exam 3 Flashcards
Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapazole)?
To limit the effect of the pituitary on the thyroid
To destroy part of the hyperactive thyroid tissue
To stimulate the pineal gland
To block the production of thyroid hormones
To block the production of thyroid hormones
Medical management for hyperthyroidism may include administration of drugs that block the
production of thyroid hormones, such as propylthiouracil or methimazole.
To which diet should a patient with Cushing syndrome adhere?
Less sodium
More calories
Less potassium
More carbohydrates
Less sodium
The diet should be lower in sodium to help decrease edema.
A patient has returned to his room after a thyroidectomy with signs of thyroid crisis. During
thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the
potentially lethal complication of:
severe nausea and vomiting.
bradycardia.
delirium with restlessness
congestive heart failure.
congestive heart failure.
In thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. The patient
may develop congestive heart failure and die
The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to:
stimulate the thyroid gland.
depress the pituitary
destroy some of the thyroid tissue.
alter the stimulus from the pituitary.
destroy some of the thyroid tissue.
Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more
normally functioning gland.
Which precaution(s) should the nurse take when caring for a patient who is being treated with radioactive iodine 131 (RAIU)?
Initiate radioactive safety precautions
Avoid assigning any young woman to the patient
Wait three days after dose before assigning a pregnant nurse to care for this patient
Advise visitors to sit at least 10 feet away from the patient
Wait three days after dose before assigning a pregnant nurse to care for this patient
The dose is patient specific and at a very low level. No radioactive safety precautions are necessary
and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to nonpregnant
women
What is the postoperative position for a person who has had a thyroidectomy?
Prone
Semi-Fowler
Side-lying
Supine
Semi-Fowler
Postoperative management of this patient includes keeping the bed in a semi-Fowler position, with pillows supporting the head and shoulders. There should be a suction apparatus and tracheotomy tray available for emergency use.
What extra equipment should the nurse provide at the bedside of a new postoperative thyroidectomy patient?
Large bandage scissors
Tracheotomy tray
Ventilator
Water-sealed drainage system
Tracheotomy tray
There should be a suction apparatus and tracheotomy tray available for emergency use.
As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the patient has a spasm of the facial muscles. What should the nurse recognize this as?
Chvostek sign
Montgomery sign
Trousseau sign
Homanssign
Chvostek sign
The spasm of facial muscles when stimulated is the Chvostek sign, an indication of hypocalcemic tetany
patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion. She should be informed of which potential complication?
Osteoporosis
Lethargy
Laryngeal spasms
Kidneystones
Laryngeal spasms
Decreased parathyroid hormone levels in the blood stream cause a decreased calcium level. Severe hypocalcemia may result in laryngeal spasm, stridor, cyanosis, and increased possibility of asphyxia.
A 27-year-old patient with hypothyroidism is referred to the dietitian for dietary consultation. What should nutritional interventions include?
Frequent small meals high in carbohydrates
Calorie-restricted meals
Caffeine-rich beverages
Fluid restrictions
Calorie-restricted meals
What instructions should be included in the discharge instructions for a 47-year-old
patient with hypothyroidism?
Taking medication whenever symptoms cause discomfort
Decreasing fluid and fiber intake
Consuming foods rich in iron
Seeing the physician regularly for follow-up care
Seeing the physician regularly for follow-up care
Regular checkups are essential, because drug dosage may have to be adjusted from time to time.
Howshould the nurse administer insulin to prevent lipohypertrophy?
At room temperature
At body temperature
Straight from the refrigerator
After rolling bottle between hands to warm
At room temperature
In fact, it is now believed that insulin should be administered at room temperature, not straight
from the refrigerator, to help prevent insulin lipohypertrophy
A patient with a history of Graves disease is admitted to the unit with shortness of breath. The nurse notes the patients vital signs: T 103 F, P 160, R 24, BP 160/80. The nurse also notes distended neck veins. What does the patient most likely have?
