Lecture 3 Flashcards
1
Q
Thyroid gland regulates the body’s _________
. Parathyroid glands regulate _________ levels. It DOES/DOES NOT effect on the body’s metabolism
A
metabolism
Ca2+
Does not
2
Q
Role of PTH
A
- Increases Ca2+ absorption. in the kidney and activates [25-hydroxyvitamin D ->1,25 dihydroxyvitamine D] so. that it can go into the intestines and increase Ca2+ absorption in the GI tract.
- Increases bone resorption
3
Q
Hypoparathyroidism: ____calcemia
A
HYPO
4
Q
Hypoparathyroidism: Hypocalcemia
Causes:
A
- -Surgical removal of glands during thyroidectomy,
- DiGeorge Syndrome,
- hereditary autoimmunity syndrome.
5
Q
-___________ is most common cause of hypocalcemia.
A
Hyparathyriodidm
6
Q
Hypoparathyroid/Hypocalcemia Signs & Symptoms:
A
- Neuropsych: Seizures, dementia, anxiety, depression, extrapyramidal symptoms (parkinsonism most common), papilledema •
- Neuromuscular: Paresthesia around mouth and fingers/toes, muscle stiffness, myalgia and spasms •
- CV: CHF, hypotension, prolongation of QT interval •
- Autonomic: Biliary colic, bronchospasm, diaphoresis •
- Other: Cataracts, dry coarse skin, hyperpigmentation, eczema, steatorrhea
7
Q
How to check hypoparathyroidism
A
- Chvostek Sign- pt relaxes facial nerve, then tap it. + sign is twitching and spasm
- Trousseau’s Sign- inflate BP cuff and see carpo-pedal shuffling
8
Q
work up for hypoparathyroid
A
- Check: Serum calcium, albumin, magnesium and PTH level
- hour calcium
9
Q
manage and tx hypoparathyroidism
A
Calcium and Vitamin D
10
Q
Hyperparathyroidism: Hypercalcemia
Causes of primary hyperparathyroidism (caused by. high PTH)
A
- Adenomas (MC 80%) –tumor: may be associated with MEN 1
- Multiple endocrine neoplasia (MEN)–endocrine gland(s) overactive or forms a tumor.
- Hyperplasia (15%) – gland enlargement (chief cells)
- Carcinoma (rare)
11
Q
Hyperparathyroidism: Hypercalcemia
Causes of secondary hyperparathyroidism (caused by ____)
A
low calcium causes high PTH
12
Q
Hyperparathyroidism: Hypercalcemia
Causes of secondary hyperparathyroidism (caused by low calcium -> high PTH)
A
- renal failure
- Vit D def
- malabsorption
13
Q
About 90% of hypercalcemia is caused by _________ or ________.
A
- hypercalcemia
- malignancy
14
Q
Hyperparathyroidism: Hypercalcemia sx
A
- CNS: Lethargy, weakness, confusion, coma
- Renal: Polyuria, making him dehydration, nocturia, renal stones, renal failure
- GI: Constipation, nausea, anorexia, gastric ulcer, pancreatitis
- Cardiac: Syncope from arrhythmias
15
Q
Hyperparathyroidism: Hypercalcemia
mneumonic
A
Mnemonic
- Stones (kidney or biliary calculus)
- Bones (bone pain)
- Groans (abdominal pain, N/V)
- Thrones (polyuria) resulting in dehydration.
- Psychiatric overtones (Depression 30-40%)
16
Q
work up for hyperPTH
A
- Serum calcium, albumin, magnesium and PTH level
- hour ca2+
- Workup for malignancy, genetic disorder, evaluate patient’s medications, evaluate patient diet if indicated
17
Q
tx. for hyperPTH
A
- Monitor dietary and medication high in calcium and Vit D –
- Keep well hydrated –
- Maintain physical activity –
- Surgery
18
Q
TH active form
A
T4 (inactive form) -> T3 (active form)
19
Q
Hypothyroidism (low thyroid)
hormone levels
A
TSH is high in response to low T4, low T3
20
Q
Hyperthyroidism (high thyroid)
hormone levels
A
TSH is low in response to high T4, high T3
21
Q
conduct a thyroid. exam
A
To locate thyroid, use cues from visual inspection.
Isthmus overlies 2nd -4 th tracheal rings.
- Have patient flex neck slightly to relax SCM
- Place fingers of both hands on patient’s neck so that index fingers lie just below cricoid cartilage.
- Have patient swallow so thyroid rises up under fingerpads.
- Observe for contour and symmetry.
- Displace trachea to right and palpate right lobe. Repeat for left lobe.
- Anterior surface of lateral lobe is approximately the size of distal phalanx of thumb and feels somewhat rubbery.
- If enlarged, listen over lateral lobes to detect bruit, which may be heard in hyperthyroidism or toxic multinodular goiter.
