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NUNA 684 Advanced Pathophysiology > Exam III: Thyroid and Parathyroid Disorders and Surgery > Flashcards

Exam III: Thyroid and Parathyroid Disorders and Surgery Flashcards

1
Q

Synthesis of thyroid hormones in response to ___, ___, or ___

[Normal Thyroid Gland Functions]

A

TSH, low serum iodide levels, or medication

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2
Q

Production of thyroglobulin (precursor to ___)
-Must be iodized to form ___ ___

[Normal Thyroid Gland Functions]

A

THs
T4 T3

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3
Q

Secretion of [Calcitonin or Calcitrol]

[Normal Thyroid Gland Functions]

A

Calcitonin

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4
Q

Increasing the rate of protein, fat, and ___metabolism

[Normal Thyroid Gland Functions]

A

glucose

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5
Q

Increasing body ___ through the metabolism of the above.

[Normal Thyroid Gland Functions]

A

temperature

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6
Q

Thyroid Hormone Actions: (6)

A

Increased BMR
-Increases rate of biochemical rxns
Increases O2 Consumption
Increases Body temp
Supports normal growth and development
Increases Cardiac Contractility & Function
Glucose, Carbohydrate, Fat, Protein Metabolism

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7
Q

Regulation:
Both controlled by TSH & are released in response to___ ___

Thyroxine (T3, T4)

A

metabolic demand

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8
Q

Regulation:
Amount secreted influenced by: gender, pregnancy,___ secretion, temperature, nutritional state, circulating chemicals & ___

Thyroxine (T3, T4)

A

steroid, catecholemines

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9
Q

Function:
Regulate ___, ___, ___

Thyroxine (T3, T4)

A

protein, fat, CHO catabolism

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10
Q

Function:
Metabolic rate of ___cells

Thyroxine (T3, T4)

A

all

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11
Q

Function:
Body ___ regulation

Thyroxine (T3, T4)

A

heat

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12
Q

Function:
GH ___
Skeletal muscle maturation
Cardiac rate, force and output
Resp rate and O2 utilization
Ca++ mobilization
RBC production assistance

Thyroxine (T3, T4)

A

secretion

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13
Q

Function:
Skeletal muscle ___

Thyroxine (T3, T4)

A

maturation

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14
Q

Function:
Cardiac rate,___ and ___

Thyroxine (T3, T4)

A

force and output

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15
Q

Function:
Resp rate and ___ utilization

Thyroxine (T3, T4)

A

O2

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16
Q

Function:
C___ mobilization

Thyroxine (T3, T4)

A

Ca++

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17
Q

Function:
RBC ___assistance

Thyroxine (T3, T4)

A

production

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18
Q

Regulation:
Responds to [elevated/depressed] serum Ca++ level

[Calcitonin]

A

Elevated

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19
Q

Regulation:
Other stimulants are: ___, ___, ___

[Calcitonin]

A

Gastrin, Ca++ rich foods, pregnancy

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20
Q

Regulation:
Low serum calcium [suppresses/stimulates] calcitonin release
[Calcitonin]

A

suppresses

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21
Q

Function:
Major function is [lower/higher] serum calcium levels by opposing bone ____effects of PTH (prevents Ca++ from being released into blood when bone___ ___)

[Calcitonin]

A

lower, resorption, breaks down

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22
Q

Function:
[Lowers/Increases} serum phosphate levels

[Calcitonin]

A

Lowers

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23
Q

Function:
[Decreases/Increases] Ca++ and PO4 absorption in the GI tract

[Calcitonin]

A

Decreases

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24
Q

___: essential in carbohydrate and fat metabolism

[Hormones secreted by the Thyroid]

A

Somatostatin

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25
Q

___: regulation of Calcium

[Hormones secreted by the Thyroid]

A

Calcitonin

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26
Q

Two forms of Thyroid Hormone are present in the body:
___ ___(T4)
___ (T3)

[Hormones secreted by the Thyroid]

A

Thyroxine tetraiodothyronine
Triiodothyronine

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27
Q

Together they are simply called ___ ___

[Hormones secreted by the Thyroid]

A

Thyroid Hormone or (TH)

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28
Q

TH is regulated by a ___ feedback loop with the hypothalmus, anterior pituitary and thyroid gland.
-Tsh stimulated by [low/high] T3, T4 and exposure to cold

[Hormones secreted by the Thyroid]

A

negative
low

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29
Q

The loop is ___ by thryotropin releasing hormone (TRH) from the hypothalmus.