Pulmonary embolism
Hypertensive crisis
Thyroid storm
Cushing crisis
Thyroid storm
In a thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. Additionally,
the patient may develop nausea, vomiting, severe tachycardia, severe hypertension, and occasionally
hyperthermia up to 41 C (106 F). Extreme restlessness, cardiac arrhythmia, and delirium may
also occur. The patient may develop heart failure and may die
What is the master gland of the endocrine system?
Thyroid
Parathyroid
Pancreas
Pituitary
Pituitary
The pituitary gland, located in the brain, is the master gland of the endocrine system. It has been called the master gland because through the negative feedback system, it exerts its control over the other endocrine glands.
What information should be obtained from the patient before an iodine-131 test?
Presence of metal in the body
Allergy to sulfa drugs
Status of possible pregnancy
Use of prescription drugs for hypertension
Status of possible pregnancy
The patient being treated for hypothyroidism should be instructed to eat well-balanced meals including intake of iodine. Which of the following foods contains iodine?
Eggs
Pork
White bread
Skinless chicken
Eggs
The hypothyroid diet should be adequate in intake of iodine, in foods such as saltwater fish, milk, and eggs; fluids should be increased to help prevent constipation.
The nurse is caring for a patient who is receiving calcium gluconate for treatment of hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug?
Increase in heart rate
Flushing of face and neck
Drop in blood pressure
Urticaria
Drop in blood pressure
Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and hypotension
The adrenal cortex secretes glucocorticoids. The most important is cortisol. What is it involved in? (Select all that apply
Glucose metabolism
Releasing androgens and estrogens
Providing extra reserve energy during stress
Decreasing the level of potassium in the blood stream
Increasing retention of sodium in the blood stream
Glucose metabolism
Providing extra reserve energy during stress
Cortisol is involved in glucose metabolism and provides extra reserve energy in times of stress
Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the previous 8 to 12 weeks?
Fasting blood sugar (FBS)
Oral glucose tolerance test (OGT)
Glycosylated hemoglobin (HbA1c)
Postprandial glucose test
Glycosylated hemoglobin (HbA1c)
Which test will furnish immediate feedback for a newly diagnosed diabetic who is not yet under control?
Fasting blood sugar (FBS)
Glycosylated hemoglobin (HgbA1c)
Oral glucose tolerance test (OGTT)
Clinitest
Fasting blood sugar (FBS)
Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime each day until their disease is under control. The HgbA1c serum test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks
The patient is a 20-year-old college student who has type 1 diabetes and normally walks each evening as part of an exercise regimen. The patient plans to enroll in a swimming class. Which adjustment should be made based on this information
Time the morning insulin injection so that the peak action will occur during swimming
Delete normal walks on swimming class days.
Delay the meal before the swimming class until the session is over.
Monitor glucose level before, during, and after swimming to determine the need for alterations in food or insulin.
Monitor glucose level before, during, and after swimming to determine the need for alterations in food or insulin.
Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia
What is a long-term complication of diabetes mellitus?
Diverticulitis
Renal failure
Hypothyroidism
Hyperglycemia
Renal failure
Long-term complications of diabetes include blindness, cardiovascular problems, and renal
failure.
In diabetes insipidus, a deficiency of which hormone causes clinical manifestations?
antidiuretic hormone (ADH)
follicle-stimulating hormone (FSH)
thyroid-stimulating hormone (TSH)
adrenocorticotropic hormone (ACTH)
antidiuretic hormone (ADH)
Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in
which ADH is deficient.
What should the nurse caution a type I diabetic about excessive exercise?
It can increase the need for insulin and may result in hyperglycemia.
It can decrease the need for insulin and may result in hypoglycemia.
It can increase muscle bulk and may result in malabsorption of insulin.
It can decrease metabolic demand and may result in metabolic acidosis.
It can decrease the need for insulin and may result in hypoglycemia.
The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia.
