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Assessment Exam 4 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the approximate weight of the thyroid gland?

A

̴20g

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2
Q

What are the two lobes of the thyroid gland connected by?

A

Isthmus

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3
Q

Where are the parathyroid glands located in relation to the thyroid gland?

A

Posterior aspect of each lobe

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4
Q

What innervates the thyroid gland?

A

Adrenergic and cholinergic nervous systems

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5
Q

What fills the numerous follicles of the thyroid gland?

A

Thyroglobulin

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6
Q

What do C cells in the thyroid gland produce?

A

Calcitonin

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7
Q

How is iodine obtained for the production of thyroid hormones?

A

Mainly from diet

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8
Q

What happens to iodine in the GI tract?

A

Reduced to iodide

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9
Q

What enzymes catalyze the binding of iodide to thyroglobulin?

A

Iodinase enzyme

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10
Q

What does the coupling of monoiodotyrosine and diiodotyrosine produce?

A

T3 and T4

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11
Q

Why does the thyroid have protection against depletion of hormones?

A

Large store and low turnover rate

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12
Q

What is the typical T4/T3 ratio?

A

10:1

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13
Q

What are the three major proteins that T4 and T3 reversibly bind to in the blood?

A

Thyroxine-binding globulin, prealbumin, albumin

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14
Q

What are the main functions of thyroid hormones on the body?

A

Stimulate metabolic processes, growth and maturation of tissues, protein synthesis, carbohydrate and lipid metabolism

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15
Q

What controls the regulation of thyroid function?

A

Hypothalamus, pituitary, and thyroid glands

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16
Q

What hormone is secreted from the hypothalamus to promote release of TSH?

A

Thyrotropin-releasing hormone (TRH)

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17
Q

What hormone enhances all processes of synthesis and secretion of T3 & T4?

A

TSH

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18
Q

What happens when there is a decrease in TSH?

A

Decreased T3 & T4 synthesis, cell size, vascularity

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19
Q

What happens with an increase in TSH?

A

Increased hormone production, gland cellularity, vascularity

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20
Q

How does TSH secretion relate to plasma levels of T3 & T4?

A

Negative feedback loop

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21
Q

What mechanism does the thyroid have to maintain consistent hormone stores?

A

Autoregulatory mechanism

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22
Q

What is the best test of thyroid hormone action at the cellular level?

A

TSH assay

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23
Q

What does small changes in thyroid function cause in TSH secretion?

A

Significant changes

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24
Q

What is the normal TSH level?

A

0.4-5.0 milliunits/L

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25
Q

What does the TRH stimulation test assess?

A

Functional state of TSH-secreting mechanism

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26
Q

What do thermal thyroid scans evaluate in thyroid nodules?

A

Warm”

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27
Q

How accurate is an ultrasound in determining the nature of a thyroid lesion?

A

90-95%

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28
Q

What are the majority of the cases of hyperparathyroidism related to?

A

Graves disease, toxic multinodular goiter, toxic adenoma

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29
Q

What symptoms are related to the hypermetabolic state in hyperparathyroidism?

A

sweating, heat intolerance, fatigue, inability to sleep

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30
Q

What may occur in hyperparathyroidism related to bone health and weight?

A

Osteoporosis, weight loss

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31
Q

What cardiovascular responses can T3 cause in hyperparathyroidism?

A

Direct effects on myocardium and peripheral vasculature

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32
Q

What is Graves disease?

A

Leading cause of hyperthyroidism

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33
Q

Who does Graves disease typically occur in?

A

Females (7:1), 20-40 y/o

34
Q

What is the proposed cause of Graves disease?

A

Autoimmune (stimulating antibodies)

35
Q

How is Graves disease diagnosed?

A

TSH antibodies, low TSH, high T3 & T4

36
Q

What is a common symptom of Graves disease?

A

Diffusely enlarged thyroid

37
Q

What is the first-line treatment for Graves disease?

A

Antithyroid drug (methimazole or propylthiouracil)

38
Q

When is high concentrations of iodine usually used in Graves disease treatment?

A

Pre-op or thyroid storm

39
Q

What may relieve symptoms in Graves disease but doesn’t affect the underlying abnormality?

A

β-blockers

40
Q

What impairs the peripheral conversion of T4 to T3 in Graves disease?

A

Propranolol

41
Q

What is recommended when medical treatment has failed in Graves disease?

A

Ablative therapy or surgery

42
Q

What is associated with a lower incidence of hypothyroidism than radioactive iodine therapy in Graves disease?

