THYROID DISORDERS Flashcards
These hormones are synthesized and stored bound to proteins in the cells of the thyroid gland until needed for release into the bloodstream.
THYROID HORMONES
T3 + T4
secretion of T3 and T4 by the thyroid gland is controlled by
TSH
THYROID STIMULATING HORMONE (THYROTROPIN)
is essential to the thyroid gland for synthesis of its hormones.
IODINE
INCREASES OF DECREASES?
If the thyroid hormone concentration in the blood decreases, the release of TSH
INCREASES
TSH controls the rate of thyroid hormone release through a
NEGATIVE FEEDBACK MECHANISM
secreted by the hypothalamus and exerts a modulating influence on the release of TSH from the pituitary.
TRH
THYROTROPIN RELEASING HORMONE
What are the by-products of cellular metabolism
ATP
HEAT
ENERGY
The main function of thyroid hormone is
CONTROL CELLULAR METABOLIC ACTIVITY
OR
CONTROL BMR
a relatively weak thyroid hormone, maintains body metabolism in a steady state
T4 or THYROSINE
is another important hormone secreted by the thyroid gland. The hormone is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.
CALCITONIN
is about five times as potent as T4 and has a more rapid metabolic action
T3 OR TRIIODOTHYRONINE
occurs when there is inadequate secretion of thyroid hormone during fetal and neonatal development, results in intellectual disability and stunted physical growth because of general
depression of metabolic activity
CONGENITAL HYPOTHYROIDISM
Enlargement of thyroid gland that commonly occurs due to deficiency in iodine.
GOITER
When palpated, isthmus should be
FIRM
RUBBER BAND CONSITENCY
Separates the 2 lobes of thyroid gland
ISTHMUS
TRUE OR FALSE
isthmus is the only portion of the thyroid that is normally palpable.
TRUE
For patient has a very thin neck, two thin, smooth, nontender lobes may also be palpable
If palpation of thyroid gland reveals enlargement, it should be auscultated for
BRUIT
Soft texture of thyroid gland upon palpation is an indication of
GRAVE’S DISEASE
upon auscultation, it is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism.
BRUIT
Firmness of thyroid gland upon palpation is an indication of
HASHIMOTO DISEASE
Tenderness of thyroid gland upon palpation is an indication of
THYROIDITIS
used for monitoring thyroid hormone replacement therapy and for differentiating between disorders of the thyroid gland itself and disorders of the pituitary or hypothalamus.
SERUM TSH
is the primary screening test of
thyroid function.
SERUM TSH CONCENTRATION
a direct measurement of free (unbound) thyroxine, the only
metabolically active fraction of T4
FREE T4
measures the rate of iodine uptake by the thyroid gland.
RADIOACTIVE IODINE UPTAKE
The patient is given a tracer dose of iodine 123 or another radionuclide, and a count is made over the thyroid gland with a scintillation counter, which detects and counts the gamma rays released from the breakdown of 123I in the thyroid.
RADIOACTIVE IODINE UPTAKE
used to detect persistence or recurrence of thyroid carcinoma.
SERUM THYROGLOBULIN
results from suboptimal levels of thyroid hormone.
HYPOTHYROIDISM
most common cause of hypothyroidism in adults is
HASHIMOTO DISEASE
refers to a condition in which the immune system attacks the thyroid gland leading to hypo function of the gland.
HASHIMOTO DISEASE
Refers to the cause of the hypothyroidism that is associated to dysfunction of the thyroid gland itself.
PRIMARY OR THYROIDAL HYPOTHYROIDISM
Refers to the the cause of the thyroid dysfunction that is failure of the pituitary gland, the hypothalamus, or both
CENTRAL HYPOTHYROIDISM
If the cause of hypothyroidism is entirely a pituitary disorder, it may be referred to as
PITUITARY OF SECONDARY HYPOTHYROIDISM
If the cause of hypothyroidism is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH, it is referred to as
HYPOTHALAMIC OR TERTIARY HYPOTHYROIDISM
refers to the accumulation of
mucopolysaccharides in subcutaneous and other interstitial tissues.
