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SU 17: Wine regions of South America > Endocrine Lecture 5: Thyroid > Flashcards

Endocrine Lecture 5: Thyroid Flashcards

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1
Q

Thyroid gland regulates the metabolic rate of the body. Complete lack of thyroid secretion results in the basal metabolic rate of the body to decrease by __-__% percent

A

40-50%

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2
Q

Extreme excesses of thyroid secretion can increase basal metabolic rate by __-__% percent above normal.

A

60-100%

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3
Q

The Thyroid gland is located:

A

Located immediately below the larynx, anterior and to each side of the trachea

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4
Q

The Thyroid produces 3 main hormones that influence metabolism:

A

Thyroxine (T4)

Triiodothyroxine (T3)

Reverse T3 (rT3)-inactive

The thyroid also produces calcitonin (important for Ca regulation)

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5
Q

____ is required for the synthesis of thyroid hormones.

A

Iodine

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6
Q

Thyroxine(T4), and triiodothyronine (T3) are the most important thyroid hormones for

A

Metabolic Control

The functions of these two hormones are qualitatively the same, but they differ in their rapidity and intensity of action

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7
Q

The thyroid secretes 93% ______ and 7% _____, though nearly all is converted to ___ in the tissues

A

The thyroid secretes 93% thyroxine (T4) and 7% triiodothyronine (T3), though nearly all is converted to T3 in the tissues

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8
Q

T_ is 4x more potent than T_, but is more scarce and is cleared more rapidly

A

T3, T4

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9
Q

Thyroid Regulation:

Thyrotropin-releasing hormone (TRH) is released by the _______.

TRH causes release of thyroid-stimulating hormone (TSH) by the _____ _____.

TSH causes release of thyroid hormones(TH-both T3 and T4) from the ____ ____.

A

Thyrotropin-releasing hormone (TRH) is released by the hypothalamus

TRH causes release of thyroid-stimulating hormone (TSH) by the anterior pituitary

TSH causes release of thyroid hormones(TH-both T3 and T4) from the thyroid gland

Only free TH is active, but, over 99% is bound to protein, either Thyroxine binding globulin (TGB) or albumin

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10
Q

TH activate intracellular processes such as:

A
  • increase gene transcription
  • protein and enzyme production which increase metabolic rate

TH increases the size and number of mitochondria, which are the energy generators of cells

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11
Q

Peripheral tissues contain enzymes that convert ___ to ___, which is the more metabolically active hormone.

A

T4 to T3

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12
Q

How does Thyroid Hormone effect the cardiovascular system?

A

- increased blood flow secondary to vasodilation

  • increased CO
  • increased heart strength and HR
  • Increases SBP, decreases DBP, inc. pulse pressure.
  • Increased minute ventilation (more CO2 produced d/t faster metabolism)
  • increased number and affinity of beta-adrenergic receptors
  • decreased # of cardiac alpha-adrenergic receptors
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13
Q

How does Thyroid Hormone effect the nervous system?

A

-Increased mentation, but also increased anxiety and neurosis.

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14
Q

How does Thyroid Hormone effect the musculoskeletal system?

A

muscles are more vigorous, but become weak d/t protein catabolism

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15
Q

What are the main effects of thyroid hormone on the body in general?

A

Stimulation of Carbohydrate Metabolism

Stimulation of Fat Metabolism

Increased Requirement for Vitamins- for enzyme synthesis

Increased Basal Metabolic Rate

Decreased Body WT–not always as appetite increases.

Sleep effects- exhaustive/excitable effects. tired, but cannot sleep

Endocrine effects: increases both secretion by glands.

Reproductive/sexual effects- Lack of TH causes loss of libido, excessive can cause impotence, inconsistent menstrual changes

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16
Q

What is hypothyroidism? How is it manifested?

A

thyroid does not make an adequate amount of thyroid hormones.

Symptoms: cold intolerance, wt gain, constipation, dear taste/smell, depression, hoarseness, fatigue, menstrual disorders muscle/joint pain, puffy face, hands, feet, paleness, slow speech, thin brittle fingernails & hair, thickening of skin, thinning of eyebrows, weakness.

