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CMN572 > thyroid/adrenal > Flashcards

thyroid/adrenal Flashcards

1
Q

NORMAL thyroid hormone cycle: the _______ releases _____ which signals the _______ to release ________ which signals the _______ to produce ______ & _______

A
  • hypothalamus
  • TRH (thyroid releasing hormone)
  • anterior pituitary
  • TSH (thyroid stimulating hormone)
  • thyroid gland
  • T3 & T4
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2
Q

the thyroid hormone cycle depends on proper functioning of which three endocrine glands

A
  • hypothalamus
  • pituitary
  • thyroid
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3
Q

the hypothalamus produces which thyroid hormone?

A

Thyroid releasing hormone

TRH

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4
Q

they anterior pituitary secretes _______ in response to TRH?

A

TSH thyroid stimulating hormone

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5
Q

TSH signals the thyroid gland to produce ______

A

T3 & T4

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6
Q

increased concentrations of T3 &/or T4 signal the hypothalamus to do what?

A

decrease TRH

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7
Q

decreased concentrations of T3 &/or T4 signal the hypotalamus to do what?

A

INCREASE TRH

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8
Q

true or false. thyroid dysfunction can be caused by congenital issues

A

TRUE

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9
Q

true or false. thyroid dysfunction can be caused by infections issues?

A

TRUE

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10
Q

true or false. thyroid dysfunction can be caused by necrosis

A

TRUE.. of what? they thyroid? like after irradiation? I dk

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11
Q

true or false. thyroid dysfunction can be caused by autoimmune issues

A

TRUE

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12
Q

true or false. thyroid dysfunction can be idiopathic

A

TRUE

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13
Q

______ is the most sensitive lab for both HYPO and HYPERthyroid

A

TSH

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14
Q

subclinical hypothyroid #’s are TSH >_____ & ______ T4?

A

TSH > 4

NORMAL T4

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15
Q

what does T4 measure? what does FREE T4 measure?

A
  • the level of bound and free T4.

* free (unbound) T4

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16
Q

T3 is also known as? & measures?

A

Tri-iodo-thyronine

*the level of total (free and bound) T3 in the blood

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17
Q

Tri-iodo-thyronine is the metabolically active form of _____ ?

A

T4

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18
Q

when do you want to measure a T3?

A

when HYPERthyroidism is suspected but T4 is normal

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19
Q

antiTHYROglobin and antiTHYROperoxidase antibodies are both INCREASED in what thyroid disorder?

A

GRAVES

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20
Q

thyroid stimulating immunoglobulin & TSH receptor antibody are both usually _______ in ______ disease

A

positive

graves

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21
Q

name that disorder: intolerance to cold

A

hypo

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22
Q

name that disorder: anorexia

A

hypo

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23
Q

name that disorder: brittle hair & nails

A

hypo

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24
Q

name that disorder: menstrual disturbances

A

hypothyroid

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25
Q

name that disorder: constipation

A

hypo

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26
Q

name that disorder: dry skin

A

hypo

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27
Q

name that disorder: lethargy

A

hypo

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28
Q

name that disorder: intolerance to heat

A

hyper

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29
Q

name that disorder: bulging eyes

A

hyper

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30
Q

name that disorder: facial flushing

A

hyper

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31
Q

name that disorder: enlarged thyroid

A

hyper usually but can be both

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32
Q

name that thyroid disorder: muscle wasting

A

hyper

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33
Q

name that disorder: finger clubbing

A

hyper

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34
Q

both hypo & hyper thyroid are more common in which sex?

A

female

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35
Q

people w down’s syndrome are at an increased risk of developing which thyroid disorder?

A

hyper

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36
Q

people who smoke are at increased risk for which thyroid disorder?

A

hyper

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37
Q

peopl who have other autoimmune diagnoses (DM1, RA, pernicious anemia, Sjogren’s) are at increased risk for which thyroid disorder?

