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Endocrine - Troutmanm > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What does the thyroid gland regulate?

A

regulates the metabolic rate of the body

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2
Q

Complete lack of thyroid secretion results in the basal metabolic rate of the body to decrease by

A

40 to 50 %

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3
Q

Extreme excesses of thyroid secretion can increase basal metabolic rate by

A

60 to 100% above normal

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4
Q

What shape is the thyroid gland?

A

butterfly shaped

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5
Q

Where is the thyroid gland located?

A

Located immediately below the larynx, anterior and to each side of the trachea

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6
Q

What is the size of the endocrine gland?

A

One of the largest endocrine glands, weighs 15 to 20 grams in adults

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7
Q

What hormones does the thyroid secrete?

A 
Thyroxine (T4) 
Triiodothyronine (T3) 
Reverse T3 (rT3)-inactive
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8
Q

The thyroid also produces calcitonin, and important hormone is ______ regulation

A

calcium

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9
Q

Thyroid gland is made of follicles of _______ surrounding a colloid matrix

A

cuboidal epithelial cells

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10
Q

What is required for thyroid hormone synthesis?

A

iodine

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11
Q

What are the most important thyroid hormones for metabolic control

A

T3 and T4

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12
Q

how does T3 and T4 compare to each other

A

The functions of these two hormones are qualitatively the same, but they differ in their rapidity and intensity of action

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13
Q

The thyroid secretes 93% _____ and 7% ______, though nearly all is converted to ___ in the tissues

A

thyroxine (T4)
triiodothyronine (T3)
T3

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14
Q

T3 is 4x more potent than T4, but is

A

more scarce and is cleared more rapidly

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15
Q

Thyrotropin-releasing hormone (TRH) is released by the ______

A

hypothalamus

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16
Q

What does TRH cause release of?

A

TRH causes release of thyroid-stimulating hormone (TSH) by the anterior pituitary

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17
Q

What dies TSH cause release of?

A

TSH causes release of thyroid hormones(TH-both T3 and T4) from the thyroid gland

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18
Q

Only free TH is active, but, over 99% is bound to protein, either _____ or _____

A

Thyroxine binding globulin (TGB) or albumin

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19
Q 
Thyroid hormone (TH) is slowly released from \_\_\_\_\_
TH is taken up by \_\_\_\_\_\_
A

protein

peripheral tissues

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20
Q

Peripheral tissues contain enzymes that convert T4 to T3, ___ is more metabolically active

A

T3

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21
Q

TH activate intracellular processes, what do these increase?

A

increase gene transcription, protein and enzyme production which increase metabolic rate

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22
Q

TH increases the size and number of ______, which are the energy generators of cells

A

mitochondria

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23
Q

T/F: Thyroid hormones have important effects on many mechanisms throughout the body. It is likely that all cells in the body are targets for thyroid hormones

A

True

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24
Q

In general, what do thyroid hormones effect?