The nurse caring for a 75-year-old man who has developed diabetes insipidus following a head injury will include in the plan of care provisions for
limiting fluids to 1500 mL a day.
encouraging physical exercise.
protecting patient from injury.
discouraging daytime naps.
protecting patient from injury.
The patients need protection from injury because they are often exhausted from sleep deprivation
and having to get up frequently at night. Fluids should not be limited and their energy should be
preserved
The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U100 subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack of milk and crackers be given?
To improve nutrition
To improve carbohydrate metabolism
To prevent an insulin reaction
To prevent diabetic coma
To prevent an insulin reaction
Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia
(a less-than-normal amount of glucose in the blood, usually caused by administration of too much
insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is taking
The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of insulin reaction would include information about
abdominal pain and nausea.
dyspnea and pallor.
flushing of the skin and headache.
hunger and a trembling sensation
hunger and a trembling sensation
The patient should be instructed to notify a member of the nursing staff if any signs of hypoglycemic
(low insulin) reaction occur: excessive perspiration or trembling.
The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of
hypoglycemic reaction; give 6 oz of orange juice.
hyperglycemic reaction; give ordered regular insulin
.
hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal cavity.
hypoglycemic reaction; give ordered insulin.
hypoglycemic reaction; give 6 oz of orange juice
Hypoglycemic reaction is due to not enough food for the insulin. Quick acting carbohydratessuch as orange juice or longer acting foods such as milk, crackers, and cheeseare beneficial
What instructions should a nurse give to a diabetic patient to prevent injury to the feet?
Soak feet in warm water every day.
Avoid going barefoot and always wear shoes with soles.
Use of commercial keratolytic agents to remove corns and calluses are preferred to cutting off corns and calluses
Use a heating pad to warm feet when they feel cool to the touch.
Avoid going barefoot and always wear shoes with soles.
Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not beneficial to preserve the health of a diabetics feet
The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when diet and exercise have not been able to control type 2 diabetes. What should the nurse include in the teaching plan about this medication?
It is a substitute for insulin and acts by directly stimulating glucose uptake into the cell.
It does not cause the hypoglycemic reactions that may occur with insulin use.
It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites
It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites
What kind of control mechanism is indicated when increased blood glucose levels stimulate increased secretion of insulin?
Control by releasing hormones
Control by tropic hormones
Negative feedback control
Hypothalamus/hypophysis coordination
Negative feedback control
What is the most common cause of endocrine disorders?
Malignant neoplasm
Infection
Congenital defect
Benign tumor
Benign tumor
Choose the statement that applies to type 1 diabetes mellitus
Onset often occurs during childhood.
Relative insufficiency of insulin or insulin resistance develops.
It can be treated by diet, weight control and exercise, or oral hypoglycemics.
Complications rarely occur.
Onset often occurs during childhood.
Whydoes polyuria develop with diabetes mellitus?
Increased thirst and hypoglycemia
Ketoacidosis
Osmotic pressure due to glucose
Diabetic nephropathy
Osmotic pressure due to glucose
What is the cause of diabetic ketoacidosis?
Excess insulin in the body
Loss of glucose in the urine
Failure of the kidney to excrete sufficient acids
Increased catabolism of fats and proteins
Increased catabolism of fats and proteins
What is a precipitating factor for diabetic ketoacidosis?
Skipping a meal
Anorexia
Serious infection
Insulin overdose
Serious infection
Which of the following may cause insulin shock to develop?
Strenuous exercise
Missing an insulin dose
Eating excessively large meals
Sedentary lifestyle
Strenuous exercise
Which of the following indicates hypoglycemia in a diabetic?
Deep, rapid respirations
Flushed dry skin and mucosa
Thirst and oliguria
Staggering gait, disorientation, and confusion
Staggering gait, disorientation, and confusion
Which of the following are signs of diabetic ketoacidosis in an unconscious person?
