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Endocrine - Summer 2019 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Controls metabolic rate

A

thyroxin

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2
Q

lowers blood calcium levels by removing from the blood and putting into the bone

A

calcitonin

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3
Q

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

A

40 to 50

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4
Q

Extreme excess of thyroid secretion can increase basal metabolic rate by __ to _____ percent above normal

A

60 to 100

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5
Q

The thyroid is butterfly shaped and located immediately below the _____, anterior and to each side of the trachea

A

larynx

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6
Q

The thyroid is one of the largest endocrine glands and weighs about

A

15-20 grams in adults

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7
Q

What three hormones does the thyroid gland produce

A

Thyroxine (T4), Triiodothyronine (T3), reverse T3 (rT3 - inactive)

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8
Q

Thyroid gland also produces _______ which is important for calcium regulation

A

calcitonin

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9
Q

Thyroid gland is made of follicles of ____ epithelial cells surrounding a colloid matrix

A

cuboidal

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10
Q

________ is required for thyroid hormone synthesis

A

iodine

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11
Q

___ and ___ are the most important thyroid hormones for metabolic control

A

T4 and T3

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12
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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13
Q

__ is 4x more potent than ___, but is more scarce and is cleared more rapidly

A

T3 / T4

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14
Q

Thyrotropin releasing hormone is released by the _______

A

hypolthalamus

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15
Q

TRH causes release of ______ by the ____ ______

A

TSH / anterior pituitary

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16
Q

TSH causes release of __ and ___ from the thyroid gland

A

T3 and T4

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17
Q

Only _____ TH is active, but over 99% is bound to protein, either Thyroxin bidning globulin or albumin

A

free

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18
Q

Thyroid hormone is slowly released from ______ and then taken up by ____ _____

A

protein / peripheral tissues

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19
Q

Peripheral tissues contain _____ that convert ___ to ___ (T3 is more metabolically active)

A

enzymes / T4 / T3

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20
Q

TH activate _______ processes which increase gene transciption, protein and enzyme production which increases metabolic rate

A

intracellular

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21
Q

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

A

mitochondria

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22
Q

T/F It is likely that all cells in the body are targets for thyroid hormones

A

TRUE

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23
Q

Thyroid hormones in general effect what?

A

metabolism, growth, development

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24
Q

Thyroid hormone stimulates ________ metabolism by increasing uptake of glucose by cells and by the ___ tract. It further enhances ____,____,____

A

carbohydrate / GI / glycolysis, gluconeogensis, insulin secretion

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25
Q

Thyroid horomone stimulates fat metabolism by mobilizing lipids, decreasing fat stores and decreasing ___________

A

cholesterol

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26
Q

Thyroid hormone INCREASES the requirements for vitamins because vitamins are needed for increased _______ synthesis

A

enzyme

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27
Q

Thyroid hormone increases the basal metabolic rate because metabolism is _______ in almost all cells

A

increased

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28
Q

Thyroid hormone can decrease body weight but this does not always occur because it can also increase _______

A

appetite

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29
Q

Cardiovasular effects of Thyroid Hormone - ______ blood flow secondary to vasodilation

A

increased

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30
Q

Cardiovasular effects of Thyroid Hormone - ______ cardiac output

A

increased

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31
Q

Cardiovasular effects of Thyroid Hormone - _______ heart strength and heart rate

A

increased

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32
Q

Cardiovasular effects of Thyroid Hormone - _______ MAP (increased SBP, decreased DBP, increased PP)

A

normal

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33
Q

Cardiovasular effects of Thyroid Hormone - _______ respiration because more C02 is produced

A

increased

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34
Q

Cardiovasular effects of Thyroid Hormone - Increased number and affinity of ______ receptors

A

beta-adrenergic

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35
Q

Cardiovasular effects of Thyroid Hormone - Decreased number of cardiac _____ receptors

A

alpha

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36
Q

CNS effects of thyroid hormone

A

increased mentation, but also increased anxiety and neurosis

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37
Q

Muscular effects of thyroid hormone

A

muscles more vigorous, become weak with protein catabolism

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38
Q

Thryoid hormone sleep effects

A

causes exhausted/excitable effects, constantly tired but can’t sleep

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39
Q

Endocrine effects of thyroid hormone

A

increases both secretion by glands, but also need for hormone from peripheral tissues