A

hyper

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38
Q

most common cause of hypothyroidism is?

A

hashimotos thyroiditis (autoimmune)

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39
Q

hypothyroidism is associated with what abnormal lipid labs?

A

increased LDL

decreased HDL

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40
Q

acute psych probs may cause what thyroid marker to be high?

A

T4/T3

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41
Q

AIDS may cause what thyroid marker to be high?

A

T4/T3

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42
Q

morning sickness & hyperemesis gravidarum secondary to pregnancy may cause which thyroid marker to be high?

A

T4/T3 AND TSH

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43
Q

nemonic for issues & meds that increase T4/T3:

HARP TABLE HAM

A

“HARP” (syndromes or whatever)

  • H = hyperemesis gravidarum/morning sickness
  • A = AIDS
  • R = refetoff syndrome
  • P = psych problems (acute)

“TABLE” (rx drugs)

  • T = tamoxifen (breast cancer drug)
  • A = amiodarone
  • B = biotin
  • L = levothyroxine (or any thyroid replacement)
  • E = estrogens (oral)

“HAM” (“hard” drugs)

  • H = heroin
  • A = amphetamines
  • M = methadone
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44
Q

nemonic for isses & meds that decrease TSH:

HOP’N LSD CAB

A

“HOP’N” (syndromes or whatever)

  • H = hypoPITUITARism
  • O = OLD
  • P = pregnant (morning sickness)
  • N = nodule (thyroid)

“LSD” (drugs)

  • L = levothyroxine (or any thyroid replacement)
  • S = steroid use (acute)
  • D = dopamine

“CAB” (drugs)

  • C = ccb’s
  • A = amphetamines
  • B = biotin
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45
Q

labs that indicate hypo: ____ TSH & _____ T4

A

increased TSH

decreased T4

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46
Q

what other labs do you wanna check in a hypothyroid pt

A

CBC for anemia

lipid panel for low HDL, or high LDL

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47
Q

6 common causes of hyperthyroidism

A
  1. graves
  2. toxic multinodular goiter (elderly women)
  3. toxic adenoma (single adenoma)
  4. thyroiditis
  5. subacute (deQuervain) thyroiditis (viral usually)
  6. hasimotos thyroiditis
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48
Q

MOST common cause of hyperthyroid

A

GRAVES (autoimmune)

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49
Q

graves more commonly affects which sex between what ages?

A

women 20-40’s

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50
Q

toxic multinodular goiter is most commonly seen in _______

A

older women. also known as plummers disease

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51
Q

toxic adenoma is a

A

autonomously functioning thyroid nodule

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52
Q

thyroiditis typically causes hyperthyroidism followed by ________

A

hypo

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53
Q

sub acute “de Quervain” thyroiditis may occur in response to an ______

A

infection

54
Q

in hyperthyroidism, radioactive iodine (RAI) uptake is usually high or low?

A

high

55
Q

what dx test may be useful and cost effective to evaluate nodules?

A

ultrasound

56
Q

raynauds syndrome may be seen in which thyroid disorder?

A

hypo

57
Q

muscle cramps may be seen in which thyroid disorder?

A

hypo

58
Q

hyporeflexive DTRs may be noted in which thyroid disorder?

A

hypo

59
Q

goiter may be present in which thyroid disorder?

A

both hyper and hypo

60
Q

thyroiditis may cause _____ on palpation

A

tenderness

61
Q

afib may be a s/s of which thyroid disorder?

A

hyper

62
Q

before beginning thyroid replacement what two other issues do you want to assess for?

A
  • adrenal insufficiency

* angina

63
Q

what is the initial dose of synthroid?

A

25-50mcg/day and increase slowly until euthyroid

64
Q

how do you adjust levothyroxine? by how many mcg and how often?

A

25mcg every 1-3w until euthyroid

65
Q

what is considered euthyroid for pts on replacement therapy?