Pale moist skin
Thirst and poor skin turgor
Deep rapid respirations and fruity breath odor
Tremors and strong rapid pulse
Deep rapid respirations and fruity breath odor
Immediate treatment for insulin shock may include:
administration of bicarbonates
consumption of fruit juice or candy.
induced vomiting.
consumption of large amounts of water.
consumption of fruit juice or candy
What causes loss of consciousness in a person with diabetic ketoacidosis?
Toxic effects of excessive insulin
Excessive glucose in the blood
Metabolic acidosis
Lack of glucose in brain cells
Metabolic acidosis
Which of the following does NOT usually develop as a complication of diabetes?
Osteoporosis
Nephropathy
Impotence
Peripheral neuropathy
Osteoporosis
Howdomanyoral hypoglycemic drugs act?
To replace insulin in patients with insulin-dependent diabetes mellitus (IDDM)
To transport glucose into body cells
To prevent gluconeogenesis
To stimulate the pancreas to produce more insulin
To stimulate the pancreas to produce more insulin
Diabetes may cause visual impairment through damage to the lens; this is referred to as:
cataracts.
macular degeneration.
myopia.
strabismus
cataracts.
Which of the following applies to diabetic macro-angiography?
It affects the small arteries and arterioles.
It is related to elevated serum lipids.
It leads to increased risk of myocardial infarction and peripheral vascular disease.
It frequently causes damage to the kidneys
It is related to elevated serum lipids.
It leads to increased risk of myocardial infarction and peripheral vascular disease
Whyis amputation frequently a necessity in diabetics?
Necrosis and gangrene in the feet and legs
Lack of glucose to the cells in the feet and legs
Severe dehydration in the tissues
Elevated blood glucose increasing blood viscosity
Necrosis and gangrene in the feet and legs
Atype of diabetes that may develop during pregnancy and disappear after delivery is
called
temporary maternal diabetes.
fetal diabetes.
acute developmental diabetes.
gestational diabetes.
gestational diabetes.
Which one of the following develops hypoglycemia more frequently?
Type 1 diabetic patients
Type 2 diabetic patients
Patients with a poor stress response
Patients with a regular exercise and meal plan
Type 1 diabetic patients
Which of the following hormonal imbalances causes Addisons disease?
Increased glucocorticoids
Decreased glucocorticoids
Deficit of antidiuretic hormone (ADH)
Deficit of T3 and T4
Decreased glucocorticoids
Which of the following hormonal imbalances causes diabetes insipidus
Increased insulin
Decreased glucocorticoids
Deficit of ADH
Deficit of T3 and T4
Deficit of ADH
What is caused by hyperparathyroidism?
Hypocalcemia
Tetany
Bone demineralization
Deficit of vitamin D
Bone demineralization
What is caused by hypocalcemia due to hypoparathyroidism?
Skeletal muscle twitching or spasm
Weak cardiac contraction
Increased secretion of parathyroid hormone (PTH)
Decreased serum phosphate level
Skeletal muscle twitching or spasm
Weak cardiac contraction
Which of the following applies to acromegaly?
It occurs in infants and children.
It causes excessive longitudinal bone growth.
It results from excessive secretion of growth hormone (GH).
It does not change soft tissue growth
It results from excessive secretion of growth hormone (GH)
Which of the following may cause goiter?
Hyperthyroidism
Hypothyroidism
Lack of iodine in the diet
Pheochromocytoma
Hyperthyroidism
Hypothyroidism
Lack of iodine in the diet
Which signs are typical of Graves disease?
Facial puffiness, bradycardia, and lethargy
Exophthalmos and tachycardia
delayed physical and intellectual development
Goiter and decreased basal metabolic rate (BMR)
Exophthalmos and tachycardia
Characteristics of Cushings syndrome include all of the following EXCEPT
Heavy body and round face
Atrophied skeletal muscle in the limbs
Staring eyes with infrequent blinking
Atrophy of the lymph nodes
Staring eyes with infrequent blinking
Which of the following is an effect of long-term glucocorticoid therapy?
