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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
What is Hyperaldosteronism?
Increased secretion of aldosterone with mineralocorticoid excess.
26
S/sx of Hyperaldosteronism?
Hypokalemia and elevated blood pressure
27
What labs and imaging are checked with the diagnosis of hyperaldosteronism?
Labs: Electrolytes (k, Na) Imaging: CT and MRI
28
What is the most common tx for hyperaldosteronism?
Surgery is most common treatment (removal of one or both adrenal glands)
29
What medications are used in the tx of hyperaldosteronism?
Spironolactone (potassium sparing diuretic) and Potassium supplements
30
What should we monitor in a patient with hyperaldosteronism?
Electrolytes, Blood pressure, Cardiac rhythm, and Intake/output
31
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)
32
What are secondary causes of hypothyroidism?
inadequate production of thyroid stimulating hormone (TSH): Hypothalamic or pituitary tumors, trauma, infection, infarcts, Congenital pituitary defects.
33
What is the most common cause of hypothyroidism in the US?
Hashimotos thyroiditis
34
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
35
What are the complications of hypothyroidism?
Myxedema coma/hypothyroid crisis
36
Which medication is commonly used to treat hypothyroidism?
Levothyroxine, synthetic form of T4
37
Which medications are used to treat hyperthyroidism?
Methimazole and PTU
38
What are s/sx of hyperthyroidism?
insomnia, palpitations, low grade fever, restlessness, and irritability
39
What is the most common type of thyroid cancer in women?
Papillary carcinoma
40
What is the most common type of thyroid cancer in people over 50?
Medullary carcinoma
41
What conditions can precipitate myxedema coma?
acute illness, discontinuation of thyroid medications, chemotherapy, surgery, use of sedatives/opioids
42
How will labs look like in hypothyroidism?
Low T3 and T4 and high TSH
43
When should Levothyroxine be administered?
On an empty stomach in the morning at the same time every day
44
Patient with hypothyroidism should immediately report what symptoms?
Chest pain or discomfort
45
What are causes of hyperthyroidism?
Graves disease, toxic multinodular goiter, excessive thyroid replacement hormones
46
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
47
Complications of hyperthyroidism?
Thyroid storm
48
Sx of thyroid storm?
high fever, hypertension, tachycardia, GI distress, may lead to coma and death
49
What can lead to thyroid storm?
trauma, infection, DKA and pregnancy, vigorous palpation of the goiter
50
Medications to manage hyperthyroidism?
Antithyroid medications: Propylthiouracil (PTU), methimazole, lithium carbonate
51
What medications will manage sx of hyperthyroidism?
Beta adrenergic blockers
52
What is the surgical tx for hyperthyroidism?
Radioablation and partial or total thyroidectomy
53
What electrolyte imbalance is associated with hypoparathyroidism and why?
hypocalcemia because calcium is not mobilized out of the bones
54
What is iatrogenic hypoparathyroidism?
Commonly caused by surgical removal of parathyroid during thyroidectomy surgery
55
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
56
Tx for hypoparathyroidism?
calcium, vitamin D, and correct underlying hypomagnesemia
57
What electrolyte imbalance is associated with hyperparathyroidism?
hypercalcemia and hypophosphatemia
58
Causes of hyperparathyroidism?
Parathyroid tumor/cancer
59
What are sx of hyperparathyroidism?
Lethargy, Confusion, Muscle weakness, Fatigue, Generalized bone pain, Cardiac arrhythmias, Constipation
60
What medications are used to treat hyperparathyroidism?
Cinacalcet and Calcitonin

AG (30 decks)

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