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Thyroid problems Flashcards

1
Q

Primary adrenal insufficiency/ Addison’s disease is caused by what?

A

Destruction of the adrenal glands

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2
Q

Secondary adrenal insufficiency is caused by what?

A
  1. Decreased secretion of adrenocorticotropic hormone (ACTH)

2. Dysfunction of the hypothalamus

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3
Q

Common causes of primary adrenal issuficiency?

A 
Autoimmune disease
Adrenalectomy
Metastatic cancer
Abdominal radiation therapy
Drugs/toxins
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4
Q

Common causes of secondary adrenal insufficiency?

A

Cessation of long term corticosteroids (>2 weeks)
Pituitary tumors
Hypophysectomy
Postpartum pituitary necrosis
High dose pituitary/whole brain radiation

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5
Q

Neuromuscular S/sx of adrenal insufficiency?

A

Neuromuscular: Weakness, fatigue, muscle/joint pain

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6
Q

GI S/sx of adrenal insufficiency/addison’s disease?

A

Anorexia, n/v, abdominal pain,

weight loss, salt craving

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7
Q

Integumentary S/sx of adrenal insufficiency?

A

Darkened, bronzed hyperpigmentation OR Vitilgo

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8
Q

Cardiovascular S/sx of adrenal insufficiency?

A

Anemia, hypotension, hyponatremia,
hyperkalemia

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9
Q

GU S/sx of adrenal insufficiency?

A

Menstrual changes (female), impotence (male), loss of libido

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10
Q

Mental/psychosocial S/sx of adrenal insufficiency?

A

Emotional lability

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11
Q

What labs and imaging are evaluated in the diagnosing of adrenal insufficiency?

A

Labs: Electrolytes, Cortisol, ACTH
Imaging: CT, MRI

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12
Q

What is a complication of adrenal insufficiency?

A

Addisonian crisis

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13
Q

Why do we have to implement fall precautions for a patient in adrenal insufficiency?

A

Because Addisonian crisis can lead to severe hypovolemia, hypotension, and dehydration

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14
Q

What is the tx of adrenal insufficiency?

A

treat electrolyte imbalance (hyponatremia and hyperkalemia), hormone replacement w/ cortisol (prednisone) and a mineralocorticoid (fludrocortisone)

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15
Q

What should the patients monitor when taking Fludrocortisone?

A

Monitor BP and s/s of HTN and any weight gain/edema

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16
Q

What is Cushing’s disease?

A

Excess secretion of cortisol from adrenal cortex

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17
Q

What is the most common cause of Cushing’s diseaes?

A

glucocorticoid therapy

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18
Q

What are other causes of Cushing’s disease?

A

Autoimmune disorders
Cancer chemotherapy
Chronic fibrosis

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19
Q

What are some complications of Cushing’s disease?

A

Damage to heart, vascular, kidneys, eyes; Diabetes; Cardiac dysrhythmias; Adrenal crisis

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20
Q

What labs and imaging are used in the diagnosis of Cushing’s?

A

Labs: Electrolytes (glucose, sodium, calcium); CBC, including lymphocyte count; cortisol levels in the blood, saliva, and urine; Dexamethasone suppression testing.

Imaging: CT, MRI

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21
Q

What medication is used to tx Cushing’s?

A

Steroidogenesis inhibitors

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22
Q

What are Steroidogenesis inhibitors?

A

Interfere with ACTH production or adrenal hormone synthesis

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23
Q

What are surgical options for Cushing’s?

A

Transphenoidal hypo-physectomy (If pituitary cause) or Adrenalectomy (If adrenal cause)

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24
Q

What labs should we be monitoring with Cushing’s?

A

Serum glucose, potassium, electrolytes

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25
Q

What is Hyperaldosteronism?

A

Increased secretion of aldosterone with mineralocorticoid excess.

26
Q

S/sx of Hyperaldosteronism?

A

Hypokalemia and elevated blood pressure

27
Q

What labs and imaging are checked with the diagnosis of hyperaldosteronism?

A

Labs: Electrolytes (k, Na)
Imaging: CT and MRI

28
Q

What is the most common tx for hyperaldosteronism?

A

Surgery is most common treatment (removal of one or both adrenal glands)

29
Q

What medications are used in the tx of hyperaldosteronism?