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40
Q

Sexual - Lack of thyroid hormone causes loss of _____ while excess can cause ______

A

libido / impotence

41
Q

Hypothyroidism is a condition where the thyroid does not make an adequate amount of thyroid hormones. Symptoms inlcude (these are underlined)

A

cold intolerance, depression, fatigue, joint pain, thin brittle nails, weakness. Additional symptoms are weight gain, consitpation, decreased taste and smell, hoarseness, menstural disorders, puffy face hands and feet, thickening of skin, brittle hair, thinning of eyebrows

42
Q

** Primary hypothyroidism is where __ and ___ are not produced because of problems with the thyorid gland itself. It is most commonly due to _______ and surgical removal of thyroid tissue. Other causes for primary hypothyroidism include inadequate dietary iodine, radiation exposure, lithium, surgery

A

T3 and T4 / Hashimoto’s thyroiditis

43
Q

**Secondary hypothyroidism is from inadequate T3 and T4 due to _____ not being release from the Pituitary

44
Q

**Tertiary hypothyroidism is from inadequate T3 and T4 due to lack of ______ from the hypothalamus

45
Q

Hypothyroidism that occurs in infancy leads to MR and growth deficits. This is called __________

46
Q

The most severe form of hypothyroidism is _____ _____

A

myxedema coma

47
Q

Myxedma coma is a rare condition that is triggered by ILLNESS, INFECTION, EXPOSURE TO COLD, MEDICINES. Sympoms include what?

A

coma, decreased breathing, decreased blood sugar, decreased BP, decreased temperature

48
Q

_______ is the standard test for thyroid function

A

Serum T4 assay

49
Q

Total T4 elevated in 90% of people with _______

A

hypethyroidism

50
Q

Total T4 low in 85% of people with _______

A

hypothyroidism

51
Q

T4 levels are affected by levels of ____

52
Q

Blood levels of T3 and T4 are low in _______

A

hypothyroidism

53
Q

Blood levels of TSH are _____ in primary hypothyroidism

54
Q

Blood levels of rT3 are high in _______ sick states (critical illness)

55
Q

Levothyroxine is ____ and is the most commonly used med

56
Q

Armour thyroid contains __ and __

57
Q

Hypothyroidism and Anesthesia - Elective surgery should be postponed until _______ state is achieved but this is not always done

58
Q

Associated problems with hypothyroidism and anesthesia

A

lethargy, hypotension, bradycardia, CHF, gastroparesis, hypoglycemia, hypothermia, hypoventilation, hyponatremia. Basically everything is in the toilet

59
Q

Anesthesia management of hypothyroidism - Be aware of _____ on induction possibility. _________ is frequently used on induction. Volatile agents are not recommended due to the sensitivity of the ______ to depression. Pancuronium/rocuronium have vagolytic/sympathmomimetic effects. Art line is indicated with PAC in setting of cardiac failure.

A

crash / ketamine / myocardium

60
Q

Hyperthyroidism is a condition of thyroid gland ______

A

overactivity

61
Q

_______ is inflammation of the thyroid which causes release of excessive hormone but not increased ___________

A

thyroiditis / production

62
Q

Thyrotoxicosis is an oversupply of thyroid hormones on _______

A

peripheral tissues

63
Q

Symptoms of Hyperthyroidsim

A

palpitations, nervousness, breathlessness, fatigue, tachycardia, muscle weakness, hair loss, heat intolerance, insomnia, increased BMs, light or absent menstrual cycles, trembling hands, warm moist skin, staring gaze (exopthalmos)

64
Q

With Hyperthyroidism, symptoms begin slowly and diagnosis is not made until _______ worsens

65
Q

Most common cause of hyperthyroidism is _______ which is an autoimmune dz

66
Q

In Grave’s dz, autoantibodies activate the _____ receptor. Causes multinodular goiter. Stimulates thyroid hormone synthesis, ______ and thyroid growth.

