Exam 1 Lecture 6 Flashcards
What is the term for protruding eye
Exophthalmos
What is graves disease?
Does it cause Hyper or hypothyroidism
Hyper
graves disease( stimulation of TSH receptors by auto antibodies, results in increase TSH and thus higher TH) weird antibodies because most AB destroy things; these stimulate them
What is the benefit of giving radioactive iodine?
Is it used for Hyper or Hypothyroid
Hyper
radioactive iodine- will be taken up by iodine pumps and will go into and destroy the thyroid tissue
The thyroid is only thing that uses iodine, so very safe for radioactive iodine
What drug looks very similar to iodine and tricks the iodine pumps? It is used for the treatment of hyperthyroid
Thyocyniate
How much more idoine do we need to give to overwhelm the iodine pumps and treat hyperthyroid?
100X as much as the daily amount
How many month’s supply of TH do we have in the body
About 3 months supply of thyroid hormone
What percent of amiodarone is iodine?
35% of it is iodine
Is idonine in circulation ready to go and work in the systemic circulation
No it needs to be oxidized first before it is useful by the thyroid.
What autoimmune disease cause hypothyroid?
Hashimoto’s thyroiditis( body produces Antibodies that attack gland)
What deficiency can cause hypothyroidism
Iodine!- stupid I know
What percent of the population has idiopathic hypothyroidism
5%
How does Hypothyroid affect our NMB
decreased NMJ excitability- can be more sensitive to NMB agents
What is the synthetic version of thyroid hormone
Synthroid- used for hypothyroid treatment
For my class, what is the syndrome/disease process of lack of thyroid hormone during early childhood, stunted growth, irreversible
cretinism
Will high TH in childhood allow you to reach NBA star height?
Sadly no,
High TH in childhood will grow faster earlier not taller just quicker
For my class, what are some treatment options for a wide array of conditions that cause hypothyroid
Can give steroids for treatment or plasmapheresis to skim off the bad antibodies(Hashimotos)
can also give Synthroid or levothyroxine
WHat 2 things control the thyroid gland
Pituitary gland and hypothalamus
What are our circulating thyroid hormones
T3 and T4
What is the base or parent compound for thyroid hormone
Tyrosine
What is Tyrosine
It is an amino acid
What do we call a compound with 1 iodine + tyrosine
monoiodotyrosine or T1
What do we call a compound with 2 iodine + tyrosine
diiodotyrosine or T2
What 2 compounds combine to make T3
T1+T2
What is the chemical name for T3
Triiodothronine
What 2 compounds combine to make T4
T2+T2
What is the chemical name for T4
Thyroxine
How many benzene rings do T1 and T2 have
Each have 1
How many benzene rings do T3 and T4 have
2 each
How much iodine per gram comes from sea salt
0
What is iodine attached to provide humans with an adequate supply of iodine
Table salt
How many mg per year of iodine are needed per year
50 mg
What organ is responsible for the swift removal of iodine
Kidney
What enzyme uses oxidative stress to oxidize iodine and convert to a form that connects to tyrosine, is a crucial step in thyroid hormone production
Peroxidase
What is another “good” example in the body that uses oxidative for the benefit of the system
Immune system uses oxidative stress and free radicals to destroy bad stuff
What class of hormone is Thyroid hormone
Steroid and very lipid soluble
Where are the TH transport proteins manufactured
Liver
What are the 3 primary transport proteins for TH
Primary TBG- thyroxine binding globulin
Secondary- Thyroxine binding pre albumin
Tertiary -albumin
Why does TH need transport proteins
It is very lipid soluble and needs assistance getting to its destination
What are the percents of T3 and T4 in circulation
T3- 7%
T4-93%
Between T3 and T4, which is the least active
T4 is the least active
T3 is the most active
How will liver failure impact thyroid hormone
LF will have issues regulating thyroid levels since TH needs a transporter since it is fat soluble
Which portion of the pituitary controls ADH
Posterior
What portion of the pituitary controls Thyroid gland
Anterior
What else does the Anterior pituitary gland control
TH controlled
sex hormone
LH or luteinizing hormone-ovaries
FSH- follicle stimulating hormone- ovaries
prolactin- controlling lactation
cortisol release from adrenal gland
pancreatic activity to insulin
Cotricotopin works on adrenal cortex to increase blood glucose
What are the proteins called that encapsulate production spaces for thyroid hormone? This will also be dissolved to release the TH
Thyroglobulin
1 Thyroglobulin holds how many T3 and T4
For my class, around 60
If we have severe iodine deficiency what will happen to:
T3 and T4
TSH
TRH
decreased T3 and T4 and increased TSH and TRH, this can cause goiter from swelling or overstimulating
For my class, a goiter doesn’t necessarily mean you have hyperthyroid, you can have hypothyroid and a goiter like described above
What is next to the cricothyroid ligament and can be in the way for an oh shit emergent airway
Thyroid gland
I know shocker from our THYROID lecture…… but you try and write a card for this not swell
For my class, what happens when you accidentally cut the thyroid
It bleeds….. a lot
#increase confiendence card!
