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thyroid Flashcards

1
Q

THYROID DISORDER: HYPERTHYROIDISM
(THYROTOXICOSIS - Primary:

A

Hyperactivity of thyroid gland → increased levels of circulating thyroid hormone
Prevalence: about 1.2% in the US of which 0.7% is subclinical
Classified as either:
Primary: Hypersecretion of TH related to the thyroid gland

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2
Q

HYPERTHYROIDISM: GRAVE’S DISEASE (graves is a glob)

A

An autoimmune disease that results in development of antibodies to the TSH receptor
Thyroid stimulating immunoglobulins bind to TSH receptors on the thyroid gland → excess secretion of TH
Accounts for 75% of hyperthyroidism cases

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3
Q

HYPERTHYROIDISM: GRAVE’S DISEASE - Signs & Symptoms (grave’s goiter)

A

Signs & Symptoms (Lewis table 49-9):
Diffuse thyroid enlargement: goiter

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4
Q

HYPERTHYROIDISM: Diagnosis based on

A

Medical hx, physical exam, symptoms

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5
Q

HYPERTHYROIDISM: Treatment- Propylthiouracil (Judy is a pro)

A

Treatment:
Drug therapy
Propylthiouracil (PTU) 1st drug of choice: taken TID
Inhibits thyroxine synthesis and blocks conversion of T4 to T3

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6
Q

HYPERTHYROIDISM: Total or Partial Thyroidectomy - POST-OP CARE - lying in what position?

A

POST-OP CARE
Pillows to support the head, semi-fowler’s for respiratory support
Avoid hyper-flexion of neck

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7
Q

hYPOTHYROIDISM: PATHOPHYSIOLOGY - most common cause in US (hashi is slow)

A

Deficiency of thyroid hormone leading to slowing of metabolic rate
Most common cause worldwide is iodine deficiency
Uncommon in the US where iodine is usually adequate
Most common cause in US is atrophy of the thyroid gland (e.g. Hashimoto’s thyroiditis)

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8
Q

HYPOTHYROIDISM - HASHIMOTO’S THYROIDITIS (Chronic autoimmune thyroiditis) (Hashi is low TSH)

A

The most common cause of hypothyroid goiter in the US
A chronic autoimmune disease in which thyroid tissue is replaced by lymphocyte and fibrous tissue
T3 and T4 are initially elevated in subacute, acute, and silent thyroiditis but becomes depressed over time
TSH is low then elevated (feedback mechanism)
Positive anti-thyroid antibodies

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9
Q

HYPOTHYROIDISM-MYXEDEMA - is it lifethreatening?

A

MYXEDEMA (Severe and longstanding hypothyroidism)
Carries a mortality risk as high as 40 %

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10
Q

PARATHYROID GLANDS: HYPERPARATHYROIDISM

A

Over secretion of PTH
PTH regulates calcium and phosphate levels

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11
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A
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12
Q

HYPERPARATHYROIDISM: EVALUATION AND TREATMENT- Ca and phos levels (big parrot drinks too much milk at 10, and not enough phos at 3)

A

Diagnostic criteria:
Detection usually through routine lab work
Serum Ca >10mg/dL
Serum Phos <3mg/dL

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13
Q

HYPOPARATHYROIDISM- how does it happen? (little parrot got removed)

A

Inadequate circulating PTH
Uncommon condition
Etiology:
Commonly iatrogenic: accidental removal of parathyroid gland during neck surgery

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14
Q

HYPOPARATHYROIDISM: Signs and Symptoms

A

Signs and Symptoms related to low serum Ca+:
Hypocalcemia lowers the threshold for nerve and muscle excitation

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15
Q

what meds for hypoparathyroidism? (think low calcium)

A

For tetany, slow IV Ca gluconate so as not to cause hypotension or cardia dysrhythmias. Avoid IV CaCl unless in emergency (caustic to veins)
Oral Ca supplement with meals (gastric acid promotes Ca absorption)
Vit D is given rather than PTH
Calcitriol
PTH replacement expensive and given IV only

