Exam III: Thyroid and Parathyroid Disorders and Surgery Flashcards by Linsley Lloyd

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

[Normal Thyroid Gland Functions]

TSH, low serum iodide levels, or medication

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

[Normal Thyroid Gland Functions]

THs
T4 T3

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Secretion of [Calcitonin or Calcitrol]

[Normal Thyroid Gland Functions]

Calcitonin

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Increasing the rate of protein, fat, and ___metabolism

[Normal Thyroid Gland Functions]

glucose

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Increasing body ___ through the metabolism of the above.

[Normal Thyroid Gland Functions]

temperature

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Thyroid Hormone Actions: (6)

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

Thyroxine (T3, T4)

metabolic demand

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

Thyroxine (T3, T4)

steroid, catecholemines

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Function:
Regulate ___, ___, ___

Thyroxine (T3, T4)

protein, fat, CHO catabolism

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Function:
Metabolic rate of ___cells

Thyroxine (T3, T4)

all

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Function:
Body ___ regulation

Thyroxine (T3, T4)

heat

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

Thyroxine (T3, T4)

secretion

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Function:
Skeletal muscle ___

Thyroxine (T3, T4)

maturation

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Function:
Cardiac rate,___ and ___

Thyroxine (T3, T4)

force and output

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Function:
Resp rate and ___ utilization

Thyroxine (T3, T4)

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Function:
C___ mobilization

Thyroxine (T3, T4)

Ca++

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Function:
RBC ___assistance

Thyroxine (T3, T4)

production

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

[Calcitonin]

Elevated

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Regulation:
Other stimulants are: ___, ___, ___

[Calcitonin]

Gastrin, Ca++ rich foods, pregnancy

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

suppresses

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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]

lower, resorption, breaks down

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Function:
[Lowers/Increases} serum phosphate levels

[Calcitonin]

Lowers

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

[Calcitonin]

Decreases

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___: essential in carbohydrate and fat metabolism

[Hormones secreted by the Thyroid]

Somatostatin

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___: regulation of Calcium [Hormones secreted by the Thyroid]

Calcitonin

Two forms of Thyroid Hormone are present in the body: ___ ___(T4) ___ (T3) [Hormones secreted by the Thyroid]

Thyroxine tetraiodothyronine Triiodothyronine

Together they are simply called ___ ___ [Hormones secreted by the Thyroid]

Thyroid Hormone or (TH)

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]

negative low

The loop is ___ by thryotropin releasing hormone (TRH) from the hypothalmus. [Hormones secreted by the Thyroid]

initiated

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

Decrease free T4 Increase TSH

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

Decrease Free T4 & TSH

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

Increase Free T4 Decrease TSH

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

Increased Free T4/TSH

Hyperthryoidism (___): hyperfunctioning of the thyroid gland [Hyperthyroid Pathophysiology]

thyrotoxicosis

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]

Graves Gland, enlargement T3 and T4

Primary Cause: Toxic multinodular ___ [Hyperthyroid Pathophysiology]

goiter

Primary cause: Thyroid nodule (___) or tumor [Hyperthyroid Pathophysiology]

adenoma

Primary Cause: ___: release of stored hormones [Hyperthyroid Pathophysiology]

Thyroiditis

Secondary ___ TSH from multiple conditions [Hyperthyroid Pathophysiology]

Excess

Iatrogenic Thyroxine, iodides, ____medications [Hyperthyroid Pathophysiology]

amiodarone

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

Hypermetabolic 2-3

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

↑ , ↓ , ↑ Warm

[Fine/Gross] motor hand tremor Muscle weakness and extreme ___ [Hyperthyroidism (thyrotoxicosis) s/s]

Fine fatigue

[Diarrhea/Constipation] [Osteopenia/Osteogenesis imperfecta] [Hyperthyroidism (thyrotoxicosis) s/s]

Diarrhea Osteopenia

[Hypersomnia/Insomnia] Anxiety and [heat/cold] intolerance [Hyperthyroidism (thyrotoxicosis) s/s

Insomnia heat

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]

hyperthyroidism extraocular protrusion, exophthalmos

Exophthalmos occurs in ___% of cases [Hyperthyroidism]

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

first synthesis 6-8

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]

Rapid, decreases, dereases surgery

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

blockers do not decreases

Radioactive Iodides (Common US treatment) -___-___% of patients treated become ___ [Hyperthyroidism Medical Treatment]

40-70 hypothyroidic

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 ]

increase thyroid storm euthyroid

Airway and goiter assessment: ___ ___may be present [Hyperthyroid Preop surgical prep ]

tracheal deviation

[Increase/Decrease]. blood volume, [Increase/Decrease] svr, wide pulse pressure, [Increase/Decrease] cardiac contractility [Hyperthyroid Preop surgical prep ]

Increase, Decrease, Increase

Only proceed with surgery if___-___ [Hyperthyroid Preop surgical prep ]

life-threatening

Oral thionamides, followed in one hour by ___ ___(ssKI) [Hyperthyroid Preop surgical prep ]

potassium iodide

Have ___ or ___ ready for iv titration [Hyperthyroid Preop surgical prep ]

propranolol or esmolol

Potentially ___ monitoring [Hyperthyroid Preop surgical prep ]

