Thyroid conditions

Question 1

Thyroid hormones

Answer 1

1. TRH (thrytropi releasing hormone) Stimulates anterior pituitary to secrete TSH
2. TSH (thyroid stimulating hormone) Stimulate thyroid to secrete T3 and T4
3. T3: Tri-iodo-thyronine - ACTIVE, 10% of secreted thyroid hormone
4. T4 - Convetered to T3 in Liver, 90% of secreted thyroid hormone

Question 2

Thyroid Pathophysiologic Pathway

Answer 2

HYPOTHALAMUS -> secrete TRH -> pituitary secrete TSH -> Thyroid gland secrete T3 and T4

Question 3

hypothyroidism

Answer 3

decreased secretion of thyroid hormones

Hashimotos

SSx
Bradycardia, cold, decreased appetite, weight gain, constipation, fatigue (#1 Symptom), dry skin

increase TSH
decrease T4

Question 4

hyperthyroidism

Answer 4

too much T3 and T4
o Excessive ingestion of thyroid hormone

• GRAVES disease

o SSx: tachycardia, irritability, nervous/tremor, increased bowel movements, Goiter, hunger, heat intolerance, weight loss, insomnia

Thyroid STORM
o Rare life threatening condition associated with undertreated or untreated hyperthyroidism

SSX: tachy >140, hyperpyrexia, cardiac arrythmia, death from cardiovascular collapse

TREATMENT:
o Thioamides (GOLD STANDARD)
o Sodium iodide
o Potassium iodide

Question 5

PTH

Answer 5

PTH – release from parathyroid gland in response to decreased calcium levels
o Pulls in calcium from bone into bloodstream PTH receptor on osteoclasts that moves calcium from bone into bloodstream
INCREASED calcium absorption in intestine
INCREASED calcium reabsorption in kidney
OVERALL INCREASED SERUM CALCIUM

Resorption
o Osteoclasts: bone removal - Release calcium and phosphate

Formation
o Osteoblasts bone building - Fill in empty spaces of bone with collagen and calcium/phosphate crystals

Question 6

Hyperparathyroidism

Answer 6

:is a condition in which one or more of the parathyroid glands become overactive and secrete too much parathyroid hormone (PTH).

This causes the levels of calcium in the blood to rise, a condition known as hypercalcemia.

TX:
cincalcet

Question 7

Calcium and Vitamin D recall:

Answer 7

Calcium and Vitamin D recall:

Vitamin D increases calcium absorption in the intestines and reabsorption in the kidneys
• Cholecalciferol (D3) – more potent and longer acting
• Ergocalciferol (D2) – not as good

Calcium incorporated into bone
• Calcium carbonate – most common (tums)
• Calcium citrate- best absorbed
• Calcium gluconate

** Calcium citrate and cholecalciferol buy them separately!!!!

Question 8

osteoporosis/penia

Answer 8

GOLD STANDARD TX: Bisphosphates

TX:
• anabolic agents: build bone
• antiresorptive agents: osteoclasts so they don’t break down bone

Question 9

osteoclast vs blast

Answer 9

clast - breaks down bone due to decreased serum calcium level

blast - builds bone by taking excess calcium from bloodstream

Question 10

adrenal cortex disorders: hyperactivity

Answer 10

Cushings Syndrome

increased ACTH production -> increase circulating cortisol levels
tumor on the pituitary or excessive glucocorticoid administration

Question 11

adrenal cortex disorders: hyperaldosteronism

Answer 11

adrenal glands produce too much aldosterone

treat w aldosterone antagonists

Question 12

adrenal cortex disorders: hypoactivity

Answer 12

Addisons: not enough corticosteroids to produced endogenously

autoimmune treat w glucocorticoids or mineralocorticoid

secondary adrenal insufficiency: pituitary cannot produce enough PTH