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Physiology > Thyroid and Adrenal Glands > Flashcards

Thyroid and Adrenal Glands Flashcards

1
Q

Enlargement of the Thyroid gland is called what?

A

Thyroid goiter

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2
Q

What is absorbed in the GI track and incorporated into T3 and T4 as thyroglobulin?

A

Iodine

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3
Q

What releases the stimulating factors/hormones for the thyroid gland?

A

Release of hormone occurs by Hypothalamic – Pituitary interaction

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4
Q

Interactions among the hypothalamus, the pituitary gland, and the adrenal (also called “suprarenal”) glands, (HPA axis) is a major part of the neuroendocrine system that controls reactions to ____ and regulates many body processes.

A

reaction to stress

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5
Q

Which of the following are regulated by the HPA axis?

A. Digestion
B. The immune system
C. Mood and emotions
D. Sexuality 
E. Energy storage and expenditure
F. All of the above
A

F

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6
Q

What links the nervous system to the endocrine system via the pituitary gland?

A

hypothalamus

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7
Q

How does the hypothalamus affect the thyroid gland

A

It secretes TRH, which is produced by the hypothalamus.

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8
Q

What is TRH?

A

Thyrotropin-releasing hormone (TRH), also called thyrotropin-releasing factor (TRF), a hormone that stimulates the release of TSH (thyroid-stimulating hormone) and prolactin from the anterior pituitary.

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9
Q

Some people develop antibodies against their own TSH receptors. When these bind the receptors, they “fool” the cell into making more T4 causing hyperthyroidism. The condition is called_______.

A

thyrotoxicosis or Graves’ disease.

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10
Q

The secretion of TSH is

stimulated by ___ and inhibited ___.

A

The secretion of TSH is
stimulated by the arrival of thyrotropin releasing hormone (TRH) from the hypothalamus.
inhibited by the arrival of somatostatin from the hypothalamus.

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11
Q

TSH stimulates the thyroid gland to secrete its hormone_______ .It does this by binding to transmembrane _______on the surface of the cells of the thyroid.

A

thyroxine (T4)

G-protein-coupled receptors (GPCRs)

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12
Q

A deficiency of TSH causes ______: inadequate levels of______.

A

hypothyroidism, T4 (and thus of T3)

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13
Q

____ is more metabolically active and formed peripherally by de-iodination of ___.

A

triiodothyronine (T3) is more metabolically active and formed peripherally by de-iodination of thyroxine (T4)

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14
Q

_____ is necessary for the production of T3 and T4. A deficiency leads to _____ production of T3 and T4, enlarges the _____ and will cause the disease known as ____.

A

Iodine

leads to decreased production of T3 and T4, enlarges the thyroid tissue and will cause the disease known as goitre.

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15
Q

The major form of thyroid hormone in the blood is ____, which has a longer half-life than___. The ratio of __to released into the blood is roughly 20 to 1.

A

thyroxine (T4),which has a longer half-life than T3. The ratio of T4 to T3 released into the blood is roughly 20 to 1.

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16
Q

T or F. If there is a deficiency of dietary iodine, the thyroid will not be able to make thyroid hormone.

A

True

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17
Q

The lack of thyroid hormone will lead to _______ negative feedback on the pituitary, leading to ______ production of thyroid-stimulating hormone, which causes the thyroid to ____.

A

decreased negative feedback on the pituitary

increased production of TSH

enlarge (the resulting medical condition is called endemic colloid goiter

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18
Q

What causes the thyroid gland to enlarge and what effect does this have?

A

a deficiency of dietary iodine-> thyroid unable to make thyroid hormone->lack of thyroid hormone -> goiter

This has the effect of increasing the thyroid’s ability to trap more iodide, compensating for the iodine deficiency and allowing it to produce adequate amounts of thyroid hormone.

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19
Q

What limits the thyroid hormones peripheral function?

A

Thyroid hormones are extensively protein bound limiting their peripheral function

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20
Q

List 5 functions of the thyroid hormone.

