SAQ 6 Flashcards by Duke A

the thyroid gland is Composed of _______, which are hollow spheres filled
with thyroid colloid that contains
thyroglobulin.

there are two types:

________________
_______________

follicles

Two types of cells: follicular and parafollicular
cells

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Before being stored in the colloid of follicles, T3 & T4 are attached to ______molecules, forming ____________ complexes

globulin

thyroglobulin

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Upon release, T3 & T4 detach from globulin and enter the bloodstream; Once in the blood, T3 &T4 attach to _______ _______
and travel as a_______-_______ complex

plasma globulins

hormone-globulin

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the Thyroid gland contains numerous follicles that Release several hormones such as _______ (T4) and _______________(T3)

thyroxine

triiodothyronine

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Thyroid hormones end up attached to

thyroid binding globulins (TBG) such as: ________ or ________

transthyretin

albumin

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________hormone helps regulate the metabolic rate of all cells and cell growth and tissue differentiation

Thyroid

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_________ is Produced in the thyroid gland by the parafollicular cells

Calcitonin

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___________ Influences the processing of calcium by bone cells by ________ blood calcium levels and promoting _________ of hard bone matrix

calcitonin

decreasing

conservation

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_________ ________ acts as antagonist to calcitonin in maintaining calcium homeostasis

Parathyroid hormone

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specific binding protein is ________ _______ _______ while non specific binding proteins are _________ and ___________

thyroxine Binding globulin (TBG)

Albumin

Transthyretin (prealbumin)

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list the 3 regulatory factors that stimulate secretion of thyroid hormone:

TSH
Thyroid-stimulating immunoglobulin
Increased TBG levels (e.g., pregnancy)

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list 3 regulatory factors that inhibit secretion of thyroid hormone:

• Iodine deficiency
• Deiodinase deficiency
•Excessive iodide intake (Wolff-Chaikoff
effect)
• Perchlorate; thiocynate(inhibit Na-I cotransport)
•Propylthiouracil (inhibits peroxidase enzyme)
•Decreased TBG levels (e.g.,liver disease)

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hyperthyroidism= hyperthyroid(clinical state)

hypothyroidism= hypothyroid (clinical state)

estrogens/ pregnancy = __________ (clinical state)

liver disease, glucocorticoids and androgens = __________(clinical state)

Euthyroid

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if there’s an increase in carbohydrate metabolism then t3 and t4 _________, glycogenesis ________, and glycolosis _________

Increases

** if there’s a decrease in metabolism all are decreased as well

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if there’s an increase in protein metabolism then there’s going to be an ________ in t3 and t4, a ________ in proteolysis and a _______ in muscle wasting.

increase

** if there’s a decrease in metabolism all are decreased as well

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if there’s an increase in lipid metabolism then theres going to be an _______ in t3 and t4, an _____ in lipogenesis, and _______ in lipolysis and a ________ in serum cholesterol

increase

decrease

** if there’s a decrease in metabolism all are opposite

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there are three causes of thyrotoxicosis (Graves disease):

1) Primary hyperthroidism
2) Thyrotoxicosis without hyperthyroidism
3) Secondary hyperthyroidism

most common form of thyrotoxicosis?

Graves’ disease

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there are three causes of thyrotoxicosis (Graves disease):

1) Primary hyperthroidism
2) Thyrotoxicosis without hyperthyroidism
3) Secondary hyperthyroidism

give me two details about number 2:

-Thyroiditis

–Iatrogenic

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there are three causes of thyrotoxicosis(Graves disease):

1) Primary hyperthroidism
2) Thyrotoxicosis without hyperthyroidism
3) Secondary hyperthyroidism

what causes # 3?

–TSH-secreting pitutary adenoma

– Hypothalamic disease

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List at least 3 symptoms associated with Thyrotoxicosis (Graves disease)

Hyperactivity, irritability,dysphoria
Heat intolerance & sweating
Palpitations
Fatigue & weakness
Weight loss & increased appetite
Diarrhea
Oligomenorrhea

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List at least 3 signs associated with Thyrotoxicosis (Graves disease)

Tachycardia, atrial fibrillation
Tremor
Goiter
Warm moist skin
Muscle weakness
proximal myopathy
Gynecomastia

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what are some primary causes of hypothyroidism?

