Exam 2 Study Guide Thyroid Disorders Flashcards
What are infrequent ectopic sites of the thyroid in the oral cavity?
Intralingual
Lingual Thyroid Tissue
Excessive activation of the thyroid leads to…
a hypermetabolic state causing protein catabolism and enhanced sympathetic NS activity.
Thyroid disease is most common in…
Females
What is “thyroid storm”?
Fever Tachycardia Sweating Shaking Agitation Unconsciousness
What disease is affiliated with Hyperthyroidism?
Grave’s Disease (in 90% of cases)
What are causes of Grave’s disease?
Autoimmune-antibodies function as agonists to thyroid-related receptors- causing excessive thyroid receptor activation.
What are the symptoms of Grave’s disease?
Hyperthyroidism
Exophthalmos
Thyroid gland hyperplasia
What is Plummer’s Disease?
A multi lobular goiter
5-10% of hyperthyroidism cases
What disease is affiliated with Hypothyroidism?
Hashimoto’s Disease
most common in females
Characteristics of a goiter…
- Most common thyroid lesion
- Rare with Hypothyroidism
- Not a cancer
- Iodine Deficiency
- Diagnosed with fine needle aspiration (look for colloid)
What is the most common thyroid neoplasm?
Thyroid adenomas
*not malignant
Thyroid Carcinomas are typically…
Low risk and low metastasis
*Most common is Papillary carcinoma
What are mostly benign and found in 6% of women and 2% of males?
Thyroid Nodules
What drugs are used to treat Hyperthyroidism?
Thiomides
Iodides-Lugo Solution
Beta Blockers
Radiation Iodine
What is an example of a thiomide and how dies it work?
propylythiouracil (PTU)
- inhibits the thyroid peroxidase reaction and blocks synthesis of the hormone.
How doe Iodides-Lugol solution work?
Inhibit hormon release
How do beta blockers (propranolol) treat hyperthyroidism?
Inhibit the conversion of T4 to T3
How does Radiation iodine treat hyperthyroidism?
Destroys thyroid parenchyma
How do you treat Hypothyroidism?
Thyroid replacement
Synthroid or Levothroid
What is the function of the Parathyroid?
- Secrete PTH regulated by free calcium in blood.
- Low Ca++ = increased PTH
- PTH activates Osteoclasts and bone resorption to increase serum Ca++
- also increases tubular reabsorption of calcium
- Activates vitamin D
- Increases GI absorption
Hyperparathyroidism causes what?
Hypercalcemia
*Primary and Secondary
What are the characteristics of Primary Hypercalcemia?
- Common Endocrine Disorder (adenoma)
- cause Arrhythmias
- Elevated serum Ca++
- Hypophosphatemic
What are symptoms of Primary Hypercalcemia?
Osteoporosis (fractures) Constipation Weakness Anorexia Stones Ulcers depression coma
What is the treatment for Primary Hypercalcemia
Surgery
What is Secondary Hypercalcemia?
Intestinal malabsorption of Vitamin D or Calcium
What drugs are used to treat Osteoporosis?
Denosumab (Xgeva)
Teraparatide (Forteo)
Estrogens and Estrogen Modulators
Bisphosphonates
How does Denosumab (Xgeva) work?
antibody to the osteoclastic-stimulating protein (RANK)
-This drug blocks osteoclast number and activity
How does Teraparatide (Forteo) work?
a recombinant form of parathormone segment which selectively activates osteoblasts and stimulates new bone formation.
How does estrogen (Modulators) work?
Prevent bone loss in early post-menopausal period
- should be used in combination with progestin to protect against venous thrombi
How do bisphosphonates work?
Suppress activity of osteoclasts and inhibit bone resorption
*BRONJ
What are examples of Bisphosphonates?
Ibandronate (Boniva)
Alendronate (Fosamax)
What drugs promote osteoporosis?
Glucocorticoids
-antagonizes Vit. D stimulated intestinal Ca++ transport and stimulates renal secretion (Blocks osteoblasts)
What are the symptoms of Hypoparathyroidism?
Hypocalcemia
Decreased PTH
Tetany
Dental changes in children
What is the most common cause of Hypoparathyroidism?