A

Thyroid Hormone
Increases carbohydrate and fat metabolism
Is important for growth
Is important for stress response
It increases metabolic rate
Increased adrenergic-receptor responsibility

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21
Q

How does thyroxine (T4) effect each of the following:

Cardiac Output
Heart Rate
Ventilation Rate
Basal Metabolic Rate

A

Increases all of them

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22
Q

T or F. T4 Potentiates the effects of catecholamines (i.e. increases sympathetic activity)

A

True

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23
Q

t or f . Tyroid hormones increase the body’s sensitivity to catecholamines (such as adrenaline) by permissiveness.

A

True. Thyroid hormone increases the number of receptors available for epinephrine at the latter’s target cell, thereby increasing epinephrine’s effect on that cell. Without the thyroid hormone, epinephrine would have only a weak effect

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24
Q

Permissiveness is a biochemical phenomenon in which ______ is required for _____.

A

the presence of one hormone is required in order for another hormone to exert its full effects on a target cell

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25
Q

What are the three cardiac effects of hyperthyroidism? Why are these common?

A

Tachycardia
Atrial fibrillation
Congestive heart failure

Common bc these pts are hyper-sensitized to catecholamines

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26
Q

The following are characteristic of what endocrine disease?

Muscle weakness
Nervousness
Hyperactive reflexes
Weight loss
Heat intolerance
Tremor
A

Hyperthyroidism

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27
Q

What are three ways to treat hyperthyroidism?

A

Inhibit Synthesis

Prevent Release

Block the End Results

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28
Q

What two drugs can be used to inhibit the synthesis of thyroid hormone?

A

Propylthiouracil and methimazole

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29
Q

What are two things that can be taken to prevent the release of thyroid hormone?

A

Potassium Iodide or Sodium Iodide

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30
Q

One way to treat hyperthyroidism is to block the end results of the thyroid hormone. What class of drugs is used to do this?

A

Block the End Results w/ Beta-blockers. This is what we do.

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31
Q

List 3 things that are required to render a patient w/ a known hx of hyperthyroidism as euthyroid they present for an elective case.

A

elective cases should be rendered euthyroid
Normalization of TFT’s (want T3/T4 brought down, and TSH brought up to normal levels)
Heart rate < 85 / min
Continue medications on morning of surgery

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32
Q

List the 6 intra-op anesthetic considerations for hyperthyroid patients.

A 
Protect Eyes
Close monitoring of CV system
Accurate temperature monitoring
Avoid sympathetic stimulating drugs (Ketamine, Pancuronium)
Likely hypovolemic and vasodilated
Be careful with muscle relaxants
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33
Q

What are the 4 indications of a Thyroid Storm?

A

Hyperpyrexia
Tachycardia
Mental Status Changes
Hypotension

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34
Q

T or F. Thyroid Storm mimics MH, including muscle rigidity, and lactic acidosis

A

False. it mimics MH but the difference is that with Thyroid storm, there is

No muscle ridgidity
No lactic acidosis

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35
Q

T or F. Thyroid Storms can occur intra-op or post-op, but they most commonly occur intra-op.

A

False. Most commonly occurs 6-24 hrs post-op

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36
Q

How do you treat a Thyroid Storm?

A

Volume replacement
Control Cardiovascular system
Block Thyroid hormone release

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37
Q

What is the “Paper Test” ?

A

Used on hyperthyroidism pts - i u put there ares straight out in front of them, and put a piece of paper on the back their hands, it will shake right off of them.

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38
Q

T or F. Hypothyroidism is characterized by weight loss despite increased appetite.

A

False. That is hyperthyroidism

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39
Q

Low LDL, diarrhea, brisk reflexes and osteoporosis is seen in what thyroid disease

A

Hyperthyroidism

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40
Q

What is the most common reason for hyperthyroidism?

A

Graves Disease (or thyrotoxicosis) - develop antibodies against their own TSH receptors. When these bind the receptors, they “fool” the cell into making more T4 causing hyperthyroidism. The condition

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41
Q

What is Hot Adenoma? What does it cause?

A

It is a functional thyroid tumor, producing excessive thyroid hormone - Causes hyperthyroidism

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42
Q

What is Factitious hyperthyroidism? What type of patients are susceptible to this?