A

Surgery (subtotal thyroidectomy)

43
Q

What are some complications of surgery in Graves disease treatment?

A

Hypothyroidism, hemorrhage, RLN damage, parathyroid glands damage

44
Q

Why should thyroid levels be established preoperatively for Graves Disease?

A

Assess baseline

45
Q

What may be be a cause for delaying elective cases in Graves Disease? How long should the surgery be delayed?

A

Antithyroid drugs
6-8 weeks

46
Q

What is usually necessary in emergent cases of Graves Disease pre-op?

A

IV BBs, glucocorticoids, PTU

47
Q

What should be evaluated in Graves Disease pre-op for evidence of tracheal compression?

A

Upper airway

48
Q

What is a thyroid storm?

A

Life-threatening exacerbation of hyperthyroidism

49
Q

What can precipitate a thyroid storm?

A

Trauma, infection, medical illness, surgery

50
Q

How are thyroid storm and malignant hyperthermia similar?

A

Difficult to differentiate

51
Q

Do thyroid hormone levels in thyroid storm significantly differ from basic hyperthyroidism?

A

Not much higher

52
Q

When does thyroid storm most often occur?

A

Postoperative period in untreated hyperthyroid patients after emergency surgery

53
Q

What is the mortality rate of thyroid storm?

A

20%

54
Q

What is the 1st most common cause of primary hypothyroidism?

A

Radioactive iodine or surgery

55
Q

What is Hashimoto thyroiditis characterized by?

A

Goitrous enlargement & hypothyroidism

56
Q

What are common symptoms of hypothyroidism in adults?

A

Cold intolerance, weight gain, nonpitting edema

57
Q

What is a common GI complication associated with hypothyroidism?

A

Adynamic ileus

58
Q

What is the drug of choice for treating hypothyroidism?

A

L-thyroxine

59
Q

What preoperative implications should be considered for a patient with hypothyroidism?

A

Airway compromise, gastric emptying ↓, cardiovascular and respiratory issues, hypothermia, electrolyte imbalances

60
Q

How soon before elective surgery should thyroid treatment be initiated?

A

At least 10 days prior

61
Q

What is the immediate management for a patient with hypothyroidism in emergent surgery?

A

IV Thyroid replacement and steroids ASAP

62
Q

What is myxedema coma?

A

Rare, severe hypothyroidism

63
Q

What are the cardinal features of myxedema coma?

A

Hypothermia

64
Q

What is the mortality rate of myxedema coma?

A

> 50%

65
Q

How is myxedema coma treated?

A

IV thyroid hormones

66
Q

What interventions are necessary in myxedema coma?

A

IV hydration, temp regulation, electrolyte correction

67
Q

When do HR, BP, and temp usually improve in myxedema coma?

A

Within 24 hours

68
Q

What is the cause of swelling of the thyroid gland?

A

Hypertrophy & hyperplasia of follicular epithelium

69
Q

What are some possible causes of goiter?

A

Lack of iodine, ingestion of goitrogen, defect in hormonal biosynthetic pathway

70
Q

How is a goiter typically treated?

A

L-thyroxine

71
Q

When is surgery indicated for a goiter?

A

If medical therapy is ineffective or goiter compromises airway or is cosmetically unacceptable

72
Q

What is a predictive factor of possible airway obstruction during general anesthesia in patients with a preoperative history of dyspnea?

A

Preop hx of dyspnea in upright or supine position

73
Q

In what positions should echocardiogram be performed to assess the degree of cardiac compression in patients with goiter or thyroid tumors?

A

Upright & supine

74
Q

What do limitations in the inspiratory limb of flow-volume loops indicate in patients with goiter or thyroid tumors?

A

Extra-thoracic obstruction

75
Q

What does delayed flow in the expiratory limb of flow-volume loops indicate in patients with goiter or thyroid tumors?

A

Intra-thoracic obstruction

76
Q

What is the approximate morbidity rate from thyroid surgery?

A

13%

77
Q

What are the possible outcomes of recurrent laryngeal nerve (RLN) injury during thyroid surgery?

A

Hoarseness, airway obstruction

78
Q

What are the potential consequences of bilateral RLN involvement during thyroid surgery?

A

Airway obstruction, respiratory issues

79
Q

How soon after thyroid surgery may symptoms of hypocalcemia due to hypoparathyroidism occur?

A

24-48 hours postoperatively

80
Q

Why should a trach-set be kept at bedside during the immediate postoperative period after thyroid surgery?

A

Hematoma may lead to tracheal compression

Assessment Exam 4 (9 decks)

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