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16
Q

hyperthyroidism - Secondary

A

Secondary : rare; related to TSH secreting pituitary adenomas

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17
Q

All forms of thyrotoxicosis

A

share the same clinical manifestations

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18
Q

hyperthyroidism - disease ex. (hyper in the grave)

A

e.g. Graves disease, toxic multinodular goiter and rarely follicular thyroid carcinomas

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19
Q

complication of hyperthyroidism

A

Complication: Thyroid storm/Acute thyrotoxicosis manifested by infection, trauma or surgery, is a medical emergency but rarely causes death if treated early

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20
Q

thyroid storm - symptoms (hot storm in the hall)

A

Sx: restlessness, severe tachycardia, heart failure, shock, hyperthermia, delirium, seizures

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21
Q

thyroid storm may progress to (storms go low)

A

destruction of thyroid tissue → hypothyroidism

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22
Q

graves disease - Goiter is a result of (goiter can go either way)

A

Goiter is a result of hypo or hyperthyroidism, nontoxic or nodular goiter

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23
Q

graves - most common cause- and what foods? (salty grave)

A

Most common cause d/t low iodine intake or Goitrogen related
*goitrogens are foods/drugs that inhibit uptake of iodine in thyroid gland e.g. PTU, methimazole, broccoli, brussels sprouts, etc. see Lewis T49-4

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24
Q

graves - symptoms (you know this- just one)

A

Exophthalmos (bulging eyeballs) d/t impaired venous drainage from the orbitwill be on exam, increased fat deposits and fluid in the tissue behind the orbits
Weight loss, palpitations, tremors, HTN

25
Q

graves symptoms - Derm related (grave legs)

A

Derm related: Peritibial myxedema (indurated and erythematous skin in the anterior portion of the leg)

26
Q

hyperthyroidism - blood tests

A

Blood tests to measure thyroxine and TSH levels

27
Q

Primary hyperthyroidism - how to tell - what hormone will be low?

A

Primary hyperthyroidism : ↓TSH (pituitary) , ↑ thyroxine (thyroid) = hyperactive thyroid (pituitary will probably be fine)

28
Q

Secondary hyperthyroidism - how to tell (the second you get high, you get high)

A

Secondary hyperthyroidism: ↑TSH, ↑ thyroxine = pituitary over secretion of TSH

29
Q

hyperthyroidism - Radioactive iodine uptake

A

Radioactive iodine uptake: RAIU to establish the etiology
Normal uptake is 15 to 25%
↑ uptake indicates increased thyroxine production either d/t Grave’s disease (35-95%) or presence of a thyroid nodule (normal to high uptake)
↓uptake could suggest thyroiditis (<2%)

30
Q

hyperthyroidism - meds - Methimazole (meth for judy)

A

Methimazole inhibits thyroxine synthesis
β blockers for thyrotoxicosis (propranolol and atenolol)

31
Q

hyperthyroidism - Radioactive iodine

A

Radioactive iodine - destroys thyroid tissue - not for pregnant woman

32
Q

hyperthyroidism - Thyroidectomy

A

Thyroidectomy - for large goiters causing compression to trachea - no response to anti-thyroid drugs
- thyroid CA
***Complication of above treatments may lead to hypothyroidism

33
Q

thyroidectomy - Watch for S & S of

A

Watch for S & S of hypocalcemia (can accidentally take out parathyroid glands during surgery) which is 2/2 to hypoparathyroidism. Tingling around the mouth, toes, fingers and muscle twitching. Have Ca gluconate available

34
Q

thyroidectomy - Assess for laryngeal damage:

A

Assess for laryngeal damage: hoarseness and a weak voice are temporary

35
Q

thyroidectomy - Assess for signs of tracheal compression and hemorrhage how often?

A

Assess for signs of tracheal compression and hemorrhage q 2hrs x 24hrs and watch for laryngeal stridor; have tracheostomy tray at bedside

36
Q

thyroidectomy - measure what?

