Thyroid problems Flashcards
Primary adrenal insufficiency/ Addison’s disease is caused by what?
Destruction of the adrenal glands
Secondary adrenal insufficiency is caused by what?
- Decreased secretion of adrenocorticotropic hormone (ACTH)
2. Dysfunction of the hypothalamus
Common causes of primary adrenal issuficiency?
Autoimmune disease Adrenalectomy Metastatic cancer Abdominal radiation therapy Drugs/toxins
Common causes of secondary adrenal insufficiency?
Cessation of long term corticosteroids (>2 weeks)
Pituitary tumors
Hypophysectomy
Postpartum pituitary necrosis
High dose pituitary/whole brain radiation
Neuromuscular S/sx of adrenal insufficiency?
Neuromuscular: Weakness, fatigue, muscle/joint pain
GI S/sx of adrenal insufficiency/addison’s disease?
Anorexia, n/v, abdominal pain,
weight loss, salt craving
Integumentary S/sx of adrenal insufficiency?
Darkened, bronzed hyperpigmentation OR Vitilgo
Cardiovascular S/sx of adrenal insufficiency?
Anemia, hypotension, hyponatremia,
hyperkalemia
GU S/sx of adrenal insufficiency?
Menstrual changes (female), impotence (male), loss of libido
Mental/psychosocial S/sx of adrenal insufficiency?
Emotional lability
What labs and imaging are evaluated in the diagnosing of adrenal insufficiency?
Labs: Electrolytes, Cortisol, ACTH
Imaging: CT, MRI
What is a complication of adrenal insufficiency?
Addisonian crisis
Why do we have to implement fall precautions for a patient in adrenal insufficiency?
Because Addisonian crisis can lead to severe hypovolemia, hypotension, and dehydration
What is the tx of adrenal insufficiency?
treat electrolyte imbalance (hyponatremia and hyperkalemia), hormone replacement w/ cortisol (prednisone) and a mineralocorticoid (fludrocortisone)
What should the patients monitor when taking Fludrocortisone?
Monitor BP and s/s of HTN and any weight gain/edema
What is Cushing’s disease?
Excess secretion of cortisol from adrenal cortex
What is the most common cause of Cushing’s diseaes?
glucocorticoid therapy
What are other causes of Cushing’s disease?
Autoimmune disorders
Cancer chemotherapy
Chronic fibrosis
What are some complications of Cushing’s disease?
Damage to heart, vascular, kidneys, eyes; Diabetes; Cardiac dysrhythmias; Adrenal crisis
What labs and imaging are used in the diagnosis of Cushing’s?
Labs: Electrolytes (glucose, sodium, calcium); CBC, including lymphocyte count; cortisol levels in the blood, saliva, and urine; Dexamethasone suppression testing.
Imaging: CT, MRI
What medication is used to tx Cushing’s?
Steroidogenesis inhibitors
What are Steroidogenesis inhibitors?
Interfere with ACTH production or adrenal hormone synthesis
What are surgical options for Cushing’s?
Transphenoidal hypo-physectomy (If pituitary cause) or Adrenalectomy (If adrenal cause)
What labs should we be monitoring with Cushing’s?
Serum glucose, potassium, electrolytes
What is Hyperaldosteronism?
Increased secretion of aldosterone with mineralocorticoid excess.
S/sx of Hyperaldosteronism?
Hypokalemia and elevated blood pressure
What labs and imaging are checked with the diagnosis of hyperaldosteronism?
Labs: Electrolytes (k, Na)
Imaging: CT and MRI
What is the most common tx for hyperaldosteronism?
Surgery is most common treatment (removal of one or both adrenal glands)
What medications are used in the tx of hyperaldosteronism?
Spironolactone (potassium sparing diuretic) and Potassium supplements
What should we monitor in a patient with hyperaldosteronism?
Electrolytes, Blood pressure, Cardiac rhythm, and Intake/output
What are primary causes of hypothyroidism?
Hint: specific to the thyroid
- Destruction of the thyroid d/t auto-immune causes, radiation, surgery
- Congenital or poor thyroid development.
- Iodine deficiency.
- Medications (Lithium, propylthiouracil aka PTU)
What are secondary causes of hypothyroidism?
inadequate production of thyroid stimulating hormone (TSH): Hypothalamic or pituitary tumors, trauma, infection, infarcts, Congenital pituitary defects.
What is the most common cause of hypothyroidism in the US?
Hashimotos thyroiditis
What are s/sx of hypothyroidism?
Decreased energy, Increased sleep, Fatigue, Weight gain, Decreased appetite, Susceptibility to cold temperatures, Depression, Cool, pale, yellowish, dry, coarse scaly skin, Goiter, Hypotension, bradycardia
What are the complications of hypothyroidism?
Myxedema coma/hypothyroid crisis
Which medication is commonly used to treat hypothyroidism?
Levothyroxine, synthetic form of T4
Which medications are used to treat hyperthyroidism?
Methimazole and PTU
What are s/sx of hyperthyroidism?
insomnia, palpitations, low grade fever, restlessness, and irritability
What is the most common type of thyroid cancer in women?
Papillary carcinoma
What is the most common type of thyroid cancer in people over 50?
Medullary carcinoma
What conditions can precipitate myxedema coma?
acute illness, discontinuation of thyroid medications, chemotherapy, surgery, use of sedatives/opioids
How will labs look like in hypothyroidism?
Low T3 and T4 and high TSH
When should Levothyroxine be administered?
On an empty stomach in the morning at the same time every day
Patient with hypothyroidism should immediately report what symptoms?
Chest pain or discomfort
What are causes of hyperthyroidism?
Graves disease, toxic multinodular goiter, excessive thyroid replacement hormones
S/sx of hyperthyroidism?
Elevated heart rate, cardiac dysrhythmias, increased heart sounds, Thyroid bruit, Increased gastric activity, Increased appetite, Weight loss, Fatigue, Nervousness, Insomnia, Light to absent menses, Hair loss
Complications of hyperthyroidism?
Thyroid storm
Sx of thyroid storm?
high fever, hypertension, tachycardia, GI distress, may lead to coma and death
What can lead to thyroid storm?
trauma, infection, DKA and pregnancy, vigorous palpation of the goiter
Medications to manage hyperthyroidism?
Antithyroid medications: Propylthiouracil (PTU), methimazole, lithium carbonate
What medications will manage sx of hyperthyroidism?
Beta adrenergic blockers
What is the surgical tx for hyperthyroidism?
Radioablation and partial or total thyroidectomy
What electrolyte imbalance is associated with hypoparathyroidism and why?
hypocalcemia because calcium is not mobilized out of the bones
What is iatrogenic hypoparathyroidism?
Commonly caused by surgical removal of parathyroid during thyroidectomy surgery
s/sx of hypoparathyroidism?
Decreased calcium levels, Numbness and tingling around mouth, in hands and feet, Severe muscle cramps, Spasms of hands and feet, Tetany
Tx for hypoparathyroidism?
calcium, vitamin D, and correct underlying hypomagnesemia
What electrolyte imbalance is associated with hyperparathyroidism?
hypercalcemia and hypophosphatemia
Causes of hyperparathyroidism?
Parathyroid tumor/cancer
What are sx of hyperparathyroidism?
Lethargy, Confusion, Muscle weakness, Fatigue, Generalized bone pain, Cardiac arrhythmias, Constipation
What medications are used to treat hyperparathyroidism?
Cinacalcet and Calcitonin