Thyroid and Adrenal Disease Flashcards
The thyroid and adrenal gland both get stimulation from
pituitary gland
More common, thyroid or adrenal disease?
thyroid
Fxns of thyroid:
metabolism, growth/ maturation of tissues, cell turnover, nutrients
Calcitonin comes from:
thyroid
What regulates serum Ca and P?
calcitonin, parathyroid hormone, V. D
Fxns of calcitonin:
Blood Ca, P levels, skeletal remodeling
Active form T3 or T4?
T4
Wo sufficient iodine, a person will develop:
goiter
Where is T3 produced?
follicular cells of thyroid
What regulates the release of T3?
pituitary TSH
Fxn of T3:
metabolic processes, O2 use
What is needed for T3 to fxn?
iodine
Hyperthyroid results in:
excessive thyroid hormone
Symptoms of hyperthyroidism:
SWEATING, heat intolerance, inc bowel movements, tremor, nervousness, agitation, rapid HR, weight loss, fatigue, dec concentration, irregular/ scant menstrual flow
Most common cause of endogenous hyperthyroidism:
Graves’ disease
Other causes of hyperthyroidism:
Toxic multinodular goiter, Toxic adenoma, Pituitary adenoma, Metastatic tumors, Thyroiditis, Overmedication (synthetic thyroid hormone, hypo to hyper possible)
How can adenoma lead to hyperthyroidism?
acc release of TH, pituitary gland TSH inc, too much
Symptoms of Graves Disease:
hyperthyroidism, enlarged thyroid, lymphocytic infiltration, ophthalmopathy, exophthalmos
What causes Grave’s disease?
AI
Hyperthyroidism leads to:
enlargement of thyroid, lymphocytic infiltration
TF? Most cases of exophthalmos due to Graves disease resolve after the disease is managed.
T
Tx for hyperthyroidism:
radioactive iodine uptake, 6-18mo
Indications that hyperthyroidism is poorly controlled:
Inc HR & BP
TF? Pulse rate is a measure of thyroid function.
T, hyperthyroidism: above 100
Caution for treating pts w uncontrolled hyperthyroidism:
don’t use epi
Goal of surgery for hyperthyroidism:
leave enough thyroid for normal function, too much excised is better
The use of epi w a pt w hyperthyroidism could lead to:
Palpitations, Arrhythmias, Chest pains
Mgmt of pts w hyperthyroidism:
limit psychological / surgical stress, aggressive infections tx (reserve is not great)
TF? Infections should be treated aggressively in pts w DM or hyperthyroidism.
T
Ppl most likely to enter thyrotoxic crisis:
elderly women
Incidence of thyrotoxic crisis a overt hyperthyroid.
1-2%
Mortality rate of thyrotoxic crisis:
10-20%
Thyrotoxic crisis is aka:
thyroid storm
presentation, thyrotoxic crisis:
Inc HR, BP, fever, neurological / GI symptoms, N, abdominal pain, anxiety, seizures
Decompensated state of TH-induced hypermetabolism:
thyrotoxic crisis
symptoms of hypothyroid:
weight gain, lethargy, cold intolerance, bradycardia, EDEMA, SWEATING
Causes of hypothyroid:
Hashimoto’s, lymphocytic thyroiditis, thyroid destruction, pituitary or hypothalamic disease, meds, iron deficiency (severe)
Hashimoto’s disease leads to __ and Grave’s disease leads to ___.
hypo, hyper
TF? Hashimoto’s and Graves disease are both AI diseases.
T
Types of inflammation that Hashimoto’s and Graves leads to:
lymphocytic and AI inflammation (in gland and autoantibody production)
Hashimoto’s can lead to:
myxedema
TF? Hashimoto’s disease can lead to Grave’s disease.
F. vice versa
Hypothyroidism in infancy can cause:
cretinism, developmental delay, frontal bossing (swelling) , big tongue, small jaw, short, hypertelorism (inc distance bw eyes)
Oral manifestations of hypo:
delayed eruption, enamel hypoplasia, ant open bite, small jaw, big tongue
How to treat hypo:
No tx if euthyroid w autoantibodies, Levothyroxine (Synthroid, replacement hormone)
Which is more common, hypo or hyper?
hypo
Dental mgmt of pt w hypo:
Inc subcutaneous mucopolysaccharides –> red capillary constriction –> red hemostasis, dec fibroblast activity –> delayed wound healing
causes delayed wound healing in hypo:
dec fibroblast activity
Causes red hemostasis in pts w hypo:
excess subcutaneous mucopolysaccharides –> red capillary constriction –> red homeostasis
anticoagulated, hypo or hyper and why?
Hypo, CV effects
What to be aware of if pt is taking Levothyroxine:
inc Warfarin effects, dec oral hypoglycemics effects
Warfarin is what type of drug?
anticoagulant
Why do pts w hypo on thyroid replacement hormones need to be monitored?
they can become hyper
TF? If BP & P are elevated in a pt w hypo you should avoid epi.
T
Is elevated TSH hyper or hypo?
Hypo, body putting out more TSH since it isn’t getting response.
neoplasms that can occur in the thyroid?
adenomas: benign, can produce hormones and cause hyper, usually nonfunctional, toxic adenomas produce hormones
TF? Toxic adenomas do not produce hormone.
F. They do
elevated if too much thyroid hormone is produced, t3 or T4?
T4
problem if TH is tool low?
Pituitary or thyroid
Cause of many thyroid neoplasms:
ionizing radiation
First familial form of thyroid neoplasm?
yes, genetic variant, 70% get cancer
Tx for pts with genes for familial form of thyroid neoplasm.