A

Measure neck circumference (to make sure there is no bleeding) - its called wet neck protocol - using a skin pen to mark
*Total thyroidectomy requires life-long hormone therapy (Levothyroxine)

37
Q

hypothyroidism - Other causes:

A

post thyroidectomy or drugs to treat hyperthyroidism
Classification

38
Q

hypothyroidism - Primary (primarily destroy the thyroid)

A

destruction of thyroid tissue or defective hormone synthesis

39
Q

hypothyroidism - Secondary

A

related to pituitary or hypothalamic disease

40
Q

primary hypothyroidism - TSH levels (again, primarily opposite)

A

TSH level ↑, Thyroxine ↓

41
Q

secondary hypothryoidism - TSH levels (secondary makes sense)

A

↓ TRH and/or TSH ↓, ↓ Thyroxinem

42
Q

myxedema - is it an emergency?

A

A medical emergency

43
Q

myxedema - S/SX (mix it low)

A

diminished LOC, hypothermia, hypotension, hypoventilation, lactic acidosis

44
Q

myxedema - causes (myxa the drugs)

A

Precipitated by: Infection, narcotics, sedatives, cold and trauma

45
Q

myxedema - treatment (just thyroid hormones)

A

Treatment: IV thyroid hormone in addition to regular resuscitation of IV fluids, IV corticosteroids, warming blanket, pressors

46
Q

myxedema - Clinical manifestations (mix the mask down low)

A

Clinical manifestations:
Mental sluggishness, masklike appearance, skin dull and puffy and periorbital edema (d/t hydrophilic mucopolysaccharides) usually depression
Myxedema coma

47
Q

hyperparathyroidism- PTH In the bone (the parrot stimulates)

A

In the bone, stimulates Ca and Phos bone resorption

48
Q

PTH - In kidneys

A

In kidneys increases renal tubular reabsorption of calcium and increase phosphate excretion

49
Q

PTH - In the GI - but how?

A

In the GI, activation of Vit D to increase Ca and Phos
absorption

**Net result is increase Ca level and slight decrease
in phosphate levels

50
Q

hyperparathyroidism - labs (think bones, kidneys, inestines tests)

A

Other labs: Elevation in urine Ca, uric acid, serum Cl, creatine, amylase
Bone density test to detect bone loss

51
Q

hyperparathyroidism = Treatments (just surgery)

A

Treatments:
Partial or complete parathyroidectomy most effective for primary and secondary hyperparathyroidism

52
Q

hyperparathyroidism = treatment (think, too much Ca - get it out)

A

Symptom management with: routine monitoring of labs, IV NS and loop diuretic to ↑urinary excretion of Ca, Bisphosphates (Alendronate) inhibits bone resorption, Sensipar for secondary hyperparathyroidism to ↑sensitivity of Ca receptors on the parathyroid gland → less bone loss

53
Q

hypoparathyroidism - complications - magnesium

A

Severe hypomagnesemia r/t alcoholism and malabsorption. Low Mg suppresses PTH secretion

54
Q

hypoparathyroidism - Diagnosis

A

Diagnosis:
↓ Ca and ↑ Phos in the absence of renal failure, intestinal disorders or nutritional deficits

55
Q

hypoparathyroidism - symptoms

A

Tingling of the lips, fingertips and feet
Muscle spasm and tetany
Hyperreflexia
Tonic-clonic convulsions

56
Q

hypoparathyroidism - tests (chvosteks)

A

Positive Chvostek’s
Tapping the facial nerve about 2 cm anterior the tragus of the ear results in twitching at the angle of the mouth, followed by nose, eye and facial muscles
Trousseau signs
Carpal spasm is noted on inflation of a BP cuff above systolic pressure
Laryngeal spasms and in severe cases and death from asphyxiation

57
Q

hypoparathyroidism - foods high in Ca

A

Teach pt about foods high in Ca: dark green vegetables, soy beans and tofu
Avoid foods high in oxalic acid which inhibit Ca absorption: spinach, rhubarb, etc.

58
Q

myxedema - hypo or hyperthyroidism?

(mix it down low)

A

hypo

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