[Hormones secreted by the Thyroid]

A

initiated

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30
Q

Primary hypothyroidism:
[Increase/decrease] Free T4
[Increase/decrease] TSH
[Effects ON Free T4 and TSH]

A

Decrease free T4
Increase TSH

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31
Q

Secondary hypothyroidism:
[Increase/decrease] Free T4
[Increase/decrease] TSH
[Effects ON Free T4 and TSH]

A

Decrease Free T4 & TSH

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32
Q

Primary hyperthyroidism
[Increase/decrease] Free T4
[Increase/decrease] TSH
[Effects ON Free T4 and TSH]

A

Increase Free T4
Decrease TSH

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33
Q

Secondary hyperthyroidism
[Increase/decrease] Free T4
[Increase/decrease] TSH
[Effects ON Free T4 and TSH]

A

Increased Free T4/TSH

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34
Q

Hyperthryoidism (___): hyperfunctioning of the thyroid gland

[Hyperthyroid Pathophysiology]

A

thyrotoxicosis

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35
Q

Primary causes:
Leading cause of hyperthyroidism is ___disease (autoimmune disease)
-TSH receptor antibodies bind to ___gland and cause gland ___
-Also Results in excessive production and secretion of ___ and ___

[Hyperthyroid Pathophysiology]

A

Graves
Gland, enlargement
T3 and T4

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36
Q

Primary Cause:
Toxic multinodular ___

[Hyperthyroid Pathophysiology]

A

goiter

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37
Q

Primary cause:
Thyroid nodule (___) or tumor

[Hyperthyroid Pathophysiology]

A

adenoma

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38
Q

Primary Cause:
___: release of stored hormones

[Hyperthyroid Pathophysiology]

A

Thyroiditis

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39
Q

Secondary
___ TSH from multiple conditions

[Hyperthyroid Pathophysiology]

A

Excess

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40
Q

Iatrogenic
Thyroxine, iodides, ____medications
[Hyperthyroid Pathophysiology]

A

amiodarone

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41
Q

[Hyper/Hypo]metobolic state
Enlarged thyroid gland (___-___x normal size)

[Hyperthyroidism (thyrotoxicosis) s/s]

A

Hypermetabolic
2-3

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42
Q

Cardiovascular: ___blood volume, ___Peripheral vascular resistance, ___ oxygen consumption → tachycardia, ↑ sbp & ↑ cardiac output
[Warm/Cool] moist skin

[Hyperthyroidism (thyrotoxicosis) s/s]

A

↑ , ↓ , ↑
Warm

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43
Q

[Fine/Gross] motor hand tremor
Muscle weakness and extreme ___

[Hyperthyroidism (thyrotoxicosis) s/s]

A

Fine
fatigue

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44
Q

[Diarrhea/Constipation]
[Osteopenia/Osteogenesis imperfecta]

[Hyperthyroidism (thyrotoxicosis) s/s]

A

Diarrhea
Osteopenia

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45
Q

[Hypersomnia/Insomnia]
Anxiety and [heat/cold] intolerance

[Hyperthyroidism (thyrotoxicosis) s/s

A

Insomnia
heat

46
Q

Graves disease symptomology is ___
-Antibodies Target thyroid gland and ___ muscles (Graves ophthalmopathy) and can also target skin (thyroid dermopathy)
-May cause ___ of the eyeballs (___)

[Hyperthyroidism]

A

hyperthyroidism
extraocular
protrusion, exophthalmos

47
Q

Exophthalmos occurs in ___% of cases
[Hyperthyroidism]