A

TSH 0.4 - 2

66
Q

do elderly require more or less thyroid hormone replacement?

A

less

67
Q

dose pregnancy require more or less thyroid hormone?

A

more, increase as pregnancy progresses

68
Q

recheck TSH every ______ when changing dose or brand

A

4-6w

69
Q

pts w CAD and newly diagnoses hypothyroidism need what before initating meds? do you know why?

A

cardiac consult
- i didnt either… apparently thyroid hormones and the CV system are intricately partnered and starting TSH can mess up a lot of things…. vascular tone, etc…T3 is v important for heart apparently….

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318631/

70
Q

symptomatic treatment for hyperthyroid

A
  • beta blockers
  • propanolol 60mg 1-2x/d PRN, max 320/d
  • reduce dose as s/s resolve and FT4 normalizes
  • if intolerant of BB can do CCB
71
Q

methimazole treats what? how?

A

hyperthyroidism
blocking the synthesis of T4 & T3
(class: thionamide)(MOA: thyroperoxidase inhibitor)

“It interferes with the step that causes the iodination of tyrosine residues in thyroglobulin, mediated by the enzyme thyroid peroxidase, thus preventing the synthesis of thyroxine (T4) and triiodothyronine(T3).
“https://www.ncbi.nlm.nih.gov/books/NBK545223/

72
Q

what is the dose range of methimazole?

A

30-60mg/day

73
Q

______ is the preferred drug for hyperthyroid if the patient is going to receive thyroid eradicating treatment (surgery or iodine)

A

methimazole

74
Q

how many days before thyroid eradication surgery do you want to stop methimazole

A

4d

75
Q

methimazole is safe for pregnancy yes or no?

A

NOOOOO. AW birth defects

76
Q

what does PTU treat? how?

A

hyperthyroidism
blocking synthesis of T3 & T4
(class: thionamide)(MOA: thyroperoxidase inhibitor)
https://www.ncbi.nlm.nih.gov/books/NBK549828/

77
Q

what is the dose of PTU?

A

300-600mg/day DIVIDED to QID (FOUR)

78
Q

can PTU be taken during pregnancy? breastfeeding?

A

yes, and yes

79
Q

PTU reduce dose as _____ resolve and ____ normalizes

A

symptoms resolve and T4 normalizes

80
Q

adrenal glands produce _______ (general name)

A

glucocorticoids

81
Q

what three glucocorticoids are produced by the adrenal glands?

A
  • cortisol
  • aldosterone
  • androgens
82
Q

most cases of addisons are due to?

A

autoimmune destruction of adrenal gland

83
Q

infections such as: _______ can also cause addisons secondary to destruction of the adrenal gland

A

TB, HIV, some fungal

84
Q

secondary causes of addisons include:

A
  • problems at the hypothalamus/pituitary (tumors, etc)

* abrupt cessation of steroids after long term use (TAPER)

85
Q

name that adrenal disorder: bronze pigment of skin

A

addisons

86
Q

name that adrenal disorder: changes in distribution of body hair

A

addisons

87
Q

name that adrenal disorder: GI disturbances

A

addisons. both really…

88
Q

name that adrenal disorder: weakness

A

addisons & cushings

89
Q

name that adrenal disorder: weight loss

A

addisons

90
Q

name that adrenal disorder: hypoglycemia

A

addisons

91
Q

name that adrenal disorder: postural hypotensions

A

addisons

92
Q

name that adrenal disorder: personality changes

A

cushings

93
Q

name that adrenal disorder: hyperglycemia

A

cushings

94
Q

name that adrenal disorder: moon face

A

cushings

95
Q

name that adrenal disorder: fat deposits on back (buffalo hump)

A

cushings

96
Q

name that adrenal disorder: sodium and fluid retention

A

cushings

97
Q

name that adrenal disorder: thin extremities

A

cushings

98
Q

name that adrenal disorder: purple striae on legs

A

cushings

99
Q

name that adrenal disorder: bruises and petichiae

A

cushings

100
Q

name that adrenal disorder: osteoporisis

A

cushings

101
Q

name that adrenal disorder: CNS irritability

A

cushings

102
Q

name that adrenal disorder: oligomenorrhea/amenorrhea

A

cushings

103
Q

name that adrenal disorder: ED

A

cushings

104
Q

whats the difference between cushings syndrome and cushings disease?

