Module 9 Flashcards
Thyroid Hormone what does it do?
What are the effects of thyroid hormone on peripheral tissues?
- Regulates metabolism
- Effects of thyroid hormone on peripheral tissues
1) Elevated rates of oxygen consumption and energy consumption; in children, may cause a rise in body temp.
2) Increased HR and force of contraction; generally results in a rise in BP
3) Increased sensitivity to sympathetic stimulation
4) Maintenance of normal sensitivity of respiratory centers to changes in oxygen and carbon dioxide concentrations
5) Stimulation of red blood cell formation and thus enhanced oxygen delivery
6) Stimulation of activity in other endocrine tissues
7) Accelerated turnover of minerals in bone - Review effects on your own
- PTU: Blocks thyroperoxidase
- PTU causes you to have more of what?
- Know about PTU & the effects of PTU (Propylthiouracil)
Hyper - In order to exothelmos
Thyroid gland
- Calorigenic Effect
- Cell consumes more energy resulting in increased heat generation
- Is responsible for strong, immediate, and short-lived increase in rate of cellular metabolism (hot flash)
- 3 hyperthyroid: hosimotos, iodince defficiency,
Hyperthyroid S/S
- cardiac
- CNS
- GI
- MS
- Derm
- GU
- Tachycardia at rest, increased CO
- Nervousness, insomnia, tremor
- emotionally labile
- increased bowel movements
- Diarrhea
- muscle weakness, muscle atrophy
- tremors
- Skin is warm and moist
- light or absent menstrual periods
- increased urine production
-Opposite of hypothyroid state
Grave’s Disease - Exopthalmos
Graves’ ophthalmopathy
Graves’ ophthalmopathy(protrusion of eyes) – what causes this?
The autoantibodies also target the fibroblasts in the eye muscles, and those fibroblasts can differentiate into fat cells (adipocytes). Fat cells and muscles expand and become inflamed. Veins become compressed, and are unable to drain fluid, causing edema.
Grave’s disease is a common cause of?
Hyperthyroidism, an over-production of thyroid hormone, which causes enlargement of the thyroid and other symptoms such as exophthalmos, heat intolerance and anxiety
Grave’s Disease - Goiter
97-99% of Hyperthyroidism cases have an enlarged thyroid gland
Grave’s Disease – Pretibial Myxedema
infrequent manifestation of Graves’ disease. It is not restricted to the pretibial area but may spread to the ankle and dorsum of the foot and may present on the elbows, knees, upper back, and neck [1]. It occurs in up to 5 percent of patients with Graves’ disease and 15 percent of patients with Graves’ disease and ophthalmopathy [2,3]. It forms the third component of the classical Triad of Graves’ Disease.
Thyroid Crisis (Storm)
- Rare but dangerous worsening of the thyrotoxic state
- Death can occur in 48 hours w/o Tx
- Cause
- Spontaneous
- Usually occurs in undiagnosed or partially treated Graves disease
- Extra stress: infection, emotional distress, etc..
- S/S
- Hyperthermia
- Tachycardia – atrial tachydysrhythmias
- Delerium
- N/V, Diarrhea – dehydration
- Tx: PTU inhibits the enzyme thyroperoxidase, which normally acts in thyroid hormone synthesis
- Not disease it’s a condition
Thyroidtoxic state
Immediate administration of Tx
Toxic Nodular Goiter (TNG)
- Benign or malignant thyroid nodule
- 2nd main cause of hyperthyroidism (15-30% of U.S. cases)
- > 60 F (never seen in children)
- Iodine deficiency? – Overcompensation
- First signs may appear from injection of Iodine (CT contrast)
- Signs and Symptoms
- S/S of hyperthyroidism
- NO exophthalamos or pretibial myxedema
- Testing
- TSH, T3/4
- Palpable
- US thyroid
- Iodine scan – hot or cold nodule
- Biopsy
Hot Or Cold Nodules - TNG
- Hot Nodule
- Increased uptake of radioactive Iodine
- Working autonomously – not regulated by TSH
- Cold Nodule
- No concentration of radioactive iodine
- Area of thyroid gland, not really doing much of anything
- Autonomously means its working automatically
Hot Or Cold Nodules - TNG
- Nodules detected by thyroid scans are classified as cold, hot, or warm. Thyroid cells absorb iodine so they can make thyroid hormone out of it. When radioactive iodine is given, a butterfly image will be obtained on x-ray film showing the outline of the thyroid.
- If a nodule is composed of cells that do not make thyroid hormone (don’t absorb iodine), then it will appear “cold” on the x-ray film. A nodule that is producing too much hormone will show up darker and is called “hot.”
- 85% of thyroid nodules are cold10% are warm, and 5% are hot.
- Remember that 85% of cold nodules are benign, 90% of warm nodules are benign, and 95% of hot nodules are benign.
- A biopsy of some sort is the only way to tell for sure.
Hot Or Cold Nodules - TNG
- The Following Features Favor a Benign Thyroid Nodule:
- Family history of Hashimoto’s thyroiditis
- Family history of benign thyroid nodule or goiter
- Symptoms of hyperthyroidism or hypothyroidism
- Pain or tenderness associated with a nodule
- A soft, smooth, mobile nodule
- “Warm” nodule on thyroid scan (produces normal amount of hormone)
- Simple cyst on anultrasound
- The Following Features Increase the Suspicion of a Malignant Nodule:
- Age less than 20
- Age greater than 70
- Male gender
- New onset of swallowing difficulties
- New onset of hoarseness
- History of external neck irradiation during childhood
- Firm, irregular, and fixed nodule
- Presence of cervical lymphadenopathy (swollen, hard lymph nodes in the neck)
- Previous history of thyroid cancer
- Nodule that is “cold” on scan
- Solid or complex on an ultrasound
Regions of hyperactivity in the thyroid
- Graves disease: diffuse (allover) uptake
- Multinodular goiter: non diffuse
- Subacute thyroiditis: non diffuse
- Follicular adenoma: non diffuse uptake
Hasimotos has high what levels?
TSH
Obsessive-Compulsive Disorder (OCD)
- Recurrent unwanted thoughts (obsessions) that are only alleviated by repeated behaviors (compulsions)
- ‘I might get AIDS from germs on the door knob, so the patient cleans the door knobs in house 2x/day”
- Signs and Symptoms
- Unwanted > thoughts, images, urges
- Seek relief with rituals
- Seen in families
- Testing
- Clinical
- R/O physical pathologies