A

Factitious or iatrogenic hyperthyroidism is due to an exogenous intake of thyroid hormone. This happens when hypothyroid pts take too much thyroid supplements.

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43
Q

What are the 4 common causes of hyperthyroidism

A

Graves Disease
Hot Adenomas
Factitious
Scondary

44
Q

What is secondary hyperthyroidism

A

Secondary hyperthyroidism, or TSH-mediated hyperthyroidism, is caused by too much TSH release. It is always associated with goiter, and approximately 40% of patients have visual field defects

45
Q

T or F. Hyperthyroidism is a metabolic up-regulation causes an up-regulation of all systems.

A

False. The brain is not up-regulated. mental confusoin, Depression, Apathy, and dementia are associated with hyperthyroidism.

46
Q

What is hypothyroidism?

A

hypothyroidism (‘sluggish thyroid’), which is the reduced production and secretion of T3 and/or T4

47
Q

T or F. A wide pulse pressure is associated with hypothyroidism.

A

False. Hyperthyroidism

48
Q

T or F. In primary hyperthyroidism, T3 and T4 levels are very high and TSH levels are very low, almost undetectable

A

True

49
Q

T or $. You need to be careful with NMB with hyperthyroid pts bc they will have prolonged neuromuscular blockade.

A

True

50
Q

Why do you want to avoid drugs that rev up the sympathetic system/ vagolytic drugs in pts with hyperthyroidism? Name some to avoid.

A

They are already revved up and will have an exaggerated response. This can lead to arrhythmias

Avoid Ketamine, pancuronium, and indirect sympathomimetics

51
Q

What disease is characterized by exophthalmos (bulging of the eyes) and lid retraction, making them more susceptible to corneal abrasions during surgery?

A

Graves Disease

52
Q

What is Hashimoto’s thyroiditis?

A

Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease in which the thyroid gland is attacked by a variety of cell- and antibody-mediated immune processes. very often results in hypothyroidism with bouts of hyperthyroidism. Symptoms of Hashimoto’s thyroiditis include Myxedematous psychosis, weight gain, depression, mania, sensitivity to heat and cold, paresthesia, fatigue, panic attacks, bradycardia, tachycardia, high cholesterol, reactive hypoglycemia, constipation, migraines, muscle weakness, joint stiffness, menorrhagia, cramps, memory loss, vision problems, infertility and hair loss.

53
Q

T or F. Goiters can result from both hypo and hyperthyroidism.

A

True

54
Q

Airway compromise associated with thyroid diseases include what?

A 
Airway Compromise
Goiter
Strider
Hematoma
Pneumothorax
55
Q

What causes stridor in patients with goiters of they thyroid gland.

A

pressure on the recurrent laryngeal nerve

56
Q

What is the major anesthetic consideration associated with hypothyroid?

A

Myxedema Coma - a state of decompensated hypothyroidism. The patient may have lab values identical to a “normal” hypothyroid state, but a stressful event (infections, MI, stroke, drugs, etc.) precipitates the myxedema coma state, usually in the elderly. Primary symptoms of myxedema coma are altered mental status and hypothermia. Hypoglycemia, hypotension, hyponatremia, hypercapnia, hypoxia, bradycardia, and hypoventilation may also occur.

57
Q

The following are characteristic of what thyroid state?

Weak heart beat
slowing of mind and body
cold intolerance

A

hypothyroidism

58
Q

Why is surgery on the adrenal glands challenging? What approach has made it easier.

A

Because they are located in the retro-peritoneal space on top o the kidneys. Laparoscopic

59
Q

The adrenal glands are responsible for releasing hormones in response to stress through the synthesis of ________ such as cortisol and ______ such as epi and NE, and _______ such as aldosterone.

A

corticosteroids
catecholamines
androgens.

60
Q

The adrenal glands affect kidney function through the secretion of ________, a hormone involved in regulating the osmolarity of blood plasma.

A

aldosterone

61
Q

T or F. The Adrenal Medulla receives input from the sympathetic nervous system and secretes catecholamines directly into the blood.

A

True

62
Q

Pheocromocytomas develop where

A

Adrenal medulla cells

63
Q

Catecholamines are derived from ______ and are _____ soluble..