Decreased secretion from the adrenal cortex gland
An increased inflammatory response to irritants
Hypotension and poor circulation
Increased number of hypersensitivity reactions
Decreased secretion from the adrenal cortex gland
Which of the following is an effect of Addisons disease?
Elevated blood glucose levels
High blood pressure
Lowserum potassium levels
Poor stress response
Poor stress response
What is the most common cause of type 1 diabetes mellitus?
Increased glucose production in the liver
Destruction of pancreatic cells by an autoimmune reaction
Increased resistance of body cells to insulin action
Chronic obesity
Destruction of pancreatic cells by an autoimmune reaction
Whydoes glucosuria occur in diabetics?
Excess ketoacids displace glucose into the filtrate.
Excess water in the filtrate draws more glucose into the urine
The amount of glucose in the filtrate exceeds the renal tubule transport limit.
Sufficient insulin is not available for glucose reabsorption.
The amount of glucose in the filtrate exceeds the renal tubule transport limit.
Which of the following are common early signs of a pituitary adenoma?
Persistent headaches
Hemianopia
Hypertension
Papilledema
Persistent headaches
Hemianopia
Which of the following does NOT apply to inappropriate ADH syndrome?
The cause is excess ADH secretion.
Severe hyponatremia results.
Excessive sodium is retained.
Fluid retention increases
Excessive sodium is retained
What is/are the effect(s) of thyrotoxic crisis
Hyperthermia and heart failure
Hypotension and hypoglycemia
Toxic goiter and hypometabolism
Decreased stress response
Hyperthermia and heart failure
Which of the following conditions may precipitate or exacerbate hyperglycemia?
Hypothyroidism
Cushings disease
Addisons disease
Growth hormone deficit
Cushings disease
Which of the following conditions may cause immunosuppression?
Graves disease
Acromegaly
Cushings disease
Diabetes insipidus
Cushings disease
Hyperosmolar hyperglycemic nonketotic coma (HHNC) more frequently develops in patients with:
type 1 diabetes.
type 2 diabetes.
Graves disease.
hyperparathyroidism.
type 2 diabetes.
Which of the following is recommended for immediate treatment of hypoglycemic shock
If conscious, immediately give sweet fruit juice, honey, candy, or sugar.
If unconscious, give nothing by mouth (require intravenous glucose 50%).
Treat immediately with insulin.
Give large quantity of clear fluids for shock.
If conscious, immediately give sweet fruit juice, honey, candy, or sugar.
If unconscious, give nothing by mouth (require intravenous glucose 50%).
All these tissues use glucose without the aid of insulin EXCEPT:
liver.
digestive system.
exercising skeletal muscle.
brain
liver
Differences between type 1 and type 2 diabetes include which of the following?
Type 1 diabetes weight gain is common, and type 2 weight loss often occurs.
Type 1 diabetes leads to fewer complications than does type 2 diabetes
Type 1 diabetes may be controlled by adjusting dietary intake and exercise, but type 2 diabetes requires insulin replacement. Type 1 diabetes occurs more frequently in children and adolescents, and type 2 diabetes occurs more often in adults.
Type 1 diabetes occurs more frequently in children and adolescents, and type 2 diabetes occurs more often in adults.
Complications of diabetes mellitus include:
peripheral neuropathy.
frequent infections.
cataracts.
A, B, and C
peripheral neuropathy.
frequent infections.
cataracts.
Which of the following often causes hyperparathyroidism?
Amalignant tumor in the parathyroid glands
End-stage renal failure
Osteoporosis
Radiation involving the thyroid gland and neck area
Radiation involving the thyroid gland and neck area
Dwarfism is caused by:
excessive levels of somatotropin (GH).
a deficit of somatotropin (GH).
excessive levels of insulin.
excessive levels of parathyroid hormone
a deficit of somatotropin (GH).
Which of the following results from a deficit of antidiuretic hormone (ADH)?