A

TSH / secretion

67
Q

Exopthalmos is caused by inflammation of the eye muscles by attacking ________

A

autoantibodies

68
Q

Range of treatment for Hyperthyroidism

A

suppressive medicines, permanent surgical or radioisotope therapy

69
Q

Antithyroid drugs inhibit production of ____. Examples are____ and ____. They inhibit ______ of thyroglobulin and conversion of T4 to T3

A

TH / methimazole and PTU / iodination

70
Q

Propanolol has two roles in hyperthyroidism. What are they

A

The L-isomer causes beta-blockade, treats tachycardia, tremor, palpitations, anxiety and heat intolerance. The D-isomer inhibits conversion of T4 to T3

71
Q

One time dose in pill form that results in destruction of thyroid tissue

A

radioactive iodine

72
Q

A partial or total thyroidectomy can be performed but not used extensively in absence of ______ as meds are efffective and risk of removing parathyroids or RLN nerve

73
Q

Thyroid storm is an extreme form of hyperthyroidism that typically occurs within ___ to ___ hours post op

A

6 to 18 hrs

74
Q

S/S of thyroid storm

A

hyperthermia, tachycarida, dysrhythmias, CHF and shock

75
Q

Causes for thyroid storm

A

surgery, infection, trauma, toxemia, DKA

76
Q

Treatment for the hyperthyroid aspect of thyroid storm

A

sodium iodide, inderal/labetolol, cortisol, PTU

77
Q

Treatment for the hyperthermic aspect of thyroid storm

A

acetaminophen, cooling blankets

78
Q

Treatment for the hydration aspect of thyroid storm

A

Fluids and glucose (increased metabolism)

79
Q

Prep for elective and emergent surgery for hyperthyroidism involves checking the airwya, administering antithyroid drugs, treating symptoms of hyperdynamisim, and treating ______ depletion and ______ problems

A

volume / electrolyte

80
Q

T/ F For elective surgery and hyperthyroidism goals include relief of tremor, relief of heat intolerance and relief of nervousness. Resolutioin of hyperthyroid related murmurs, return to normal pulse presure and sinus rhythm

81
Q

Sodium iodide and propanolol treatment lead to euthyroidism in about __ days

82
Q

Antithyroid drugs 6-8 weeks prior to surgery include _____ and ______

A

sodium iodide and PTU

83
Q

Treat hyperdynamism with

A

beta blockers

84
Q

For emergency surgery on the hyperthyroid patient you want to administer antithyroid drugs like sodium iodide, PTU and cortisol which blocks peripheral conversion of ____ to ___ (making rT3 instead)

85
Q

T/F the hyperthyroid patient may require lower doses of premedication to decrease anxiety

A

FALSE - they may require higher doses

86
Q

How would you treat heart failure in the hyperthyroid patient going for emergent surgery?

87
Q

What meds do you want to avoid in the hyperthyroid patient

A

halothane and atropine

88
Q

Goiter means enlargement and results from chronic stimulation by _____ or can occur in ____ deficiency states

A

TSH / iodine

89
Q

Intraoperative monitoing for thyroidectomy would include what?

A

neuro monitoring through a NIM tume or Dragonfly monitor

90
Q

**Post op concerns after thyroidectomy

A

RLN or SLN damage, hematoma, hypocalcemia, tracheomalacia

91
Q

**Unilateral RLN injury results in ______

A

hoarseness

92
Q

**Bilateral RLN injury results in

A

aphonia, stridor, aspiration

93
Q

**SLN injury results in abnormal voice in upper ______

94
Q

**Hematoma after thyroidectomy is an _____ emergency requiring decompression and rapid intubation before _____ compromise

A

airway / airway

95
Q

**Hypocalcemia after thyroidectomy is due to inadvertent removal of _______ glands

A

parathyroid

96
Q

**Symptoms of hypocalcemia

A

weakness, tetany, laryngospasm 24-72 hrs later

97
Q

**How can severe hypocalcemia end

A

cardiovascular collapse

98
Q

**With tracheomalacia, there is tracheal softening and airways collapse with ______

A

inspiration

Endocrine - Summer 2019 (7 decks)

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