A

the amino acid tyrosine , water soluble

64
Q

All of the hormones from the adrenal cortex are derived from ________.

A

cholesterol

65
Q

T or F. The Hormones of the adrenal cortex bind to cell membranes to G-protein-coupled receptors (GPCRs).

A

False. They are lipid soluble and act inside the nucleus where they upregulate or down regualte gene transcription

66
Q

T or F. Steroid hormones act quickly like catecholamines

A

False. Catecholamines bind to surface receptors and exert their effect immediately but, steroid hormones penetrate through the cell membrane and the nuclear membrane and impact DNA transcription…much slower process

67
Q

T or F. Aldosterone is a steroid hormone produced in the adrenal medulla.

A

False it is a steroid hormone produced in the adrenal cortex

68
Q

How does Aldosterone effect fluid and electrolytes?

A

Regulates fluid and electrolyte balance
Increases Na+ reabsorption from Distal Tubules
Retention of Na+ leads to water retention

69
Q

A tumor that releases too much ACTH will have what effect?

A

hyperaldosterone state

70
Q

When blood pressure fall, it is sensed by maculla densa cells in the distal tubules of the nephron, who then secrete _____.

A

Renin

71
Q

The_____ enzyme circulates in the blood stream and breaks down (hydrolyzes) ________ secreted from the liver into the peptide _________.

A

Renin, angiotensinogen, angiotensin I

72
Q

________ is further cleaved in the lungs by endothelial-bound angiotensin-converting enzyme (ACE) into _______, the most vasoactive peptide.

A

Angiotensin I, angiotensin II

73
Q

Angiotensin II is a potent ______ of all blood vessels. Angiotensin II also acts on the adrenal glands, causing the release ______.

A

constrictor, Aldosterone

74
Q

Which of the following stimulates the synthesis of Aldosterone?

A. Increase in plasma angiotensin II
B. ACTH
C. potassium levels
D. A and B
E. All of the above
A

E

75
Q

T or F. Exposure to cold leads to increased cortisol levels.

A

True

76
Q

What 3 things are secreted by the adrenal cortex?

A

Androgens

Glucocorticoids

Aldosterone

77
Q

T or F. Aldosterone upregulates epithelial sodium channels, leading to an increased number of Na channels allowing increased permeability for Na+.

A

True

78
Q

How do glucocorticoids promote energy storage?

A
  • Promote gluconeogenesis

- Decrease peripheral utilization of glucose

79
Q

T or F. Glucorticoids have insulin like effects?

A

False. Anti-insulin Effects. cortisol stimulates several processes that collectively serve to increase and maintain normal concentrations of glucose in blood

80
Q

T or F. Glucocorticoids are required for smooth muscle response to catecholamines.

A

True

81
Q

T or F. When you have high levels of glucorticoids, it can cause Na retention.

A

True

82
Q

Glocorticoids have effect on which of the following:

A. Muscle
B. Fat Cells
C. Liver
D. All of the above

A

D

83
Q

T or F. In attempt to preserve glucose, glucocorticoids stimulate lipolysis.

A

True

84
Q

T or F. Androgens greatly impact anesthetic management.

A

false

85
Q

List the 7 symptoms of Pheochromocytomas

A 
Hypertension 
Paroxysmal headache
Sweating 
Palpitations
Tachycardia
Weight Loss
Heat Intolerance
86
Q

T or F. Pheochromocytomas are only generated in the adrenal medulla.

A

False. They can be generated any where along Sympathetic Ganglion Cell or anywhere they have Neuroblastoma
cells - can be scattered throughout abdominal cavity or up and down their spine

87
Q

Stimulation of which Adrenergic receptor causes each of the following:

A. ↑lipolysis
B. ↑renin secretion
C. ↑glycogenolysis
D. ↓ insulin secretion

A

A. ↑lipolysis = B1 and B3
B. ↑renin secretion = B1
C. ↑glycogenolysis = B2
D. ↓ insulin secretion = A2

88
Q

T or F. Patients who have a pheo are hypertensive and hypervolemic.