Inappropriate ADH syndrome
Gigantism
Diabetes insipidus
Myxedema
Diabetes insipidus
Goiters occur more frequently in persons living in the:
Great Lakes or mountainous regions.
southwest United States.
temperate regions.
areas bordering the oceans
Great Lakes or mountainous regions.
Which of the following is caused by Graves disease?
Hypermetabolism
Decreased size of thyroid gland
Bradycardia and hypothermia
Decreased blood levels of T3, T4, and TSH
Hypermetabolism
Goiters may be caused by:
hypothyroid conditions only.
either hypothyroid or hyperthyroid conditions.
hyperthyroid conditions only.
fungal infections such as candidiasis
either hypothyroid or hyperthyroid conditions.
Severe impairment of all aspects of growth and development, including difficulty feeding, mental retardation, and stunted skeletal growth, are associated with
myxedema
Cushings syndrome.
diabetes insipidus.
cretinism.
Graves disease.
cretinism.
Abenign tumor of the adrenal medulla that secretes epinephrine and norepinephrine is called
pheochromocytoma.
Cushings syndrome.
Graves disease.
Addisons disease.
pheochromocytoma.
The anterior pituitary gland secretes all of the following hormones EXCEPT:
prolactin (PRL).
glucagon.
adrenocorticotropic hormone (ACTH).
growth hormone (GH).
glucagon.
Overproduction of thyroid hormones (T3, T4) leading to increased metabolism and sympathetic nervous system activity.
Hyperthyroidism
hyperthyroidism
Routine screening at age -_____ (unless high risk)
50
Fatigue
Weight Loss, Increased Appetite
Anxiety, Insomnia, Irritability
Heat Intolerance
Increased Bowel Motility
Vision Changes
Palpitations
Menstrual Changes
Hyperthyroidism
Muscle atrophy, tremors
Warm, flushed, and moist skin
Hyperpigmentation
Fine silky thinning hair,
Exophthalmos
Hyperactive reflexes
Tachycardia
Enlarged Thyroid
Hyperthyroidism
Agitation, delirium, psychosis, seizures, Coma (late stage), Severe tachycardia, atrial fibrillation, Shock, Heart failure, Pulmonary Edema, High fever (> 102–106°F or > 39°C), Diaphoresis, Severe nausea, vomiting, diarrhea, abdominal pain, hepatomegaly and/or jaundice
Thyroid Storm
Infection
Trauma
Severe emotional or physical stress
Abrupt withdrawal of antithyroid medications
Uncontrolled Graves’ disease
DKA (Diabetic Ketoacidosis)
Iodine overload (contrast dye, amiodarone)
can all be a cause for
Thyroid Storm
Hyperthyroidism is diagnosed by
low TSH, high T3 & T4
Confirmatory
Thyroid Autoantibodies
Radioactive Iodine Uptake (RAIU) Scan
Thyroid Ultrasound
Serum Thyroglobulin
Erythrocyte Sedimentation Rate (ESR)
Electrocardiogram (ECG)
mangement for hyperthyroidism
Beta-blockers (for tachycardia)
**Antithyroid Drugs: **
Propylthiouracil (PTU) - thyroid storm or pregnancy
Methimazole (MMI)
Radioactive Iodine
Surgery
Underproduction of thyroid hormones (T3, T4) leading to decreased metabolism and systemic effect
hypothyroidism
Primary (Thyroid Dysfunction):
Hashimoto’s thyroiditis (autoimmune destruction)
Iodine deficiency
Post-surgical or post-radioiodine ablation
Congenital hypothyroidism
Medications (e.g., lithium, amiodarone)
hypothyroidism
Fatigue, weakness
Cold intolerance
Weight gain despite normal diet
Depression, mood changes
Constipation
Dry skin, brittle nails, hair thinning
Memory impairment, brain fog