A

you can have cushings syndrome due to overuse of steroids which can be fixed by removing the steroids. cushings disease is ST a tumor, usually adrenal adenoma.

105
Q

causes of cushings disease:

A
  • benign pituitary tumor causing hypersecretion of ACTH (most common cause)
  • adrenal adenoma
  • ectopic adenoma (usually ST lung CA)
106
Q

addisons dx test: ______ levels fall and fail to rise after administration of corticotropin

A

cortisol

107
Q

addisons dx test: cortisol levels _________ after administration of corticotropin

A

fall and fail to rise

108
Q

ACTH will be increased or decreased in addisons?

A

increased

109
Q

sodium increased or decreased in addisons?

A

decreased

110
Q

potassium increased or decreased in addisons?

A

increased

111
Q

calcium increased or decreased in addisons?

A

increased

112
Q

BUN increased or decreased in addisons?

A

increased (dehydration)

113
Q

how do we treat addisons? replace what?

A

corticosteroids and mineralocorticoids

114
Q

what is first line med for addisons?

A

hydrocortisone 15-30mg/day divided to BID

115
Q

what is the dose for hydrocortisone and what is it used for?

A

15-30mg/day divided to BID

addisons

116
Q

what is an alternative to hydrocortisone? for what disease?

A

prednisone (4-6mg/day- divided dose)

addisons

117
Q

what is the treatment for addisons induced hyponatremia?

A

fludrocortisone acetate

118
Q

med doses need to be increased in addisons during periods of ?

A

increased stress… physical or mental. infection, surgery, trauma….

119
Q

K increased or decreased in cushings?

A

decreased

120
Q

blood glucose increased or decreased in cushings?

A

increased… glucose may even be in urine

121
Q

in cushings what lab will be elevated?

A

cortisol

122
Q

how can we measure cortisol? (3 sources)

A

serum, saliva, 24h urine

123
Q

in cushings caused by an adrenal tumor will the ACTH be high or low?

A

decreased

124
Q

in cushings caused by a pituitary tumor will ACTH be increased or decreased?

A

increased

125
Q

DEXA scan results for a pt with cushings will reveal increased or decreased bone density?

A

decreased…. RF osteoporosis

126
Q

what is the dx test for cushings?

A

dexamethasone suppression test (dexamethasone is manmade cortisol…. it should suppress cortisol production by the body… in cushings it does not…. cortisol level is still high the morning after dosing)

127
Q

how do we treat cushings syndrome?

A

limit long-term high-dose steroids. taper dosing.

128
Q

how do we treat cushings disease?

A

surgical resection of tumor

129
Q

what supplements do people with cushings disease need?

A

calcium and vitamin D for bone support

130
Q

in normal adrenal function the hypothalamus secretes _______ which tells the anterior pituitary to secrete ________ which tells the adrenal glands to secrete _______

A
  • Corticotrophin releasing hormone (CRH)
  • adrenal corticotrophic hormone (ACTH)
  • glucocorticoids & mineralocorticoids (cortisol & aldosterone)
131
Q

addisons mainly affects the cortex or the medulla of the adrenal gland?

A

cortex (outer part that produces glucocorticoids and mineralocorticoids

132
Q

addisonian crisis s/s: profound _____, ________ (volume status), vascular ________, and ______ failure

A
  • fatigue
  • dehyration
  • vascular collapse
  • renal failure

CMN572 (13 decks)

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