A

Spironolactone (potassium sparing diuretic) and Potassium supplements

30
Q

What should we monitor in a patient with hyperaldosteronism?

A

Electrolytes, Blood pressure, Cardiac rhythm, and Intake/output

31
Q

What are primary causes of hypothyroidism?

Hint: specific to the thyroid

A
  • Destruction of the thyroid d/t auto-immune causes, radiation, surgery
  • Congenital or poor thyroid development.
  • Iodine deficiency.
  • Medications (Lithium, propylthiouracil aka PTU)
32
Q

What are secondary causes of hypothyroidism?

A

inadequate production of thyroid stimulating hormone (TSH): Hypothalamic or pituitary tumors, trauma, infection, infarcts, Congenital pituitary defects.

33
Q

What is the most common cause of hypothyroidism in the US?

A

Hashimotos thyroiditis

34
Q

What are s/sx of hypothyroidism?

A

Decreased energy, Increased sleep, Fatigue, Weight gain, Decreased appetite, Susceptibility to cold temperatures, Depression, Cool, pale, yellowish, dry, coarse scaly skin, Goiter, Hypotension, bradycardia

35
Q

What are the complications of hypothyroidism?

A

Myxedema coma/hypothyroid crisis

36
Q

Which medication is commonly used to treat hypothyroidism?

A

Levothyroxine, synthetic form of T4

37
Q

Which medications are used to treat hyperthyroidism?

A

Methimazole and PTU

38
Q

What are s/sx of hyperthyroidism?

A

insomnia, palpitations, low grade fever, restlessness, and irritability

39
Q

What is the most common type of thyroid cancer in women?

A

Papillary carcinoma

40
Q

What is the most common type of thyroid cancer in people over 50?

A

Medullary carcinoma

41
Q

What conditions can precipitate myxedema coma?

A

acute illness, discontinuation of thyroid medications, chemotherapy, surgery, use of sedatives/opioids

42
Q

How will labs look like in hypothyroidism?

A

Low T3 and T4 and high TSH

43
Q

When should Levothyroxine be administered?

A

On an empty stomach in the morning at the same time every day

44
Q

Patient with hypothyroidism should immediately report what symptoms?

A

Chest pain or discomfort

45
Q

What are causes of hyperthyroidism?

A

Graves disease, toxic multinodular goiter, excessive thyroid replacement hormones

46
Q

S/sx of hyperthyroidism?

A

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

47
Q

Complications of hyperthyroidism?

A

Thyroid storm

48
Q

Sx of thyroid storm?

A

high fever, hypertension, tachycardia, GI distress, may lead to coma and death

49
Q

What can lead to thyroid storm?

A

trauma, infection, DKA and pregnancy, vigorous palpation of the goiter

50
Q

Medications to manage hyperthyroidism?

A

Antithyroid medications: Propylthiouracil (PTU), methimazole, lithium carbonate

51
Q

What medications will manage sx of hyperthyroidism?

A

Beta adrenergic blockers

52
Q

What is the surgical tx for hyperthyroidism?

A

Radioablation and partial or total thyroidectomy

53
Q

What electrolyte imbalance is associated with hypoparathyroidism and why?

A

hypocalcemia because calcium is not mobilized out of the bones

54
Q

What is iatrogenic hypoparathyroidism?

A

Commonly caused by surgical removal of parathyroid during thyroidectomy surgery

55
Q

s/sx of hypoparathyroidism?

A

Decreased calcium levels, Numbness and tingling around mouth, in hands and feet, Severe muscle cramps, Spasms of hands and feet, Tetany

56
Q

Tx for hypoparathyroidism?

A

calcium, vitamin D, and correct underlying hypomagnesemia

57
Q

What electrolyte imbalance is associated with hyperparathyroidism?

A

hypercalcemia and hypophosphatemia

58
Q

Causes of hyperparathyroidism?

A

Parathyroid tumor/cancer

59
Q

What are sx of hyperparathyroidism?

A

Lethargy, Confusion, Muscle weakness, Fatigue, Generalized bone pain, Cardiac arrhythmias, Constipation

60
Q

What medications are used to treat hyperparathyroidism?

A

Cinacalcet and Calcitonin

AG (30 decks)

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