A

30

48
Q

Thionamides (propylthiouracil(PTU),methimazole) are the ___ line of treatment
-Interfere with TH ___
-Euthyroid state in ___-___ weeks

[Hyperthyroidism Medical Treatment]

A

first
synthesis
6-8

49
Q

High dose iodides (lugol’s solution, Potassium iodide (SSKI))
-[Rapid/short] acting but short lived, [increases/decreases] gland size and vascularity, [increases/decreases] hormone synthesis
-Used to prepare hyperthyroid patients for ___

[Hyperthyroidism Medical Treatment]

A

Rapid, decreases, dereases
surgery

50
Q

Beta-receptor ___
-Relieve s/s but [do not/do] affect condition
-Propranolol [decreases/increases] peripheral conversion of T4 to T3

[Hyperthyroidism Medical Treatment]

A

blockers
do not
decreases

51
Q

Radioactive Iodides (Common US treatment)
-___-___% of patients treated become ___

[Hyperthyroidism Medical Treatment]

A

40-70
hypothyroidic

52
Q

Thyrotoxicosis associated with significant [increase/decrease] in operative risk
-Surgery can Trigger a ___ ___
-Elective thyroidectomy should not occur until patient ___ via medical mgmt

[Hyperthyroid Preop surgical prep ]

A

increase
thyroid storm
euthyroid

53
Q

Airway and goiter assessment: ___ ___may be present

[Hyperthyroid Preop surgical prep ]

A

tracheal deviation

54
Q

[Increase/Decrease]. blood volume, [Increase/Decrease] svr, wide pulse pressure, [Increase/Decrease] cardiac contractility

[Hyperthyroid Preop surgical prep ]

A

Increase, Decrease, Increase

55
Q

Only proceed with surgery if___-___

[Hyperthyroid Preop surgical prep ]

A

life-threatening

56
Q

Oral thionamides, followed in one hour by ___ ___(ssKI)

[Hyperthyroid Preop surgical prep ]

A

potassium iodide

57
Q

Have ___ or ___ ready for iv titration

[Hyperthyroid Preop surgical prep ]

A

propranolol or esmolol

58
Q

Potentially ___ monitoring
[Hyperthyroid Preop surgical prep ]

A

CVP

59
Q

Surgical removal of gland
Complications
-[Hypothyroidism/Hyperthyroidism] requiring medication
-[Large/Small] goiter may compress or distort airway
–Preoperative CT scan and awake FOB Intubation
–Assess for post operative ___

[Surgical Treatment of Hyperthyroidism]

A

Hypothyroidism
Large
tracheomalasia

60
Q

Postoperative respiratory distress
-Hemorrhage with___ compression
-Damage to___ ___ ___
–Unilateral – ___
–Bilateral – ___, ___

[Surgical Treatment of Hyperthyroidism]

A

tracheal
Recurrent Laryngeal Nerve
hoarseness
aphonia, intubate

61
Q

-Edema
-Damage to blood supply or inadvertent removal of parathyroid glands _ acute [hypocalcemia/hypercalcemia]
[Surgical Treatment of Hyperthyroidism]

A

hypocalcemia

62
Q

Goiter
___ of the thyroid gland associated with [increased/decreased] TH secretion

[Goiter and Hyperthryoidism]

A

Enlargement, increased

63
Q

Goiter
Varying sizes, yet, even a [small/large] goiter can cause significant symptomology
May be uni or bilateral
Surgical ____may be uni or bilateral as well
[Goiter and Hyperthryoidism]

A

Small
excision

64
Q

Continue anti-thyroid meds in ___period

[Anesthesia Implications for Hyperthyroidism]

A

periop

65
Q

Protect eyes in patient with ___/___

[Anesthesia Implications for Hyperthyroidism]

A

proptosis/exophthalmos

66
Q

Give anxiolytic
___ necessary (___) to reduce risk of airway swelling

[Anesthesia Implications for Hyperthyroidism]

A

Steroids, decadron

67
Q

Hold ___ b/c vagolytics impair sweating
Avoid: (3)

[Anesthesia Implications for Hyperthyroidism]