22
Q
palpation of thyroid should be done from. what angle
A
anterior or posterior section
23
Q
findings for thyroid
Goiter
Graves
hashimotos thyroidits and malignancy
thyroiditis
A
Goiter: simple (non-0nodular) or multinodular
Graves disease: soft
Hashimoto’s thyroiditis and malignancy: firm
Thyroiditis: tender
24
Q
Exophthalmos/Proptosis (abnormal protrusion of the eyeball) may. be seen with
A
hyperthyroidism (graves
25
**Hypothyroidism: High TSH, Low T3 and T4**
Causes:
1. Hashimoto’s thyroiditis – Autoimmune (most common cause of hypothyroidism)
2. Medications (i.e. lithium)
3. Pregnancy (during or after) – can recur with subsequent pregnancies
4. Treatment for hyperthyroidism
5. Thyroidectomy
26
most cmomon cause of hypothyroididm
hashimoto (autoimmune\*)
27
Hypothyroidism: High TSH, Low T3 and T4
* Depression
* Weight gain
* Fatigue
* Dry, brittle hair and and nails and skin
* Cold-intolerance
* high cholesterol
28
work up for hypothyrodism
tx:
1. TSH, T4
2. synthetic TH replacement and monitor TSH levels
29
Hyperthyroidism: Low TSH, High T3 and T4
Causes:
1. **Graves’ Disease** – autoimmune (most common cause of hyperthyroidism)
2. Toxic nodular or multinodular **goiter**
3. **Thyroiditis** (autoimmune or viral)
4. **Excessive consumption of iodine** or meds (like amiodarone) that contain iodine
5. **Pregnancy or first year after birth** (some women)
30
(most common cause of hyperthyroidism)
Graves’ Disease – autoimmune
31
**Hyperthyroidism: Low TSH, High T3 and T4**
sx
* 1. fatigue/muscle weakness
* 2. heat intolerance
* 3. heart palpitations
* 4. trouble sleeping
* 5 weight loss
* 6. need to poop more
* 7. light. or missing periods
* 8. irritability
* 9. tremors.
32
work up for hyperthyroididm
* **1. TSH, T4**
* **2. Radioiodine uptake**
33
tx for hyperthyroididm
1. **Methimazole** –
2. ***Radioiodine ablation*** –
3. **Thyroidectomy** – surgical removal of thyroid glands
34
Adrenal Insufficiency is called \_\_\_\_\_\_\_\_\_\_
addisons disease
35
Addison’s Disease is underproduction of \_\_\_\_\_\_\_\_\_
**CORTISOL**
36
**Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)**
Causer: Primary
90% of cases
**1. 70% are autoimmune**
**2. 20% are. d/t TB**
3. Other: infectrions, surgical removal, cancer
37
Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)
Causer: secondary
d/t lack of ACTH
1. Suddenly stopping exogenous glucocorticoids (like prednisone)
2. Surgical removal of ACTH-producing tumors from pituitary
3. Pituitary gland suddenly stops producing ACTH (as in cancerous processes)
38
Addison’s Disease / Adrenal Insufficiency (Cortisol Underproduction)
Sx.
1. Hyperpigmentation
2. NVD is 50%. of cases
3. Crave salty foods
4. HYPOTENSION
5. fatgiue
6. Weight loss:
7. menstraul irregulatiries
39
adrenal criss
fatigue, dehydration, decrease BP, renal shut dpwm: low Na. highK
40
**Addisonian Crisis/Acute Adrenal Insufficiency**
* appears at time of stress (illness, surgery, etc.) and causes Sudden penetrating pain of back, extremities, vomiting, diarrhea
* -If left untreated, could lead to death
41
work up for addisons
* cortisol level, ACTH level •
* Management/Treatment: – Steroids
42
Cushing Syndrome is what
**adrenal (cortisol) OVERPRODUCTION**
43
**Cushing’s syndrome** has \_\_\_\_\_\_\_\_\_\_\_\_causes
-**Cushing’s disease** is the most common cause of ________ form
**Cushing syndrome: exogenous and endodenous**
**Cushings disease: endogenous**
44
When Cushing's syndrome is caused by a \_\_\_\_\_\_\_\_, it is called Cushing's disease.
**pituitary tumor**
45
Cushing Syndrome - (Adrenal (Cortisol) Overproduction) Symptoms (how they feel):
sx: Fatigue and sleeping problems. HA, weight gain, bruise easily. (poor ealing wounds), hair thinning/loss, Backaches (d/t buff hump) Swelling
46
Cushing Syndrome - (Adrenal (Cortisol) Overproduction) Signs (what you see):
moon face
purple streaks on skin
buffalo hump
unusual fat build up in adomen
easy. bruising
hirutism in. W
47
\_\_\_\_\_\_ causes Abdominal Striae
cushings
48
cushing work up and tx
**Workup:** _Salivary cortisol levels_ or _24 hour urinary cortisol levels_ – _overnight 1 mg dexamethasone suppression test •_
**Management/ Treatment:** – Surgery if it is due to tumor – Adrenal enzyme inhibitor
49
AP hormones
FLAT PEG
LH- stimulates T secretion in males and ovulation in F
50
PP hormones
ADH
Oxytocin
51
Benign tumors of the pituitary may cause many different symptoms. Consider symptoms based on hormones affected
(3)
1. too much secretion
2. def in secretion
3. mass affect (compression caused by a large tumor)
52
Mass Effect can cause
1. HA
2. Visual disturbance
3. loss of balance
4. szurs
53
Most common pituitary adenoma: \_\_\_\_\_
sx:
**Hyperprolactinemia**
1. Galactorrhea (milk discharge), menstrual abnormalities, hypogonadism, erectile dysfunction, inferectiliy, if mass if large, HA and vision issues
54
w/u for hyperprolactinemia
1. prolactin levels, MRI
tx: meds (dopamine AGO), surgery
55
Amenorrhea (no menses) can be caused by
too much prolactin secretion