Accidental removal at thyroid surgery.
What are secondary hormonal regulators of Bone Mineral Homeostasis?
Calcitonin
- acts opposite of PTH by inhibiting osteoclastic activity.
- can use to treat Paget’s Disease
What is the Pituitary gland?
Brains endocrine gland, secretes through blood-brain barrier.
What to directions does the pituitary gland secrete?
Anterior - Portal circulation from hypothalamus
Posterior - axons go into systemic circulation
What is GIH known as?
Somatostatin
What are the 3 secretions from the pituitary and what can cause them to be disturbed?
Prolactin (Reproductive function) Growth Hormone (Gigantism, Acromegaly) Corticotropin (Affect ACTH causing Cushing's Disease)
*Adenomas
Which disease results in increased growth hormone before puberty?
Gigantism
*Acromegaly after puberty
What is the most common cause for Hypopituitarism?
Consecratory pituitary adenomas
- loss of sex characteristics (sterility)
- Retards child growth
- Hypothyroidism
What is the function of the adrenal glands?
Medulla makes and releases catecholamines
Cortex makes Steroids ( mineralocorticoids, glucocorticoids, and sex steroids)
What are the features of Primary Acute Cortical Insufficiency?
Weakness Nausea Hyponatremia Hypotension Skin Pigmentation
*Addison Disease
What are the features of Secondary adrenocortical Insufficiency?
Due to hypothalamic or pituitary problem
- hypoglycemia
- No hyper pigmentation
- Aldosterone Normal
What is adrenal crisis?
Sudden for increase of steroid output
*can be caused by massive adrenal hemorrhage
What are the two disorders associated with Hypercortisolism?
Cushing Disease
Secondary Adrenocortisol Insufficiency
What are the features of Cushing Disease?
Adrenal Hyperplasia
Adrenal then shrinks due to feedback
Low ACTH, High Cortisol
Adrenals Act autonomously
What are the symptoms of Cushing Disease?
Moon Face Osteoporosis Buffalo Hump Obesity Thin Skin Amenorrhea Poor wound healing
*basically someone in chronic corticosteroid treatment
What is Secondary Aderoncortsol Insufficiency?
- The result of extended use of exogenous steroids (Prednisone)
- Normal adrenal function is suppressed, but then tx is abruptly stopped causing a hypocortisolic reaction.
What is Hyperaldosteronism (Conn Syndrome)?
- Na+ retention and K+ excretion
- Supression of renin-angiotensin system
What are the 3 Adrenal Cortical Tumors?
Adenomas (Common -usually non-functional)
Carcinomas (rare)
Pheochromocytoma (adrenal medullary tumor)
What are characteristics of Pheochromocytoma?
Usually benign
Increases secretion of Catecholamines
Clinically looks like increased sympathetic function
-Hypertension and flushing
Cortisol is synthesized from…
Cholesterol
What is the primary use of Glucocorticoids?
Rapid and dramatic anti-inflammatory effects
- Suppress leukocytes and cytokines/chemokines
- Topical inhibits histamine relate and skin thinning
What are short to medium acting Glucocorticoids?
Hydrocortisone, Cortisone, Prednisone
What is a long acting Glucocorticoid?
Dexamthazone
Glucocorticoids are used for
Allergic reactions
Inflammatory bowel disease
Acute Respiratory Distress Disorder
Dermatitis
What is the treatment for Addison’s Disease?
Since the adrenal glands produce too little cortisol and aldosterone
Hydrocortisone combined with salt-retaining hormone will treat it.
What causes Cushings Disease?
Chronic high levels of Cortisol - usually due to ACTH-secreting tumor
What Drugs can be used for Cushings Disease?
Ketoconazole
Metyrapone
*treats osteoporosis and Paget’s Disease
What does Ketoconazole do?
Inhibits adrenal steroid synthesis
What does Metyrapone do?
selective inhibitor of cortisol/corticosterone synthesis.
What is Paget’s Disease (Osteitis Deformans)
Excessive bone removal followed by excessive bone formation = weakened bone and fractures.
*may be triggered by virus
Paget’s disease would see high what in the serum?
Alkaline Phosphates