MYXEDEMA
a rare life-threatening condition and a decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.
MYXEDEMA COMA
Classic to hypothyroidism is
COLD INTOLERANCE
Goiter when becomes so large that it compresses the neck and chest, it can cause
RESPIRATORY SYMPTOMS
DYSPHAGIA
Decrease level of thyroid hormones leads to
SLOWIG OF BMR
Refers to the decreased acid production in the stomach due to hypothyroidism
ACHLORHYDRIA
The most important change caused by decreased level of thyroid hormones
LIPID METABOLISM
Refers to the bulging of the eyes
EXOPTHALMUS
Decreased consumption of oxygen due to decrease metabolism can lead to
ANEMIA
the decreased in oxygen consumption stimulates the bone marrow to stop producing RBC (carry O2) thus there will be ANEMIA
drug of choice for the treatment of
hypothyroidism
LEVOTHYROXINE (SYNTHROID)
Thyroid extract or gland that is dried and powdered for medical use
DESICCATED THYROID
Most commonly used for treatment of hypothyroidism
LEVOTHYROXINE (SYNTHROID)
Desiccated thyroid takes up how many weeks to take effect?
3 weeks
Pharmacologic management for hypothyroidism
LIOTHYRONINE (CYTOMEL)
LEVOTHYROXINE
DESICCATED THYROID
Dietary management for hypothyrodisim
IODINE
IODIZED SALT
SEAFOODS
DAIRY PRODUCTS
After thyroidectomy, one should watch out for signs and symptoms of
HYPOPARATHYROIDISM
A complication of hypothyroidism
MYXEDEMA COMA
Characterized by progressive stupor ending in comatose state
MYXEDEMA COMA
Myxedema coma is triggered by
AWACS
ACUTE ILLNESS
WITHDRAWAL OF THYROID MEDS
ANESTHESIA AND SURGERY
COLD TEMPERATURE
SEDATIVES AND OPOIDS ANALGESI
ACUTE ILLNESS Increases the demand for energy leading to sudden decreased in thyroid hormone
WITHDRAWAL OF THYROID MEDICATION causes sudden drop in thyroid hormones
ANESTHESIA AND SURGERY increases demand for bmr
SEDATIVES AND OPOIDS ANALGESIC can lead to respiratory and neurologic depression
The use of these medication in hypothyroidism or myxedema coma can lead to respiratory and neurologic depression
SEDATIVES
OPOIDS
Thickened, non-pitting edema of the skin
MYXEDEMA
Priority in managing myxedema coma
AIRWAY (MECHANICAL VENTILATOR)
Pharmacologic management for myxedema coma
SODIUM LEVOTHYROXINE WITH GLUCOSE AND CORTICOSTEROID
Levothyroxine increases thyroid hormones and thus BMR which can also increases glucose metabolism. A sudden increase in glucose metabolism can cause decrease blood glucose level
Glucose is administered to provide immediate energy substrate for cells and tissues
Corticosteroid is hormone associated with stress response. Patient in myxedema coma undergoes such stress thus with the administration of corticosteroid it help maintain blood pressure, metabolic stability, and counteract the stress response associated with myxedema coma.
Corticosteroid also prevent adrenal insufficiency.
Electrolyte imbalance seen in patient with myxedema coma
HYPONATREMIA
Bradycardia seen in patient with myxedema can lead to decreased cardiac output and perfusion to the renal system causing renal failure and inability to secrete fluids thereby, fluid retention. Fluid retention causes hemodilution and thus hyponatremia.
Metabolic disorder or problem seen in patient with myxedema coma
HYPOGLYCEMIA
Severe hypothyroidism can lead to very low thyroid hormones that is important in metabolism. Thyroid hormones stimulate gluconeogenesis and glycogenolysis. Decreased with these hormones can inhibit such process leading to hypoglycemia.
is a form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones by the thyroid
HYPERTHYROIDISM
is an autoimmune disorder that results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins
GRAVES DISEASE
Immune cells mistakenly identify thyroid cells as antigen or foreign thus it produces thyroid antibodies which mimic the action of TSH leading to hyperthyroidism
The antibodies produced mimic the action of TSH because they bind on the same receptor site and thus increase production that produces thyroid hormones
Most common cause of hyperthyroidism
GRAVES DISEASE
most common form of
treatment for Graves disease.
