomyopathy, heart failure, and osteoporosis.

Question 10

Diagnostics for a thyroid storm?

Answer 10

history, physical examination, serum thyroid hormone levels, and serum TSH

Question 11

In hyperthyroidism what do the serum TSH, T3 and T4 levels look like?

Answer 11

the serum TSH will be low and the T4 and T3 will be high. The T3 increases more than the T4. Central hyperthyroidism will result in a low TSH and normal T3 and T4.

Question 12

What immuneglobulin is positive in Graves disease?

Answer 12

Thyroid-stimulating immunoglobulin
anti-TPO antibody may also be positive with Graves syndrome but not as often as in chronic autoimmune thyroiditis (Hashimoto’s thyroiditis).

Question 13

How is hyperthyroidism managed?

Answer 13

Medications and surgery

Question 14

What is used to manage used to manage symptoms such as tachycardia, anxiety, and heat intolerance in hyperthyroidism?

Answer 14

Beta Blockers

Question 15

Medication and surgical treatment of hyperthyroidism

Answer 15

radioactive iodine (which shrinks the gland) as well as antithyroid agents, such as methimazole (the primary drug), to decrease hormone production or propylthiouracil which is safe during pregnancy. Surgical removal of the thyroid (thyroidectomy) with subsequent hormone replacement is warranted when the patient does not respond to or tolerate medications.

Question 16

Even with treatment, _______remains in hyperthyroidism. What is done for comfort?

Answer 16

exophthalmos usually remains. Strategies to improve the discomfort associated with exophthalmos include cool compresses, wearing sunglasses, eye lubricants, and elevating the head of the bed

Question 17

Dietary management for hyperthyroidism

Answer 17

Increasing caloric and calcium intake is crucial to maintain weight and prevent bone loss.

Question 18

For hyperthyroidism with near-absent radioiodine uptake due to thyroiditis………

Answer 18

hormone-synthesis-blocking agents will not be effective since new hormones are not being produced. The treatment, therefore, is symptom control (e.g., via a beta blocker) or anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs.

Question 19

What is Cushings syndrome/Disease

Answer 19

condition characterized by excessive amounts of glucocorticoids, specifically cortisol.

is ACTH dependent, which refers to ACTH stimulating excess cortisol production while the negative feedback mechanism is impaired. Normal pulsatile cortisol secretion or increased cortisol response during stress is impaired.

Question 20

What is the most common cause of excessive glucocorticoids in Cushings syndrome?

Answer 20

hypercortisolism, is iatrogenic, resulting from ingestion of glucocorticoid medications. underreported. When these medications are ingested, they mimic the body’s own hormones

Question 21

What is the second most common cause of Cushings syndrome?

Answer 21

excess ACTH production, usually from a pituitary adenoma. this state is termed Cushing disease

Question 22

ectopic non-pituitary tumor

Answer 22

another form of ACTH-dependent hypercortisolism. Benign or malignant adrenal gland tumors that secrete cortisol are a form of ACTH-independent hypercortisolism.

Question 23

What is least common cause of Cushing syndrome

Answer 23

Adrenal carcinoma is the cause of 50% of childhood Cushing syndrome

Question 24

metabolic manifestations of Cushings

Answer 24

• Glucose intolerance—insulin resistance from obesity; cortisol stimulation of gluconeogenesis
• Delayed growth and development
• Obesity (especially around the trunk)
• A fatty pad between the shoulders known as a buffalo hump; fat accumulation in the cheeks known as moon face

Question 25

Derm manifestations of Cushings

Answer 25

• Hirsutism (abnormal hair growth); thin hair, oily facial skin, acne due to androgen excess in women (usually adrenal carcinoma); other virilizing signs (e.g., deep voice) if androgen is very high
• Broad purple striae (marks) on the abdomen, thighs, and breasts
• Thin skin that bruises easily—catabolic effects of glucocorticoids
• Skin atrophy—loss of subcutaneous fat
• Hyperpigmentation due to increased ACTH, which binds to melanocyte-stimulating hormone receptors

Question 26

Infections manifestations of Cushings

Answer 26

• Increased risk and frequency of infections due to glucocorticoid suppression of immune function
• Delayed wound healing

Question 27

Cardiovascular manifestations of Cushings

Answer 27

• Hypertension resulting from multifactorial causes such as increased liver production of angiotensinogen; increased sensitivity to adrenergic agonists
• Dyslipidemia
• Edema
• Hypokalemia

Question 28

Reproductive manifestations of cushings

Answer 28

• Changes in menstruation due to GnRH suppression caused by hypercortisolism
• Decreased libido
• Erectile dysfunction

Question 29

Musculoskeletal manifestations of Cushings

Answer 29

• Osteoporosis—decreased intestinal calcium absorption, decreased renal calcium reabsorption, decreased bone formation with increased bone resorption
• Muscle weakness and wasting—catabolic effects of glucocorticoids

Question 30

Neuro manifestations of cushings

Answer 30

• Mood changes (e.g., depression, anxiety) and psychosis due to excess cortisol

Question 31

Diagnostic procedures for Cushings

Answer 31

history, physical examination, and serum hormone levels (e.g., cortisol and ACTH). Adrenal and pituitary CT and MRI may be necessary to evaluate for an underlying cause. Other tests are used to further evaluate manifestations or complications of hypercortisolism and can include serum glucose, complete blood count (CBC), blood chemistry, and bone density studies

Question 32

Treatment for Cushings

Answer 32

varies depending on the underlying cause. Gradual tapering of any glucocorticoids being administered is crucial. If these glucocorticoids are suddenly discontinued, the adrenal gland does not have the opportunity to initiate its own production of hormones, leading to an adrenal crisis. Tumors will likely require surgical removal and radiation. Medications can be used to control cortisol production