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PHA223 > Thyroid and parathyroid glands pt.2 > Flashcards

Thyroid and parathyroid glands pt.2 Flashcards

1
Q

What can alterations of thyroid function lead to?

A

hypothyroidism

hyperthyroidism

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2
Q

features of hypothyroidism

A

decreased metabolic rate
accumulation of hydrophilic mucopolysaccharide substance (myxedema) in connective tissue
elevated serum cholesterol

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3
Q

features of hyperthyroidism

A

increased metabolic rate and oxygen consumption
increased use of matabolic fuels
increased sympathetic nervous system responsiveness

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4
Q

What is thyrotoxicosis?

A

excessive secretion and activity of the thyroid hormone

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5
Q

Main causes of hyperthyroidism/thyrotoxicosis?

A
  1. Grave’s disease - pretibial myxedema
  2. goitre - hyperthyroidism resulting from nodular thyroid disease
  3. thyrotoxic crisis - thyroid storm
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6
Q

When can Grave’s disease occur?

A

any age but uncommon before puberty

most commonly affects women aged 30-50yrs

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7
Q

What conditions are included in Grave’s disease?

A

state of hyperthyroidism, goiter and opthalmopathy (less commonly dermopathy)

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8
Q

What is dermopathy?

A

skin condition that results from changes to the blood vessels that supply to the skin
red swollen skin, usually on shins/tops of feet

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9
Q

What is Grave’s disease?

A

an autoimmune disorder characterised by abnormal stimulation of the thyroid gland by thyroid-stimulating antibodies (thyroid-stimulating immunoglobulins TSI) that act through the normal TSH receptors

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10
Q

What is Grave’s disease associated with?

A

human leukocyte antigens - HLA-DR3, HLA-B8

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11
Q

What does thyroid stimulating immunoglobulin (TSI) do in Grave’s disease?

A
  • it stimulates the secretion and growth of the thyroid gland like TSH
  • not subjected to negative feedback by thyroid hormone
  • thyroid hormone secretion/growth continues
  • excessive thyroid hormone release causes negative feedback on anterior pituirary so no TSH is released
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12
Q

symptoms of thyroid storm

A

very high fever
extreme CV effects - tachycardia, congestive failure, angina
severe CNS effects - agitation, restlessness, delirium
high mortality

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13
Q

What can precipitate thyroid storm?

A
  • infection in a patient with unrecognised/inadequately treated thyrotoxicosis
  • known thyrotoxicosis shortly after thyroidectomy
  • after radio therapy (transient rise in thyroid levels)
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14
Q

causes of hypothyroidism

A 
subacute thyroiditis
- autoimmune thyroitis (Hashimoto disease)
- painless thyroiditis
- postpartum thyroiditis
- myxoedema coma
congenital hypothyroidism
thyroid carcinoma
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15
Q

manifestations of hypothyroidism

A 
mental and physical sluggishness
myxedema
somnolence (drowsiness/sleepiness in excess)
decreased cardiac output, bradycardia
constipation
decreased appetite
hypoventilation
cold intolerance
coarse, dry skin/hair
weight gain
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16
Q

mainfestations of hyperthyroidism

A 
thyroid storm
restlessness/irritability/anxiety
wakefulness
increased cardiac output
tachycardia/palpitations
diarrhoea
increased appetite
heat intolerance/sweating
thin/silky skin/hair
weight loss
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17
Q

differences between skin/appendages in thyrotoxicosis and hypothyroidism

A

thyrotoxicosis

  • warm/moist skin
  • heat intolerance
  • fine/thin hair
  • Plummer’s nails
  • sweating
  • pretibial dermopathy (Grave’s)

hypothyridism

  • pale/cool/puffy/dry skin
  • brittle hair/nails
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18
Q

differences between eyes/face in thyrotoxicosis and hypothyroidism

A

thyrotoxicosis

  • retraction of upper lip
  • wide stare
  • periorbital edema
  • diplopia (Grave’s) (double vision)

hypothyroidism

  • drooping of eyelids
  • loss of temporal aspects of eyebrows
  • puffy/nonpitting face
  • large tongue
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19
Q

What is exopthalmos in thyrotoxicsis (Grave’s)?

A

wide eye staring gaze due to overactivity of sympathetic nervous system
accumulation of loose connective tissue behind the eyes which adds to the bulging apparance
bilateral in Grave’s
unilateral in orbital tumour

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20
Q

differences between CVS in thyrotoxicosis and hypothyroidism

A

thyrotoxicosis

  • decreased peripheral vascular resistance
  • increased HR/stroke volume/cardiac output/pulse pressure
  • high output heart failure
  • arrthyhmias
  • angina

hypothyroidism

  • increaed peripheral vascular resistance
  • decreased HR/stroke volume/cardiac output/pulse pressure
  • low output heart failure
  • bradycardia
  • prolonged PR interval, flat T wave
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21
Q

differences between respiratory system in thyrotoxicosis and hypothyroidism

A

thyrotoxicosis

  • dyspnea
  • decreased vital capacity

hypothyroidism

  • pleural eflusions
  • hypoventilation and CO2 retention
22
Q

differences between GIT in thyrotoxicosis and hypothyroidism

A

thyrotoxicosis

  • increased appetite
  • increased bowel movements
  • hypoproteinemia

hypothyroidism

  • decreased appetite
  • dec freuency of bowel movements
  • ascites (fluid collects in abdomen)
23
Q

differences between CNS in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • nervousness
  • hyperkinesia
  • emotional lability

