Endocrine-thyroid

Question 1

Action of Follicle cells (Acini) in the thyroid gland

Answer 1

Stores thyroglobulin & thyroid hormone

Question 2

What does the thyroid gland do?

Answer 2

Maintains optimal metabolism for tissue function

Autonomic innervation

Hypothalamus (TRH)….pituitary (TSH)…thyroid (THs)

Question 3

What are the thyroid hormones?

Answer 3

T3 (triiodothyronine)-active form

T4 (thyroxine)

Question 4

T3 is synthesized from________or_______in peripheral tissues

Answer 4

Tyrosine metabolism

OR

Conversion of T4

Question 5

T3 can increase_________&______ and cause________

Answer 5

O2 consumption & metabolism

Protein catabolism

Question 6

T4 is synthesized from

Answer 6

Tyrosine

Question 7

T4 is the pro hormone for

Answer 7

T3

Question 8

T4 accounts for _____of TH

Answer 8

80%

Question 9

T4 physiologic effects is related to

Answer 9

Conversion & action of T3

Question 10

Calcitonin is released by

Answer 10

Thyroid gland

Question 11

Calcitonin is a ______hormone

Answer 11

Polypeptide

Question 12

Calcitonin decreases concentration of ______ions ini plasma

Answer 12

Ca+

Question 13

Decreased concentration of Ca+ ions ini the plasma_____, ______&______

Answer 13

Weakens osteoclasts

Strengthens osteoblasts

Decreases renal tubular reabsorption oof Ca & Phosphate

Question 14

What is primary hypothyroidism?

Answer 14

Deficient thyroid hormone production

Iodine Deficiency

Autoimmune disease

Question 15

What is secondary (central) hypothyroidism?

Answer 15

Dysfunctional pituitary gland or hypothalamus

Question 16

What is exogenous hypothyroidism?

Answer 16

Caused by a medication side effect, by surgery or radiation of neck/head

Question 17

How to manage hypothyroidism

Answer 17

TH replacement therapy

Monitor TSH/free T4

Question 18

What is Levothyroxine (Synthroid)

Answer 18

Synthetic thyroxine T4

Question 19

MOA of levothyroxine

Answer 19

Conversion of T4 to T3 ini peripheral tissues

T3 will then bind thyroid hormone receptors and affect DNA transcription

DNA transcription will increase metabolism/SNS activity/growth & development

Question 20

What is Liothyronine

Answer 20

A synthetic isomer oof triiodothyronine (T3) and is 3x more potent than levothyroxine

Question 21

What do clinical trials say about Liothyronine

Answer 21

Little to no effect on hypothyroid symptoms, so may be prescribed T4-T3 combo

Question 22

Levothyroxine may cause_______with _______&______

Answer 22

Synergistic

Anticoagulants & Epi

Question 23

Abnormal thyroids in a patient will cause

Answer 23

Exaggerated response to anesthetics & opioids, causing sedation & delayed emergence

Respiratory depression & muscle weakness

Vasopressor-Resistance HOTN

Bradycardia & diastolic dysfunction

Diminished response to alpha/beta adrenergic drugs

Metabolic abnormalities like hypoglycemia, anemia & hypothermia

Question 24

What is hypothyroid effect on MAC?

Answer 24

No effect

Question 25

What is HYPERthyroidism

Answer 25

Excess production & secretion of thyroid hormone

Question 26

What are some disease processes related to hyperthyroidism

Answer 26

Graves disease (autoimmune disorder of TSH-receptor antibodies) Hashitoxicosis (Autoimmune) Toxic adenoma/goiter (hyperplasia or thyroid follicular cells)

Question 27

What is the treatment of hyperthyroidism

Answer 27

Anti-thyroid drugs Radioiodine Surgery Monitor TSH/T3/T4

Question 28

What are risk factors for thyroid storm?

Answer 28

Surgery Trauma/acute illness Pregnancy

Question 29

Symptoms of thyroid storm

Answer 29

Hyperthermia Agitation/delirium/seizures Tachy/Afib HF Jaundice & diarrhea

Question 30

What drug can treat hyperthyroidism

Answer 30

Thionamides

Question 31

MOA for Thionamides

Answer 31

Inhibit thyroid peroxidase (will decrease oxidation of thyroid hormone) Inhibits formation of TH Reduces concentrations of antithyrotropin-receptor antibodies PTU also inhibits deiodiniation of T4 to T3

Question 32

What should be monitored with Thionamides

Answer 32

Serum T4 & T3 assessment of euthyroid state

Question 33

Thionamides adverse effects

Answer 33

Urticaria/skin rash Arthralgia GI issues Agranulocytosis Granulocytopenia Hepatic toxicity Monitor WBC

Question 34

Potassium Iodides treat

Answer 34

Hyperthyroid

Question 35

Two Potassium Iodides medications

Answer 35

Potassium Iodide Or Potassium iodide-iodine (Lugols)

Question 36

MOA for Potassium Iodides

Answer 36

Decreases iodine uptake by thyroid, TH synthesis & release/thyroid size, & thyroid vascularity

Question 37

Adverse effects of Potassium Iodides

Answer 37

Allergic reaction (rare)-angioedema or laryngeal edema risk Bleeding disorder

Question 38

What is the definitive treatment for Graves

Answer 38

Radioactive Iodine

Question 39

MOA for Radioactive Iodine

Answer 39

Rapid & efficient uptake by the thyroid gland cells Iodine isotopes trapped in thyroid Beta rays destroy cells w/minimal to no damage to surrounding tissues

Question 40

Precautions of Radioactive Iodine

Answer 40

Hypothyroidism risk Contraindicated in pregnancy

Question 41

Adverse effects of Radioactive Iodine

Answer 41

Radiation toxicity Infertility

Question 42

Anesthesia considerations with hyperthyroidism

Answer 42

CV risk like arrhythmia, tachycardia, ischemia or HF

Question 43

CV risk associated with hyperthyroidism are best controlled by a

Answer 43

BETA Blocker (propranolol) IV to inhibit conversion of T4 to T3, which will control tachycardia, HTN and fever 0.5-1mg over 10min

Question 44

What 2 medication can be given together ini high risk patients requiring urgent surgery for hyperthyroidism?

Answer 44

Iodine & thionamides