What type of muscle is the larynx
SKM…….. PTSD from last semester
What happens to the nerves in the thyroid when we have a goiter
If we have enlarged thyroid can compress the nerves and make speech difficult, and makes it hard to have a clean airway
What happens to tracheal ligaments with a severe goiter
Enlarged thyroid(goiter)- puts a lot of pressure on larynx, can also compress tracheal ligaments and can collapse airway
What is the main sensory organ for TH
Hypothalamus
What drains hypothalamus hormones into the anterior pituitary
Portal vein
What does the hypothalamus release to go to the pituitary
TRH- thyrotropin-releasing hormone
What is considered the second messenger in TH production? Where is it released
TSH (kind of like a second messenger)is released from pituitary into systemic circulation to go to thyroid gland
What is the most active from of TH intracelluarly
T3
How do the cells convert T4 into the more active T3
iodinase- pulls iodine off something, so it works by pulling iodine off T4 to convert to more active T3, which happens at the tissue level
ase= pulls something off it
What organelle in the cell is most important for the Thyroid hormone interaction?
The nucleus
The typical response in cells from TH is inside the nucleus and increases gene transcription and upregulates transport protein, enzymes, and structural proteins
What happens to mitochondria in response to direct thyroid hormone stimulation on the cell
mitochondria upregulation, increase number and increase in size- increases more mitochondria
What happens to sodium permeability when you have an increased thyroid hormone interacting with the cells
Increases Sodium permeability
The cell has more sodium coming in and the cells will increase the cyclic rate of the NaKatpase pumps
What is the “energy hog” of the human body
NaKatpase pump
I made this up disregard
What is the typical glucose responses to an increase in TH
glucose metabolism increases, increase glucose coming in as well, increase in uptake in GI system as well from diet
increase gluconeogenesis or glucose production from destroying fats
increase rate of glycolysis rate
increase circulating insulin levels
increase activity of total endocrine system
How is the CV system impacted by increased levels of TH
Increase HR
increase SV
MAP doesn’t change really
Increase PP- from increased SV, increased systolic BP and reduced diastolic bp( increase metabolism at tissues- think BV don’t have enough energy to care and reduce resistance)
What happens to total cholesterol and triglycerides levels with an increase in TH
Reduces circulating cholesterol levels – from body using cholesterol to build things or take energy from it, and increases excretion via the GI system side effect of active GI system and increased movement of things through GI system, you will have increased bile secretion from liver as well
reduces TG’s or triglycerides
What are the neurological effects of increased TH
higher the thyroid= more neuro activity and makes it difficult to sleep, will be very alert, you will have an increase in neuromuscular junction activity as well, can have a muscle tremor
super super high levels can turn into muscles not working at all and have deficits
Between hyper and hypothyroid which one cause an increase risk for atherlosclerosis
Hypothyroid
If we artificially inject Thyroxine, how long does it take before we see effects
2-3 days
it takes a while for the nucleus to increase production of new genes
If we artificially inject Thyroxine, how long does it take before we see effects
2-3 days
it takes a while for the nucleus to increase the production of new genes
If we artificially inject Thyroxine, how long does it take before we see effects
2-3 days
it takes a while for the nucleus to increase the production of new genes
What are the 3 main labs to monitor thyroid levels
T4,TSH,TRH
If we have a high T4 level from tumor (adenoma) on thyroid, what will happen to our TSH and TRH
should have low TSH and TRH
If we have a pituitary tumor secreting TSH, what will happen to our T4 and TRH
High T4
Decreased TRH- from negative feedback
If we artificially give TRH in a healthy person, what happens to TSH and T4
Increases TSH and T4
What happens to TSH,TRh and T4 in graves disease
Decreased TSH and TRH
Increased T4
What happens to our labs with an iodine deficiency
Decreased T4
Increased TSH and TRH
How does the negative feedback system of the hypothalamus helps regulate TH
Increased in T4= increased cell metabolism, Increases temperature and metabolic rate, and hypothalamus sees this, this is how the thyroid indirectly controls communication with hypothalamus
How does decreased temperature and increased stress impact TH levels
Increases TH
Hypothalamus sees the changes and increases TH to correct this
What are the signs and symptoms of thyroid storm
increase HR
Increase ventilation
increase oxygen requirement
increase body temp
What is the term for protruding eye?
Exophthalmos