A

glycopyrrolate
ketamine, pavulon, ephedrine

68
Q

Treat hypotension with [DIRECT/INDIRECT] acting vasopressor (phenylephrine)

[Anesthesia Implications for Hyperthyroidism]

A

Direct

69
Q

MAC is typically [unchanged/increased/decreased]

[Anesthesia Implications for Hyperthyroidism]

A

unchanged

70
Q

Increased incidence of ___ ___ and skeletal muscle weakness&raquo_space;> Reduce initial ___dose and assess response

[Anesthesia Implications for Hyperthyroidism]

A

Myesthenia Gravis
NMBa

71
Q

T4 may be given to organ donors to improve ___ which are depressed due to ___ ___ failure
[Anesthesia Implications for Hyperthyroidism]

A

hemodynamics, pituitary axis

72
Q

Severe life-threatening exacerbation of [hyper/hypo]thyroidism

[Thyroid Storm]

A

Hyperthyoidism

73
Q

Mortality rate of ___%

[Thyroid Storm]

A

20

74
Q

Known Precipitants:
S___ (post operative period usually)
Vigorous thyroid p____
____ contrast dyes
Stress, trauma
Severe infection
Medical illnesses
[Thyroid Storm]

A

Surgery
palpation
Iodine

75
Q

Symptoms:
___ (T =___)
Tachycardia, arrhythmias, labile BP
N & V
R___> coma

[Thyroid Storm]

A

Hyperpyrexia, 108
Restlessness

76
Q

Treatment
Beta [blockers/agonists]
Hydration
[Cooling/warming]
Corticosteroids
Propylthiouracil (___mg Q 8 hrs)

[Thyroid Storm]

A

Blockers
Cooling
200 mg

77
Q

Hypothyroidism
Relatively uncommon – affects only ___-___% of the adult population
[Hypothyroidism]

A

0.5-0.8

78
Q

___ assault that destroys the gland (___ ___)
Typically, a very___goiter

[Hypothyroidism]

A

Autoimmune
Hashimoto’s thyroiditis
large

79
Q

Cause:
[Hypothyroidism]

A

Lack of iodine in diet

80
Q

Iatrogenic: (3)

[Hypothyroidism]

A

Gland ablation
Lithium
Amiodarone

81
Q

Secondary: ___ or ___ issue

[Hypothyroidism]

A

Pituitary or hypopituitary

82
Q

Diagnosis
[Decrease/increase] plasma T3 & T4
[Decrease/increase] basal metabolic rate (BMR)
Often, an [Decrease/increase] in TSH
Due to negative feedback system

[Hypothyroidism]

A

Decrease
Decrease
Increase

83
Q

[Decrease/increase] Iodine in the diet > [Decrease/increase] T3 & T4 > [Decrease/increase] TSH > [Decrease/increase] gland size

[Hypothyroidism]

A

Decreased
Decreased
Increased
Increased

84
Q

-[Decrease/increase] BMR
-Mucoplysacharride & protein deposition “___”

[Additional Manifestations of Hypothyroidism]

A

Decrease
myedema

85
Q

___ effusions – common
Impaired ___ & ___ drug & toxin clearance

[Additional Manifestations of Hypothyroidism]

A

Pericardial
hepatic & renal

86
Q

[Slowed/Increased] mental function
[Fatigue/Insomnia]

[Additional Manifestations of Hypothyroidism]

A

Slowed
Fatigue

87
Q

[Bradycardia/Tachycardia]; decreased CO
[Increased/Decreased]SVR; contracted blood volume

[Additional Manifestations of Hypothyroidism]

A

Bradycardia
Increased

88
Q

Anemia
Accumulation of free water - [hyponatremia/hypernatremia]

[Additional Manifestations of Hypothyroidism]

A

Hyponatremia

89
Q

[Hypodynamic/hyperdynamic] CV System

[Anesthesia Implications of Hypothyroidism]

A

Hypodynamic

90
Q

Ketamine is [appropriate/ not appropriate]

[Anesthesia Implications of Hypothyroidism]