hypothyroidism

  • lethargy
  • general slowing of mental processes
  • neuropathies
24
Q

differences between musculoskeletal system in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • weakness/muscle fatigue
  • incresed deep tendon reflexes
  • hypercalcemia
  • osteoporosis

hypothyroidism

  • stiffness/muscle fatigue
  • decreased deep tendon reflexes
  • increased alkaline phosphatase
  • inc LDH and AST
25
Q

differences between renal system in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • mild polyuria
  • inc renal blood flow
  • inc glomerular filtration rate

hypothyroidism

  • impaired water excretion
  • dec renal blood flow
  • dec glomerular filtration rate
26
Q

differences between hematopoietic in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • inc erythropoiesos
  • anaemia

hypothyroidism

  • dec erythropoiesis
  • anaemia
27
Q

differences between reproductive system in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • menstrual irregularities
  • dec fertility
  • inc gonadal steroid metabolism

hypothyroidism

  • hypermenorrhoea
  • infertility
  • dec libido
  • impotence
  • oligospermia (low sperm count)
  • dec gonadal steroid metabolism
28
Q

differences between metabolic system in thyrotoxicosos and hypothyroidism

A

thyrotoxicosis

  • inc basal metabolic rate
  • negative nitrogen balance
  • hyperglycaemia
  • inc FFA
  • dec cholesterol/triglycerides
  • inc hormone degradation
  • inc requirements for fat/water sol vitamins
  • inc drug matabolism
  • dec warfarin requirement

hypothyroidism

  • dec basal metabolic rate
  • slight positive nitrogen balance
  • delayed degradation of insulin with inc sensitivity
  • inc cholesterol/triglycerides
  • dec hormone degradation
  • dec requirements for fat/water sol vitamins
  • dec drug metabolism
  • inc warfarin requirement
29
Q

Hashimoto’s thyroditis cause of hypothyroidism

A

autoimmune destruction of thyroid
goiter present early, absent later
hypothyroidism mild/severe

30
Q

drug induced casue of hypothyroidism

A

blovked hormone formation
goiter present
mild/moderate

31
Q

dyshormonogenesis cause of hypothyroidism

A

impaired synthesis of T4 due to enzyme deficiency
goiter present
mild/severe hypothyroidism

32
Q

radition/x-ray/thyrodectomy cause of hypothyroidism

A

destruction/removal of gland
goiter absent
severe hypothyroidism

33
Q

congenital (cretinism) cause of hypothyroidism

A

athreosis/ectopic thyroid, iodine deficiency, TSH receptor blocking antibodies
goiter absent/present
severe

34
Q

secondary (TSH deficit) cause of hypothyroidism

A

pituitary/hypothalamic disease
goiter absent
mild

35
Q

How to diagnose thyroid disorders?

A 
meaure T3, T4 and TSH
resin uptake test
assessment of thyroid autoantibodies
radioiodine uptake test (123I)
thyrid scans (123I, 99m Tc-pertechnetate)
ultrasonography
CT/MRI scans
fine needle aspiration (FNA) biopsy of a thyroid nodule
36
Q

laboratory assessment of thyroid function

A

no patient preparation is needed
sample requirement - 5ml venous blood, blood plasma collected into tube containing anticoagulant, blood collected into plain tube
request information - from patient about drugs/pre-existing non-thyroid disease that can affect interpretation, brief clinical Hx
(test used to monitor effectiveness of the therapy too)

37
Q

normal levels for total thyroxine (T4)

A

4 - 11 microg/dL
hypo - low
hyper - high

38
Q

total triiodothyronine (T3) levels

A

60 - 175 nanog/dL

hypo - normal/low
hyper - high

39
Q

free T4 (FT4) levels

A

0.7 - 1.4 nanog/dL

hypo - low
hyper - high

40
Q

free T3 (FT3) levels

A

0.16 - 0.4 nanog/dL

hypo - low
hyper - high

41
Q

thyrotropic hormone (TSH) levels

A

0.4 - 4.5 micro IU/mL

hypo - high
hyper - low

42
Q

What happens if there are abnormal readings of TFTs?

A

repeat the tests to confirm the abnormality

43
Q

123I uptake at 24hrs levels

A

5 - 35%

hypo - low
hyper - high

44
Q

subclinical primary hyperthyroidism

A

plasma/serum TSH reduced
plasma/serum FT4 and FT3 normal

greater than normal risk of developing hyperthyroidism
thyroid testing every 6-12mths
reduced bone density (ospeoporosis) in postmenopause
inc risk of AF in elderly

45
Q

subclinical primary hypothyroidism

A

serum TSH raised
serum FT4 high (>10 mIU/L)
annual thyroid testing

46
Q

3 treatments for thyperthyroidism

A

antithyroid drugs
srugery
RAI (radioactive iodine)

47
Q

goals of therapy for hyperthyroidism

A

eliminate excessive thyroid hormone production and control symptoms

48
Q

2 thioureylene drugs

A

carbimazole

propylthiouracil

49
Q

other drugs for hyperthyroidism

A

beta adrenoceptor antagonists

propranolol (non-selective)

50
Q

How do beta-adenoceptor antagonists work in hyperthyroidism?

A

decrease signs and symptoms - tachycardia, dysrhythmias, tremor, agitation

51
Q

drugs for treatment of hypothyroidism

A

levothyroxine (T4)

liothyronine (T3)

52
Q

s/e of levothyroxine and loithyronine

A

inceases HR and output
dysrhythmias
symptoms of hyperthyroidism

PHA223 (43 decks)

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