Hoarseness
Menstrual irregularities, infertility
Joint and muscle pain
hypothyroidism
Bradycardia
Hypotension
Cool, dry, pale skin
Periorbital and facial edema
Delayed reflexes
Non-pitting edema (myxedema)
Goiter (enlarged thyroid in Hashimoto’s)
Coarse, brittle hair and thinning of lateral eyebrows (Queen Anne’s sign
hypothyroidism
Contributing Factors:
Infection
Surgery
Trauma
Cold exposure
Sedative or opioid use
Myxedema Crisis (Severe Hypothyroidism Emergency)
Symptoms:
Severe hypothermia
Bradycardia, hypotension
Hypoventilation
Altered mental status, coma
Hypoglycemia, hyponatremia
Myxedema Crisis (Severe Hypothyroidism Emergency)
First-line treatment: Levothyroxine (synthetic T4)
Dosing:
Start low in elderly or cardiac patients
Adjust based on TSH levels (check every 6-8 weeks initially)
Lifestyle Modifications:
Adequate iodine intake
Regular follow-up for medication adherence
Monitor for overtreatment (signs of hyperthyroidism)
Hypothyroidism
Thyroid-Stimulating Hormone (TSH):
Elevated
Free T4 (FT4): Low in all types
Hypothyroidism
S&S is painless nodule/lump in neck (fixed, nontender, firm, irregular), difficulty breathing, (hoarseness & hemoptysis indicate malignancy
thyroid cancer
thyroid cancer diagnostic tests
High-resolution ultrasonography to identify nodules present
Fine-needle aspiration biopsy to determine benign or cancerous
Elevated Serum Calcitonin is strong marker for tumor
CT or MRI best when Tumor is Large, recurrent or invades other area
Inadequate secretion of PTH, leading to hypocalcemia and neuromuscular excitability.
Rare; mostly due to post-surgical causes.
Hypoparathyroidism
Causes of ______
Surgical removal of parathyroid glands (most common)
Autoimmune destruction
Congenital disorders (DiGeorge syndrome)
Radiation-induced damage
Severe magnesium deficiency (needed for PTH secretion)
Hypoparathyroidism:
Subjective Symptoms
Muscle cramps, tingling, numbness (especially in fingers and lips)
Anxiety, depression, irritability
Dry skin, brittle nails, hair loss
Difficulty swallowing or speaking (laryngospasm)
Seizures (in severe cases)
Hypoparathyroidism:
Objective Signs
Trousseau’s sign (carpopedal spasm when inflating BP cuff)
Chvostek’s sign (facial twitching when tapping on facial nerve)
Hyperactive deep tendon reflexes
Laryngospasm or bronchospasm
Prolonged QT interval on ECG (risk for arrhythmias)
Hypoparathyroidism:
Diagnostic Testing
Low serum calcium (<8.5 mg/dL)
Low PTH levels
High serum phosphate
Normal or low magnesium
EKG: Prolonged QT interval (risk of arrhythmias)
Hypoparathyroidism:
Emergency Treatment (Acute Hypocalcemia Crisis):
IV calcium gluconate if tetany, laryngospasm, or seizures occur
Chronic Management:
Oral calcium and vitamin D (Calcitriol - active vit. D)
Magnesium supplementation if needed
Lifelong monitoring of calcium, phosphate, and PTH levels (CMP, PTH assay)
Hypoparathyroidism:
Overproduction of parathyroid hormone (PTH) leading to hypercalcemia and increased bone resorption.
More common in women; incidence increases with age.
Routine Screening: Recommended in patients with unexplained hypercalcemia.
Hyperparathyroidism
Causes
Primary: Parathyroid adenoma (85%), hyperplasia, or carcinoma.
Secondary: Chronic kidney disease (CKD), vitamin D deficiency.