A

is appropriate

91
Q

Sensitive to effects of anesthetics
-Use (2)

[Anesthesia Implications of Hypothyroidism]

A

ephedrine, dopamine

92
Q

Avoid pure alpha agonists such as ___
-Stress response and response to pure alpha agonists is [blunted/stimulated] due to underactive adrenal resulting from hypothyroidism

[Anesthesia Implications of Hypothyroidism]

A

phenylephrine
Blunted

93
Q

[Slowed/Increased] gastric emptying
___ ___precautions

[Anesthesia Implications of Hypothyroidism]

A

Slowed
Full stomach

94
Q

[Increased/Decreased] bld vol, [Increased/Decreased] SVR > Free water retention, hyponatremia, and periorbital edema

[Anesthesia Implications of Hypothyroidism]

A

Decreased, Increased

95
Q

Blunted response to ___ & ___; careful preop sedation

[Anesthesia Implications of Hypothyroidism]

A

hypercarbia & hypoxia

96
Q

___ concerns: macroglossia, goiter, upper airway edema, swollen vocal cords (gruff voice)

[Anesthesia Implications of Hypothyroidism]

A

Intubation

97
Q

Prone to [hypp/hyperthermia]
[Increased/Decreased] Drug clearance

[Anesthesia Implications of Hypothyroidism]

A

hypothermia
Decreased

98
Q

MAC of inhalational anesthetics [not affected/increased/decreased] by hypothyroidism

[Anesthesia Implications of Hypothyroidism]

A

not affected

99
Q

4:
[Thyroid surgery and airway risks]

A

External Laryngeal nerve
Superior thyroid artery
Inferior thyroid artery
Recurrent laryngeal nerve

100
Q

Typically comprised of ___glands – ___ pairs
However, may only have ___ or___

[Parathyroid]

A

4, 2
2 or 6

101
Q

Primary responsibility is to regulate serum ___ levels by secreting ___ ___

[Parathyroid]

A

calcium
parathyroid hormone (PTH)

102
Q

PTH is stimulated by a decrease in serum ___ ___

[Parathyroid]

A

ionized calcium

103
Q

Bone is a reservoir for ___
99% of ___is in bone
1% in cells and organelles
___% in extracellular fluid

[Parathyroid Hormone Feedback]

A

Ca++, Ca++
.1

104
Q

Bone is resorbed: means
Calcium (in bone) is released
into the ___ ___

[Parathyroid Hormone Feedback]

A

blood stream

105
Q

___ break down
Bone and release Calcium
Back into the blood

[Parathyroid Hormone Feedback]

A

Osteoclasts

106
Q

[Low/Increased] blood calcium detected at parathyroids

[Parathyroid Hormone Feedback]

A

Low

107
Q

Ionized Calcium C++ involved in:

Hemostasis (blood coagulation, platelet aggregation)

____and hormone release

Bone formation

Skeletal, smooth, and cardiac muscle [contraction/relaxation]

Cell function and cell division

[Ionized Calcium Functions]

A

Neurotransmitter

Contraction

108
Q

Release of parathyroid hormone: (3)
[Parathyroid Hormone]

A

-Efflux of calcium from bone
-Decreased loss of calcium in urine
-Enhanced absorption of calcium from intestine
Leads to increased concentration of calcium in blood

109
Q

Remember that Ca++ and PO4 act in ____ If one goes up, the other goes down.

Well, this affects ___ as well.

[Phosphate (PO4) , Ca++, Mg ++ and PTH]

A

opposition?
PTH

110
Q

[Increases/Decreases] in serum PO4 will [increases/decreases] serum Ca++ levels, stimulating PTH.

[Ionized Calcium Functions]

A

Increase
Decrease

111
Q

Mg++ impacts it as well:
[Hypo/hyper]magnesium (in a pt with normal ca++) will stimulate PTH

[Hyper/Hypo]magnesium unless significant, (in a pt with normal ca++) doesn’t do much to PTH.
[Ionized Calcium Functions]

A

Hypomagnesium
Hypermagnesium

NUNA 684 Advanced Pathophysiology (16 decks)

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