A

F. They are hypertensive, but the andrenergic stimulation causes natural diuresis to try to bring down the BP and these pts are often hypovolemic

89
Q

Which of the following are involved with managing a pt with a pheo

A. Alpha blockade
B. Beta blockade
C. Fluid
D. All of the above

A

D

90
Q

Why are you often dealing with hypotension following ligation of adrenal vein drainage?

A

Due to removal of catecholamines
Excess treatment of hypertension
Inadequate fluid resuscitation

91
Q

What disease is characterized by the following:

Excessive aldosterone release
Increased blood pressure 
Hypervolemia
Hypokalemia
Muscle Weakness
Metabolic Alkalosis
A

Aldosteronoma - also called Conn’s syndrome

HTN + hypoK —> think Aldosteronoma

92
Q

What disease is characterized by the following:

Muscle Wasting
Osteoporosis
Central Obesity
Abdominal Striae
Glucose Intolerance
Hypertension
Mental Status Changes
Buffalo Hump
A

Cushing’s Syndrome

93
Q

How do you treat Aldosteronoma?

A

Spironolactone (diuretic)- inhibit Na reabsorption, causes K retention or remove tumor causing it

94
Q

T or F. High levels of Aldosterone are seen in Cushing’s patients

A

True

95
Q

What causes Cushing’s Syndrome?

A

either a tumor in the adrenal gland that causes over production of cortisol OR a tumor in the pituitary gland that causes the unregulated release of ACTH (70%)

96
Q

What does ACTH stand for ?

A

adrenocorticotropic hormone (ACTH)

97
Q

What is the difference bn Cushings syndrome and Cushings disease

A

Cushing’s syndrome refers to excess cortisol of any etiology

primary hypercortisolism/hypercorticism - cortisol secreting adenoma in the cortex of the adrenal gland - The adenoma causes cortisol levels in the blood to be very high, and negative feedback on the pituitary from the high cortisol levels causes ACTH levels to be very low.

Cushing’s disease refers only to hypercortisolism secondary to excess production of ACTH from a corticotroph pituitary adenoma (secondary hypercortisolism/hypercorticism) or due to excess production of hypothalamus CRH (Corticotropin releasing hormone) (tertiary hypercortisolism/hypercorticism). This causes the blood ACTH levels to be elevated along with cortisol from the adrenal gland. The ACTH levels remain high because the tumor is unresponsive to negative feedback from high cortisol levels.

98
Q

When Cushing’s Syndrome is suspected, what diagnostic test is used and how does it work?

A

dexamethasone suppression test - administration of dexamethasone at midnight and measure cortisol and ACTH levels 12 hrs later. Dexamethasone is a glucocorticoid and simulates the effects of cortisol, including negative feedback on the pituitary gland, leading to low ACTH and cortisol levels. If the cortisol levels are high, this indicates the presence of a non-regulating tumor such as adrenal or pituitary adenoma that is not inhibited by the dexamethasone - thus would be indicative of Cushing’s syndrome.

99
Q

What do we see in Cushing patients.

A 
Fluid Overloaded
Hypokalemia
Metabolic Acidosis
Risk for Fractures - osteoporosis
Muscle Weakness – Prolonged Paralysis
Stress Intolerance
100
Q

Do Cushings pts require stress dose of steroids for surgery? if so what is the dose

A

yes. Hydrocortisone replacement 100 mg q8

101
Q

The following are characteristic of what disease?

Destruction of the adrenal gland
Hyponatremia
Hypotension
Hyperkalemia
Weight Loss
A

Addison’s Disease

102
Q

A patient is hyperkalemic but does not have kidney problems. What could explain this?

A

Addison’s Disease

103
Q

Why is a stress dose of hydrocortisone 100 mg q8 if we normally only secrete 20mg of cortisol a day?

A

In a stress state (surgery) we can secrete up to 300 mg a day. So 100mg q8 = 3*100.

104
Q

T or F. A patient who has been in the ICU for a prolonged period of time is usually adrenally suppressed ad will need a stress dose of steroids.

A

True

105
Q

T or F. A burn patient who has received multiple doses of etomidate for all of their dressing changes may require a stress dose of steroids.

A

True. Multiple doses of etomidate causes adrenal supression

Physiology (3 decks)

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