Remove thyroid
% of pts w genetic predisposition to thyroid neoplasm that get cancer:
70%
this indicates an underactive thyroid:
elevated TSH
This indicates overactive thyroid:
elevated T4
Effects of low T4:
damage thyroid or pituitary
low T4 and elevated TSH indicates:
thyroid problem
Low T4 and low TSH indicates:
pituitary problem (both are low, in the pits)
What are found on top fo kidneys:
adrenal glands
Adrenal glands, endocrine or exocrine?
endocrine
Produced by the cortex of the adrenal glands:
glucocorticoids, mineralocorticoids, androgens
Aldosterone is a:
mineralocorticoid
Testosterone is a:
androgen
Cortisol is a:
glucocorticoid
Produced in the medulla of the adrenal glands:
epi and NE
TF? There is a lot of overlay bw the adrenal glands and the thyroid.
T
Fxns of cortisol:
regulate protein, fat, carb metabolism, homeostasis, vascular reactivity, inhibition of inflammation
TF? Cortisol is an insulin antagonist.
F. insulin agonist
Fans of both cortisol and TH:
homeostasis
Steroids are prescribed for/
allergies, inflammation
HPA axis sf:
Hypothalamus, anterior Pituitary, Adrenal cortex
To where does cortisol exert negative feedback?
hypothalamus, ant pituitary gland
How does the hypothalamus exert influence over the anterior pituitary?
corticotropin releasing hormone. (-CRH)
anterior pituitary exerts influence over adrenal cortex via:
ACTH
WHat is released from the pituitary?
both TSH and ACTH
What is Addison’s disease?
Not enough hormone secretion from adrenal cortex
What can cause the insufficiency in hormone secretion from adrenal cortex in Addison’s disease?
AI, infection, hypovolemia, tumor, meds
Infection that can bring about Addison’s disease:
TB, HIV, fungal
How can hypovolemia bring about?
shut down communication bw pituitary and adrenal gland
Meds that can bring about Addison’s disease:
anticoagulants
How can anticoagulants bring about Addison’s disease?
dec circulating cortisol/steroid in system (?)
Signs and symptoms of Addison’s disease:
change in pulse and dec BP, GI symptoms inc D, N, V, weakness, fatigue, confusion, pigmentation of skin and oral mucosa
Oral manifestation of Addison’s disease:
pigmentation of skin and oral mucosa, brown spots on lips and spotches inside
Tx for Addison’s disease:
replacement corticosteroids
What is Cushing syndrome?
too much cotisol
Can lead to Cushing syndrome:
overmedication, excessive ACTH production from pituitary, adrenal tumors
TF? Cushing syndrome and Addison’s disease can both be medically induced.
T
Diseases that are treated with steroids:
Lupus, Sarcoid, Sjogren’s syndrome, MS, Cushing syndrome (all immunosuppressants, AI components)
CMLSS
Steroid use can lead to problems of the:
skeletal system (dm, hyperglycemia, too, right?)
Most steroids we use are:
topical
Most obvious sign of Cushing syndrome:
moon face
Signs and symptoms of Cushing syndrome:
hypertension, obesity, moon face, slow growth rate, bone pain/ fractures, muscle weakness, mental status change, fat deposition on back “Buffalo hump”
Cancer pts can be on high doses of these for a short period of time.
Steroids
Tx for Cushing syndrome:
wean from excessive meds, remove or radiate tumor
What is adrenal crisis?
acute adrenal insufficiency, rare, liffe-threatening, requires immediate tx
What type of pt with Addison’s is at highest risk for adrenal crisis?
1’ Addison’s
Adrenal crisis can be precipitated by:
inc stress –> inc need for cortisol –> adrenal gland can’t provide it
Normal output of cortisol from adrenal cortex:
25mg hydrocortisone (or 7.5mg prednisolone)
How can high dose steroids induce adrenal crisis:
high dose shuts down ability to produce steroids, more stress than the pills will compensate for, system shuts down
TF? We must treat Addison’s pts w steroid augmentation for routine dentistry.
F
TF? Pts taking endogenous steroids have adrenal function suppressed.
F. exogenous
Adrenal suppression may occur if:
pt took at least 20mg hydrocotisone for at least 2wk within past 2yr
Rule of 2’s applies to what disease?
Addison’s
What is the Rule of 2’s?
pt took at least 20mg hydrocotisone for at least 2wk within past 2yr
Effects of low cortisol on body:
dec liver fxn/ stomach digestive enzymes, V, D, cramps, very low sugar, coma, death
Levels of what will be low in the body if the adrenal glands aren’t functioning:
cortisol, aldosterone
Affects of aldosterone being very low in body:
water and Na loss in kidney, irregular heart beat and output, low fluid, low BP, shock, coma, death
Explain the premise of steroid augmentation:
pt taking steroids at a high enough dose for even a brief period, endogenous steroid production will be suppressed, unable to produce steroid if under additional stressor, adrenal crisis
When to consider steroid augmentation:
general anesthesia, extensive surgery, anticipate significant post-op pain
All cases of adrenal crisis in dentistry involved:
general anesthesia, 1.5-5h post-op, only 4 cases in 35y, no controls
Why is pain management important for pts w impaired adrenal function?
bc pain is a major stressor and wo steroid augmentation, they may go into adrenal crisis
This is the target dose for hydrocortisone equivalent:
50-100mg/d
Freq req for pts w adrenal insufficiency for surgical proc:
double dose of steroid on day of, and maybe day after, surgery