Tertiary: Long-standing secondary
Hyperparathyroidism
Subjective Symptoms
Fatigue, weakness
Polyuria, polydipsia (excessive urination and thirst)
Depression, confusion, or memory impairment
Constipation, abdominal pain, nausea
Bone pain, fractures
Kidney stones
Hyperparathyroidism
Objective Signs
Hypertension
Dehydration (due to excessive calcium diuresis)
Osteopenia or osteoporosis
Nephrolithiasis (kidney stones)
Muscle weakness
Hyperparathyroidism
Diagnostic Testing
Elevated serum calcium (>10.5 mg/dL)
Elevated PTH levels
Low serum phosphate
24-hour urine calcium to rule out familial hypocalciuric hypercalcemia
Bone density scan (DEXA) for osteoporosis risk
Sestamibi scan/Ultrasound to locate a parathyroid adenoma
Hyperparathyroidism
Surgical Treatment: Parathyroidectomy
Medical Management
Hydration
Biphosphonates
Vitamin D & Phosphate Binders
Hyperparathyroidism
Specifically pituitary adrenocorticotropic hormone (ACTH) excess
Due to cortical hypertrophy, tumor, or prolonged administration of glucocorticoid hormones, androgen excess
Cushing’s syndrome
S&S:
slow onset, central obesity, moon face, buffalo hump, thinning & easily bruising skin, hirsutism, acne, striae, fungal infections, muscle weakness, osteoporosis, hormone changes
Cushing’s syndrome
diagnostic tests
Plasma blood levels of cortisol (Norms Am=5-23 & afternoon=3-13) are elevated, CBC, Glucose, CMP
24-hour urinary free cortisol test is best for initial test
Consider low-dose dexamethasone suppression test
Cushing’s syndrome
Destruction of insulin-producing pancreatic islet cells
Associated with autoimmune responses
Little to no autonomous insulin Production
DM1
Defective insulin secretion
Decreased insulin sensitivity
Peripheral insulin resistance
DM2
Prediabetes
Impaired fasting glucose (IFP): Fasting plasma glucose ______-______ mg/dL
Impaired glucose tolerance (IGT): Glucose levels
____–_____/dL 2h after 75 g oral glucose tolerance test
HbA1c: ___-___%
Impaired fasting glucose (IFP): Fasting plasma glucose 100 – 125 mg/dL
Impaired glucose tolerance (IGT): Glucose levels
120-199 mg/dL 2h after 75 g oral glucose tolerance test
HbA1c: 5/7 – 6.4%
clinical presentation
Polydipsia, polyuria, polyphagia
Anorexia
Weight loss
Nocturnal enuresis
Vision changes, weakness, fatigue
dm 1
diagnostic testing for DM1
Initial testing: Symptomatic of hyperglycemia + a random plasma glucose level of ____ mg/dL or higher
Fasting plasma glucose level >___mg/dL
2-hour plasma glucose of ____ mg/dL or higher during an oral glucose tolerance test (OGTT)
Hemoglobin A1c
C-peptide level, acute insulin response test, DM
related auto antibodies
Lipid profile, urinalysis
Initial testing: Symptomatic of hyperglycemia + a random plasma glucose level of 200 mg/dL or higher
Fasting plasma glucose level >126 mg/dL
2-hour plasma glucose of 200 mg/dL or higher during an oral glucose tolerance test (OGTT)
Hemoglobin A1c
C-peptide level, acute insulin response test, DM
related auto antibodies
Lipid profile, urinalysis
complications of
Retinopathy, nephropathy, neuropathy
Coronary artery disease
Macrovascular Disease: PVD, CAD,CVD
Diabetic Ketoacidosis (DKA)
DM1
risk factors
Family History
Poor diet
Lack of exercise
Obesity
Age over 45 years old
Impaired fasting glucose
Large for gestational age baby
African American, Hispanic American, Native American, Asian American, Pacific Islander
dm2
Nonspecific symptoms
Fatigue
Malaise
Anorexia
Amenorrhea
Erectile dysfunction
Headache
Blurred vision
Muscle cramps
Dehydration
dm2
Skin Manifestations
Recurrent cellulitis or fungal infections
Poor or delayed wound healing
Generalized pruritus
Acanthosis nigricans
dm2
HA1c confirmed for DM
6.5