17
Q

Primary Hypothyroidism:

A

-T3, T4 are not produced because of problems with the thyroid gland

– Most commonly due to autoimmune Hashimoto’s thyroiditis and surgical removal of thyroid tissue
– Other causes include inadequate dietary iodine (rare), radiation exposure, lithium, surgery

18
Q

Secondary Hypothyroidism:

A

(5-10% of cases)

– Inadequate T3, T4 due to TSH not being released from the pituitary

19
Q

Tertiary Hypothyroidism:

A

(<5% of cases)

– Inadequate T3, T4 due to Thyrotropin Releasing Hormone (TRH) from hypothalamus

20
Q

Hypothyroidism that occurs in infancy leads to:

A

mental retardation and growth deficits (cretinism)

21
Q

The most severe cases of hypothyroidism lead to:

A

myxedema coma

-Rare condition
– Triggered by illness, infection, exposure to cold, medicines
– Symptoms include coma, decrease breathing, decrease blood sugar, decreased blood pressure, and decreased temperature

22
Q

______is the standard test for thyroid gland function.

A

Serum T4 Assay

23
Q

T/F: Elective surgery should be postponed until euthyroid state is achieved

A

True, though not always done.

24
Q

Levothyroxine (synthroid) is the most commonly used medicine for hypothyroidism, it contains ____ only.

A

T4

25
Q

Armour Thyroid contains:

A

Both T3 and T4

26
Q

Anesthetic management of patient with hypothyroidism:

A

-Be aware of the“crash on induction” possibility
– Ketamine frequently used on induction
– Volatile agents not recommended due to the sensitivity of the myocardium to depression
– Pancuronium/Rocuronium have vagolytic/sympathomimetic effects
– A line is indicated with PA catheter in setting of cardiac failure

27
Q

Hyperthyroidism:

A

is a condition of thyroid gland overactivity

  • Thyroiditis is inflammation of the thyroid which causes release of excessive hormone but not increased production
  • Thyrotoxicosis is an over supply of thyroid hormones on peripheral tissues
28
Q

Symptoms of Hyperthyroidism:

A

Symptoms:

Heart palpitations, Heat intolerance, nervousness, insomnia, breathlessness, increased BMs, fatigue, light or absent menses, tachycardia, tremor, muscle weakness, smooth warm moist skin, hair loss, exophthalmos.

29
Q

Most common cause of Hyperthyroidism is:

A

Grave’s disease (60-90% of cases), autoimmune disease.

  • Autoantibodies activate the TSH receptor, causes multi nodular goiter, stimulates TH synthesis, secretion and thyroid growth (goiter)
  • Exophthalmos is caused by inflammation of the eye muscles by attacking autoantibodies.
30
Q

Treatment for Hyperthyroidism:

A

initial temporary use of suppressive medicines and possibly late use of permanent surgical or radioisotope therapy.

  • Antithyroid drugs inhibit production of TH (Methimazole & Propulthiouracil (PTU), inhibits iodination of thyroglobulin and conversion to T4 & T3
  • Beta-blockers (Propranolol), treats tachycardia, tremor, palpitations, anxiety & heat intol. Inhibits conversion of T4 to T3
  • Radioactive Iodine- 1 time dose in pill form= destruction of thyroid tissue
  • Surgery: partial or total thyroidectomy
31
Q

Thyroid Storm:

A

Extreme form of hyperthyroidism (6-8 hours post op)

Tx: Sodium iodide, interal/labetalol, cortisol, PTU.

32
Q

Goiter:

A

Results from chronic stimulation by TSH

Can occur in iodine deficiency states

33
Q

Anesthetic considerations for Hyperthyroid patients:

A

Prep for elective and emergency surgery involves checking the airway, administering antithyroid drugs, treating sxs of hyperdynamism, and treating volume depletion and electrolyte problems

Emergency surgery: give cortisol, avoid halothane or atropine

34
Q

Thyroidectomy: Damage to the RLN manifests as:

A

Unilateral: hoarseness

Bilateral: aphonia, stridor, aspiration

35
Q

Thyroidectomy: Damage to the SLN manifests as:

A

Abnormal voice in upper registers

36
Q

Tracheomalacia:

A

Tracheal softening–> airway collapse with inspiration. Associated with Thyroidectomy.

37
Q

Thyroidectomy & hypocalcemia

A

Due to inadvertent removal of parathyroids

weakness, tetany, laryngospasm 24-72 hours post op.

possible CV collapse

SU 17: Wine regions of South America (10 decks)

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