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Critical Care I > Thyroid stuff > Flashcards

Thyroid stuff Flashcards

1
Q

Hyperthyroid or hypothyroid?

What is TSH doing?
What is T3 and T4 doing?

lethargy
fatigue
decreased  appetite
muscle weakness
constipation
periorbital edema
dry cool skin
brittle nails
A

Hypothyroid

High TSH
Low T3 and T4

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2
Q

Primary Hypothyroidism

what will your TSH be

A

High

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3
Q

Secondary Hypothyroidism

what will your TSH be

A

Low or normal

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4
Q

Initially in Hashimoto thyroiditis you become Hyper/hypothyroid and then become what

A

Hyperthyroid

Then Hypothyroid

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5
Q

3 phases of subacute granulomatous Thyroiditis

“de Quervain”

A

1) hyperthyroid
2) hypothyroid
3) return to normal

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6
Q

what is another name for Cretinism

A

Congenital Hypothyroidism

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7
Q

what is a antibody-mediated maternal hypothyrodism

A

Congenital hypothyroidism

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8
Q

6 ps of congenital hyothyroidism

A 
pot bellied
pale 
puffy faced
protruding umbilicus 
protuberant tongue
poor brain development
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9
Q

types of hypothyroid r/t iodine deficiency and too much iodine

A

Congenital hypothyroidism (caused by maternal deficiency)

Wolff Chaikoff effect (autoregulatory too much iodine)

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10
Q

Primary forms of hypothyroidism

A 
Hashimoto thyroiditis
Subacute granulomatous thyroiditis (de Quervain)
Reidel thyroiditis
Postpartum thyroiditis
Congenital Hypothyroidism (Cretinism)
Iodine Deficiency
Wolff-chaikoff effect
Medication related - Lithium
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11
Q

non painful goiter with hypothyroid symptoms

think….

A

Hashimoto thyroiditis

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12
Q 
Hyperactive
talking fast
Tremors
anxiety
skin warm moist
hair fine and brittle
eyelid retraction
exaggerated deep tendon reflexes
tachycardia
systolic HTN
A=fib
menstrual irregularities
waxy, discolored induration of skin (lower legs) 
muscle weakness
gynecomastia in males
A

Hyperthyroidism

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13
Q

What is TSH in hyperthyroidism

A

Low

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14
Q 
autoimmune condition with goiter
exophthalmos
high T3, T4
low TSH
High TSI antibodies levels
A

Graves disease

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15
Q

what lab will confirm graves disease

A

TSI antibody level

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16
Q

what are your TSH, T3 and T4 levels doing in Graves disease

A

Low TSH

Hight T3, T4

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17
Q

what isotope is used in a Radioactive iodine uptake scan (RAIU)

A

I23 - radioactive isotope of iodine

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18
Q

Hyperthyroid medication

A

Thionamides stop thyroid hormone synthesis

  • Methimazole
  • Propylthiouracil (PTU) (also works on peripheral)
    - High initial dose till obtain euthyroid status (free t3, t4 levels normal - then low daily maintenance dose
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19
Q

High TSH
High Free T3 and T4 levels
what could cause

A

TSH secreting pituitary adenoma

diagnosed CT or MRI
Surgical removal through nose is treatment

20
Q

what causes unregulated thyroid hormone secretion in Hyperthyroidism

A

Nodules
(Toxic multinodular goiter)
Toxic Adenoma -single nodule

21
Q

Toxic multinodular goiter)
Toxic Adenoma -single nodule

treatment

A

Used iodine 131 for radioiodine therapy

22
Q

In radioiodine therapy what precautions

A

do not go around pregnant women or young children for 3 days…your radioactive

23
Q

Treatment for Thyroid Storm

A

Beta blockers
Thionamides
Glucocorticoids

24
Q

Parathyroid hormone and vitamin D work to raise or lower the calcium level

A

raise

25
Q

Calcitonin works to raise or lower the calcium level

A

lower

26
Q

blood calcium is regulated by what hormone

A

parathyroid hormone (PTH)

27
Q

How does PTH regulate Ca+

A

stimulates osteoclasts to break down bone to release Ca+

Kidneys reabsorb Ca+

synthesizes Calcitriol (active vit D) gets the GI tract to absorb Ca+

28
Q

What syndrome causes hypoparathyroidism

A

DiGeorge syndrome

29
Q

Chvostek’s sign and Trousseau’s sign are symptoms of

A

hypocalcemia

30
Q

Calcium and phosphorous have what kind of relationship

A

inverse

31
Q

treatment for hypoparathyroidism

A

Calcium and Vitamin D supplement

if that doesn’t work recombinant human parathyroid hormone

32
Q

which hyperparathyroidism is the parathyroid the problem

A

primary

33
Q

hyperparathyroidism which the parathyroid is normal but the gland makes excess PTH

A

secondary

34
Q

who have had secondary hyperparathyroidism for years …..make parathyroid hormone independently of blood calcium levels

A

Tertiary

35
Q

Symptoms of primary hyperparathyroidism

A

“stones”
- kidney and gallbladder

“thrones”
-polyuria

“Bones”
pain

“Groans”
Constipation
muscle weakness

“psychiatric overtones”
Depressed mood
Confusion

36
Q

Diagnosis for Primary hyperparathyroidism

A

High calcium
low phosphate
High PTH

37
Q

Diagnosis for secondary hyperparathyroidism

A

Low calcium
high phosphate
low vit D
High PTH

38
Q

diagnosis for tertiary hyperparathyroidism

A

High calcium

Hight PTH

39
Q

secondary hyperparathyroidism is usually called by

A

chronic kidney disease

40
Q

the most common congenital cause of hypoparathyroidism

A

DiGeorge syndrome

41
Q

Low PTH level
Serum and urinary calcium decreased
Hyperphosphatemia
EKG - Shortened or prolonged QTc

A

Hypoparathyroidism

42
Q 
hypercalcemia
abd pain
vomiting
constipation
bone pain
parasthesias
renal stones
HTN
elevated PTH
Hypercalcemia
hypophosphatemia
alkaline phosphatase normal or elevated
A

Primary hyperparathyroidism

43
Q

• Hypercalcemia. • Abdominal pain, vomiting, constipation. • Bone pain. • Renal stones. • Paresthesias. • Hypertension. • Diagnostic evaluation: Serum calcium levels are low or normal; EKG with prolonged QTc interval, nephrolithiasis, parathyroid adenoma.

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 681). Wolters Kluwer Health. Kindle Edition.

A

secondary hyperparathyroidism

44
Q

treatment for hyperparathyroidism

A

aggressive hydration and diuretics
Restrict calcium and vit d intake
hydrocortisone
calcitonin

45
Q

Pt in thyroid storm cant have what med

A

ASA - it competes for protein with T3/T4 so increases levels

Critical Care I (27 decks)

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