Autoimmune = ____________________

Drugs = _____________________

Diffuse nontoxic goiter = ________________

Hashimoto’s thyroiditis (goiter) →atrophic thyroiditis
iodine excess, antithyroid drugs
iodine deficiency (endemic goiter), environmental goitrogens

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what are the 2 secondary causes of hypothyroidism (Myxedema)?

Hypopituitarism

- Hypothalamic disease

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what does the acronym SLUGGISH mean in relation to signs and symptoms of hypothyroidism (Hashimoto’s disease)?

Sluggish:
S= Sleepiness, fatigue, tiredness
L= Loss of memory
U= Unusually dry skin
G= Goiter
G= Gradual personality change
I= Increase in body weight
S= Sensitivity to cold
H= Hair loss, sparseness of hair

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list at least 3 symptoms of hypothyroidism:

- Weakness, tiredness - Dry skin - Feeling cold - Hair loss - Difficulty concentrating & poor memory - Constipation - Weight gain & poor appetite - Dyspnea - Hoarse voice

list at least 3 signs of hypothyroidism:

- Dry coarse skin, cool extremities - Puffy face, hands, & feet (myxedema) - Diffuse alopecia - Bradycardia - Peripheral edema - Delayed tendon reflex relaxation - Carpal tunnel syndrome

what are the 3 main controlling substances or calcium in the blood

*PTH •Vitamin D •Calcitonin

PTH is produced by ______ cells of the parathyroid

chief

thyroid hormone is made in the thyroid gland's __________ cells

follicular

Vitamin D Actions •Intestine –______ Ca2+ absorption – increase phosphate absorption •Bone –Increase mineralization (indirect effect) – increase bone resorption (direct effect) •Kidney –increase Ca2+ reabsorption (weak effect) –_____ phosphate reabsorption (weak effect)

increase increase

``` PTH Actions •Bone –receptors on osteoblasts & osteocytes –increase osteocytic osteolysis –increase resorption ( osteoclasts) ``` ``` •Kidney –increase Ca2+ reabsorption – ________ phosphate reabsorption – ________ Na+ reabsorption (weak effect) –increase 1,25-(OH) 2-D3 ``` • Intestine –increase Ca2+ absorption –increrase phosphate absorption

decrease decrease

Calcitonin •receptors on ________ •osteoclasts : ↓ activity; ↓ number •minor role in _____ regulation of plasma [Ca 2+] •no role in ______ regulation of plasma [Ca 2+] –thyroidectomy –C-cell tumors

osteoclasts acute chronic

in rickets there is a defiecency in vitamin __ rickets can be treated by vitamin ___, ________, ________ and 1,25 -D3(calcitriol)

D d2 sunlight calcium

``` in osteoperosis there is: •Aging which provides a: •decrease estrogen •decrease testosterone •decrease GH •______ Glucocorticoids •Immobilization ```

increase

treatment of osteoperosis includes: ``` ________ Therapy; with substances like: –______________ –estrogen –SERMs (raloxifene, tamoxifen) –_______ ``` and Anabolic Therapy– with _____

Antiresorptive bisphosphonates calcitonin PTH

Humoral Hypercalcemia causes some tumors to secrete ___-_____ ______ and Blood profile is similar to primary hyperparathyroidism; but _____ level is low

PTH -related peptide (PTH-rp) PTH

Treatment of humoral hypercalcemia actively uses _______ to inhibit renal Ca 2+ reabsorption & increase Ca2+ excretion. treatments also use _______ which inhibits bone resorption

Furosemide Etidronate

Adrenal cortex is Composed of three distinct layers and is Derived from __________.

mesoderm

the Adrenal medulla is Composed of neurosecretory tissue Derived from __________

neuroectoderm

name the three adrenocortical hormones:

1. cortisol 2. aldosterone 3. androgens

the synthesis of amine hormones in the adrenal medulla follows the course: ________ --> L-Dopa --> Dopamine--> ___________ --> epinepherine

tyrosine norepinephrine

Biosynthesis of adrenocortical hormones starts with _________. - corticosterone becomes ________ through _______ synthase which is activated by angiotensin 2

cholesterol aldosterone aldosterone

specific transport proteins carry individual hormones. CBG and transcortin transport ______and aldosterone while TBG and SHBG transport thyroxine, ___________, testosterone and estrogen

cortisol triiodothyronine

Zona glomerulosa depends on ______ for the first step in biosynthesis, but otherwise controlled separately via renin-angiotensin-aldosterone system

ACTH

the regulation of glucocorticoid and androgen secretion is regulated by the __________ - _______ axis. the hypothalamus releases _____ to the anterior pituitary which releases ACTH to the _____ _____ which in turn releases _______ to regulate hypothal. and Ant. pituitary.

hypothalamic- pituitary CRH adrenal cortex cortisol

Dexamethasone suppression test can distinguish between an _____-secreting tumor and an ______ ______ tumor.

ACTH adrenal cortical

if a healthy person is given a Dexamethasone in a low dose cortisone production will decrease. if the cortsol level remains high it leads to hypercorticoidism. then to further differintiate,the patient is given a low dose of DXM, in an ACTH secreting adenoma cortisol would _____ but given a high dose of DXM cortisol levels would _______. in an adrenal cortex tumor a low dose of DXM would ______ cortisol but a high dose would also also _______ cortisol levels. this is how to differentiate between ACTH secreting adenomas and adrenal cortex tumors.

increase decrease increase increase

list a few stimulatory factors of glucocorticoid and androgen secretion:

* Decreased blood cortisol levels * Stress; hypoglycemia; surgery; trauma * Psychiatric disturbances * a-adrenergic agonists * b-adrenergic antagonists

list a few inhibitory factors of glucocorticoid and androgen secretion:

* Increased blood cortisol levels * Opioids * Somatostatin

list 3 actions of glucocorticoids:

1. Increase GFR 2. Decrease REM sleep 3. Increase lipolysis

* Plasma K – greatly increases _________secretion * Angiotensin II – greatly _________ aldosterone secretion * Plasma Na – very slightly _______ aldosterone secretion * ACTH – necessary for aldosterone secretion but has little effect in rate of secretion

aldosterone increases decreases

mineralocorticoids increase ____, increase ___ and increases ___ which casues alkalosis

NA+ K+ H+

Actions of Adrenal Androgens •Females: stimulate growth of ______ and _____ hair; stimulate libido •Males: same as ________, though weak

axillary pubic testosterone

give me 3 causes of cushings SYNDROME;

1. acth hypersecretion 2. benign adrenal adenomas 3. small cell lung carcinoma

what are the top 3 symptoms in cushings syndrome/ disease?

1. central obesity 2. increased body weight 3. fatigability and weakness

Addison's and causes of adrenal insufficiency are _______ of the gland (possibly by ________), metabolic issues or secondary adrenal insufficiency (hypothalamic- pituitary disease or the supression of HPA)

destruction tuberculosis

give me the top 3 symptoms seen in addison's disease:

1. weakness 2. pigmentation of the skin 3. weight loss

Conn's syndrome aka primary aldosteronism is an apparent ___________ excess that increases ECF volume and ________, as well as ________ and metabolic alkalosis

mineralocorticoid hypertension hypokalemia slide 42

in Congenital Adrenal Hyperplasia there is a deficiency in either 21β- Hydroxylase or 11β- Hydroxylase which cause issues in ____________ production

Corticosterone

17a-Hydroxylase Deficiency is a less common congenital condition where neither ____________ nor adrenal androgens are produced, it leads to hypoglycemia. Overproduction of 11-deoxycorticosterone and corticosterone–_____________ activity is also present which cause hypertension, Hypokalemia and Metabolic alkalosis.

glucocorticoids mineralocorticoid