A

metabolism, growth and development

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25
What are they effects of increased thyroid hormone (5)
Stimulation of Carbohydrate Metabolism (Increases uptake of glucose by cells and by GI tract Enhances glycolysis, gluconeogenesis, and insulin secretion) Stimulation of Fat Metabolism (Mobilizes lipids, decreases fat stores, decreases cholesterol) Increased Requirement for Vitamins (Vitamins needed for increased enzyme synthesis) Increased Basal Metabolic Rate (Increases metabolism in almost all cells) Decreased Body Weight (Does not always occur because appetite is also increased)
26
Thyroid effects on CV
Increased BF secondary to vasodilation Increased C.O. Increased heart strength and HR Normal MAP (increased SBP, decreased DBP, increased PP) Increased respirations (because more CO2 produced) Increased number and affinity for B-adrenergic receptors DECREASED number of cardiac alpha-adrenergic receptors
27
Thyroid effect in CNS
Increased mentation, but also increased anxiety and neurosis
28
Thyroid effects on muscle
muscles more vigorous, become more weak with protein catabolism
29
Thyroid effects on sleep
Causes exhaustive/excitatable effects, constantly tired but cant sleep
30
Thyroid effects on endocrine system
Increases both secretion by glands, but also need for hormone from peripheral tissues
31
thyroid effects on reproduction and sexual effects
LACKof thyroid hormone causes loss of libido EXCESS can cause impotence Inconsistent menstrual changes occur
32
What is hypothyroidism?
Hypothyroidism is a condition where the thyroid does not make an adequate amount of thyroid hormones
33
What are symptoms of hypothyroid hormone
``` COLD INTOLERANCE Weight Gain Constipation Decreased taste and smell DEPRESSION Hoarseness FATIGUE Menstrual Disorders Muscle orJOINT PAIN Puffy face, hands, feet Paleness Slow Speech THIN, BRITTLE FINGERNAILS Thickening of skin Thin, brittle hair Thinning of Eyebrows WEAKNESS ```
34
*** What is primary hypothyroidism?
T3, T4 are not produced because of problems with the THYROID GLAND Most commonly due to autoimmune Hashimoto’s thyroiditis and surgical removal of thyroid tissue Other causes include inadequate dietary iodine (rare), radiation exposure, lithium, surgery
35
*** What is secondary hypothyroidism?
Inadequate T3, T4 due to TSH not being released from the pituitary (5-10% of cases)
36
*** What is tertiary hypothyroidism?
Inadequate T3, T4 due to Thyrotropin Releasing Hormone (TRH) from hypothalamus (<5% of cases)
37
When happens when hypothyroidism occurs in infancy?
leads to mental retardation and growth deficits (cretinism)
38
What is the most severe form of hypothyroidism?
mydexa come
39
what is mydexa coma?
Rare condition Triggered by illness, infection, exposure to cold, medicines Symptoms include coma, decrease breathing, decrease blood sugar, decreased blood pressure, and decreased temperature
40
What is the standard test for thyroid gland function?
Serum T4 assay Total T4 elevated in 90% of people with hyperthyroidism Total T4 low in 85% of people with hypothyroidism Affected by levels of TBG
41
How are blood levels are T3 and T4 in hypothyroidism?
low
42
how are blood levels of TSH in hypothyroidism?
high
43
Blood levels of ___ are high in euthyroid sick states (critical illness)
rT3
44
What is Synthroid?
T4 (and most commonly used)
45
What is armor thyroid? (this is a med)
contains both T3 and T4
46
should elective surgery happen when a patient has hypothyroidism?
Elective surgery should be postponed until euthyroid state is achieved (not always done)
47
hypothyroidism and anesthesia associated problems
Lethargy, hypotension, bradycardia, CHF, gastroparesis, hypoglycemia, hypothermia, hypoventilation, hyponatremia
48
Anesthetic management for when putting a hypothyroid patient under anesthesia
Be aware of the “crash on induction” possibility Ketamine frequently used on induction Volatile agents not recommended due to the sensitivity of the myocardium to depression Pancuronium/Rocuronium have vagolytic/sympathomimetic effects Aline is indicated with PA catheter in setting of cardiac failure
49
What is hyperthyroidism?
Hyperthyroidism is a condition of thyroid gland overactivity
50
What is thyroiditis?
Thyroiditis is inflammation of the thyroid which causes release of excessive hormone but not increased production
51
what is thyrotoxicosis
oversupply of thyroid hormones on peripheral tissues
52
What are symptoms of thyrotoxicosis/hyperthydroidism
``` Palpitations Heat Intolerance Nervousness Insomnia Breathlessness Increased bowel movements Fatigue Light or absent menstrual periods Tachycardia Trembling Hands Muscle Weakness Warm moist skin Hair Loss STARING GAZE (Exophthalmos) ```
53
How do symptoms of hyperthyroidism come on?
slowly
54
What is the most common cause of hyperthyroidism
Grave’s disease (60-90% of cases) which is an autoimmune disease Autoantibodies activate the TSH receptor Causes multinodular goiter Stimulates thyroid hormone synthesis, secretion and thyroid growth (goiter formation)
55
A treatment for hyperthyroidism is antithyroid drugs, what are examples and what do they do?
Examples are methimazole and propulthiouracil (PTU) Inhibit iodination of thyroglubulin and conversion of T4 to T3
56
A treatment for hyperthyroidism is beta blockers. what beta blocker is used and how does it treat hyperthyroidism?
Propranolol has two roles: L-isomer causes beta blockade, treats tachycardia, tremor, palpitations, anxiety, and heat intolerance D-isomer inhibits the conversion of T4 to T3
57
Radioactive iodine is a treatment for hyperthydroid, what does it do?
One time dose in pill form, results in destruction of thyroid tissue DEFINITIVE THERAPY
58
Partial or total thyroidectomy can be used but not often without S/S of cancer, why?
Not used extensively in absence of cancer as meds are effective and risk of removing parathyroids or recurrent laryngeal nerve DEFINITIVE THERAPY
59
When does thyroid storm happen?
6-18 hours post
60
S/S of thyroid storm
hyperthermia, tachycardia, dysrhythmias, CHF, shock
61
Causes of thyroid storm
Surgery, infection, trauma, toxemia, DKA
62
During thyroid storm, treatment for hyperthyroid - hyperthermia - hydration -
hyperthyroid - Sodium iodide, inderal/labetalol, Cortisol (increased utilization of cortisol), PTU hyperthermia - acetaminophen, cooling blankets hydration - Fluids and glucose (increased metabolism)
63
sodium iodide and propranolol lead to euthyroid state in how many days
about 10
64
Antithyroid drugs ___ weeks before surgery include sodium iodide and propylthiouracil
6-8
65
In emergency surgery for hyperthyroid ism, what meds should you admin
sodium iodide, CORTISOL, and PTU
66
How does cortisol work?
blocks peripheral conversion of T4 to T3, making rT3 instead
67
What meds/gasses should you avoid during hyperthyroidism
halothane and atropine
68
How/why do goiters occur
Results from chronic stimulation by TSH Can occur in iodine deficiency states
69
during a thyroidectomy there will be near monitoring, what tube do you use
nim tube or “Dragonfly monitor” | NIM - neural integrity monitoring. Used during head and neck procedure when laryngeal nerves could be injured
70
***how can you tell RLN damage unilateral - bilateral -
unilateral - hoarseness | bilateral - Aphonia, stridor, aspiration
71
***how can you tell SLN damage
Abnormal voice in upper registers
72
after a thyroidectomy, how do you treat a hematoma?
Airway emergency requiring decompression and rapid intubation before airway compromise
73
Why does hypocalcemia occur after thyroidectomy?
Due to inadvertent removal of parathyroids glands Weakness, tetany, laryngospasm 24-72 hrs later Can end with cardiovascular collapse
74
Why does tracheomalacia occurs S/P thyroidectomy
tracheal softening, airway collapse with inspiration after removal of ETT

Endocrine - Troutmanm (7 decks)

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