CVP

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]

Hypothyroidism Large tracheomalasia

Postoperative respiratory distress -Hemorrhage with___ compression -Damage to___ ___ ___ --Unilateral – ___ --Bilateral – ___, ___ [Surgical Treatment of Hyperthyroidism]

tracheal Recurrent Laryngeal Nerve hoarseness aphonia, intubate

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

hypocalcemia

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

Enlargement, increased

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]

Small excision

Continue anti-thyroid meds in ___period [Anesthesia Implications for Hyperthyroidism]

periop

Protect eyes in patient with ___/___ [Anesthesia Implications for Hyperthyroidism]

proptosis/exophthalmos

Give anxiolytic ___ necessary (___) to reduce risk of airway swelling [Anesthesia Implications for Hyperthyroidism]

Steroids, decadron

Hold ___ b/c vagolytics impair sweating Avoid: (3) [Anesthesia Implications for Hyperthyroidism]

glycopyrrolate ketamine, pavulon, ephedrine

Treat hypotension with [DIRECT/INDIRECT] acting vasopressor (phenylephrine) [Anesthesia Implications for Hyperthyroidism]

Direct

MAC is typically [unchanged/increased/decreased] [Anesthesia Implications for Hyperthyroidism]

unchanged

Increased incidence of ___ ___ and skeletal muscle weakness >>> Reduce initial ___dose and assess response [Anesthesia Implications for Hyperthyroidism]

Myesthenia Gravis NMBa

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

hemodynamics, pituitary axis

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

Hyperthyoidism

Mortality rate of ___% [Thyroid Storm]

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

Surgery palpation Iodine

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

Hyperpyrexia, 108 Restlessness

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

Blockers Cooling 200 mg

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

0.5-0.8

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

Autoimmune Hashimoto’s thyroiditis large

Cause: [Hypothyroidism]

Lack of iodine in diet

Iatrogenic: (3) [Hypothyroidism]

Gland ablation Lithium Amiodarone

Secondary: ___ or ___ issue [Hypothyroidism]

Pituitary or hypopituitary

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

Decrease Decrease Increase

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

Decreased Decreased Increased Increased

-[Decrease/increase] BMR -Mucoplysacharride & protein deposition “___” [Additional Manifestations of Hypothyroidism]

Decrease myedema

___ effusions – common Impaired ___ & ___ drug & toxin clearance [Additional Manifestations of Hypothyroidism]

Pericardial hepatic & renal

[Slowed/Increased] mental function [Fatigue/Insomnia] [Additional Manifestations of Hypothyroidism]

Slowed Fatigue

[Bradycardia/Tachycardia]; decreased CO [Increased/Decreased]SVR; contracted blood volume [Additional Manifestations of Hypothyroidism]

Bradycardia Increased

Anemia Accumulation of free water - [hyponatremia/hypernatremia] [Additional Manifestations of Hypothyroidism]

Hyponatremia

[Hypodynamic/hyperdynamic] CV System [Anesthesia Implications of Hypothyroidism]

Hypodynamic

Ketamine is [appropriate/ not appropriate] [Anesthesia Implications of Hypothyroidism]

is appropriate

Sensitive to effects of anesthetics -Use (2) [Anesthesia Implications of Hypothyroidism]

ephedrine, dopamine

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]

phenylephrine Blunted

[Slowed/Increased] gastric emptying ___ ___precautions [Anesthesia Implications of Hypothyroidism]

Slowed Full stomach

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

Decreased, Increased

Blunted response to ___ & ___; careful preop sedation [Anesthesia Implications of Hypothyroidism]

hypercarbia & hypoxia

___ concerns: macroglossia, goiter, upper airway edema, swollen vocal cords (gruff voice) [Anesthesia Implications of Hypothyroidism]

Intubation

Prone to [hypp/hyperthermia] [Increased/Decreased] Drug clearance [Anesthesia Implications of Hypothyroidism]

hypothermia Decreased

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

not affected

4: [Thyroid surgery and airway risks]

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

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

4, 2 2 or 6

Primary responsibility is to regulate serum ___ levels by secreting ___ ___ [Parathyroid]

calcium parathyroid hormone (PTH)

PTH is stimulated by a decrease in serum ___ ___ [Parathyroid]

ionized calcium

Bone is a reservoir for ___ 99% of ___is in bone 1% in cells and organelles ___% in extracellular fluid [Parathyroid Hormone Feedback]

Ca++, Ca++ .1

Bone is resorbed: means Calcium (in bone) is released into the ___ ___ [Parathyroid Hormone Feedback]

blood stream

___ break down Bone and release Calcium Back into the blood [Parathyroid Hormone Feedback]

Osteoclasts

[Low/Increased] blood calcium detected at parathyroids [Parathyroid Hormone Feedback]

Low

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]

Neurotransmitter Contraction

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

-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

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]

opposition? PTH

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

Increase Decrease

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]

Hypomagnesium Hypermagnesium