RADIOACTIVE IODINE (IODINE 131)
3 principal hallmarks of graves disease
HYPERTHYROIDISM
GOITER
EXOPTHALMUS
One of the cause of hyperthyroidism that is generally seen in in people over 50 years old with long standing goiter and is characterized by multiple thyroid nodules
TOXIC MULTINODULAR GOITER
Hyperthyroidism that is caused by excessive use of thyroid replacement hormone and overdosage of medication
EXOGENOUS HYPERTHYROIDISM
Hallmark of hyperthyroidism
HEAT INTOLERANCE
Classic sign of hyperthyroidism
EXOPTHALMUS
Common complication of hyperthyroidism
HEART DISEASE
Cells in the thyroid that is responsible for production of thyroid hormones
FOLLICULAR CELLS
What are the three major forms of hyperthyroidism medications
ANTITHYROID
ADRENERGIC BLOCKING AGENTS
RADIOACTIVE THERAPY
Antithyroid medications are
PROPYLTHIOURACIL
METHIMAZOLE
IODINE THERAPY (SSKI + LUGOL’S SOL)
SSKI stands for
SATURATED SOLUTION OF POTASSIUM IODIDE
Prior to surgery (thyroidectomy), the patient is given with this solution to decrease size and vascularity thus easy manipulation during surgery and prevent excessive bleeding
LUGOL’S SOLUTION
When Lugol’s solution is ingested, it saturates the thyroid gland with iodine. This excess iodine temporarily suppresses the synthesis and release of thyroid hormones from the thyroid gland.
refers to a phenomenon in which high levels of iodine temporarily suppress thyroid hormone synthesis and release
WOLFF-CHAIKOFF EFFECT
block the utilization of iodine leading to decrease synthesis and release
ANTITHYROID
This antithyroid drug is mix with juice or milks and is given by straw to prevent staining of the teeth.
SATURATED SOLUTION OF POTASSIUM IODIDE (SSKI)
indicated to decrease the cardiovascular signs and symptoms of thyrotoxicosis
ADRENERGIC BLOCKING AGENTS
Diet for patient with hyperthyroidism.
4000-5000 KCAL
This is because the patient has hyperactivity due to increase BMR. To support the needs for energy, one must have high caloric diet
Refers to sustained contraction of muscle as a result of hypocalcemia
TETANY
Pharmacologic management for patient experiencing tetany after thyroidectomy
CALCIUM GLUCONATE
After thyroidectomy, what are the things that must be readily prepared at bedside
CALCIUM GLUCONATE
TRACHEOSTOMY CARE
Management for thyroid storm
ENSURE PATENT AIRWAY
ANTIPYRETIC
PNSS FOR HYDRATION
PTU - 300 TO 900 mgs
METHIMAZOLE - up to 60 mgs
SSKI - 2g IV
BETA BLOCKERS 1 to 3 mgs IV
HYDOROCORTISONE - 100 to 50 mgs IV
What must be assess after thyroidectomy?
RNT
RESPIRATORY DISTRESS
NERVE DAMAGE
TETANY
RESPIRATORY DISTRESS related to hemorrhaged, edema, or laryngeal spasm
NERVE DAMAGE nerve damage is common in thyroidectomy because of the location of the thyroid gland *Check for ability to speak, tone, and quality of the voice
TETANY as s/s of hypocalcemia related to accidental removal of parathyroid gland
To prevent Addisonian crisis in patient with thyroid storm, what is given?
HYDROCORTISONE 100-150 mgs IV
TRUE OR FALSE
patient who has thyroid storm should not palpate the thyroid gland
TRUE
Palpation could stimulate the production of thyroid hormones
Severe form of hyperthyroidism
THYROID STORM
