Thyroid stuff Flashcards
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
Hypothyroid
High TSH
Low T3 and T4
Primary Hypothyroidism
what will your TSH be
High
Secondary Hypothyroidism
what will your TSH be
Low or normal
Initially in Hashimoto thyroiditis you become Hyper/hypothyroid and then become what
Hyperthyroid
Then Hypothyroid
3 phases of subacute granulomatous Thyroiditis
“de Quervain”
1) hyperthyroid
2) hypothyroid
3) return to normal
what is another name for Cretinism
Congenital Hypothyroidism
what is a antibody-mediated maternal hypothyrodism
Congenital hypothyroidism
6 ps of congenital hyothyroidism
pot bellied pale puffy faced protruding umbilicus protuberant tongue poor brain development
types of hypothyroid r/t iodine deficiency and too much iodine
Congenital hypothyroidism (caused by maternal deficiency)
Wolff Chaikoff effect (autoregulatory too much iodine)
Primary forms of hypothyroidism
Hashimoto thyroiditis Subacute granulomatous thyroiditis (de Quervain) Reidel thyroiditis Postpartum thyroiditis Congenital Hypothyroidism (Cretinism) Iodine Deficiency Wolff-chaikoff effect Medication related - Lithium
non painful goiter with hypothyroid symptoms
think….
Hashimoto thyroiditis
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
Hyperthyroidism
What is TSH in hyperthyroidism
Low
autoimmune condition with goiter exophthalmos high T3, T4 low TSH High TSI antibodies levels
Graves disease
what lab will confirm graves disease
TSI antibody level
what are your TSH, T3 and T4 levels doing in Graves disease
Low TSH
Hight T3, T4
what isotope is used in a Radioactive iodine uptake scan (RAIU)
I23 - radioactive isotope of iodine
Hyperthyroid medication
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
High TSH
High Free T3 and T4 levels
what could cause
TSH secreting pituitary adenoma
diagnosed CT or MRI
Surgical removal through nose is treatment
what causes unregulated thyroid hormone secretion in Hyperthyroidism
Nodules
(Toxic multinodular goiter)
Toxic Adenoma -single nodule
Toxic multinodular goiter)
Toxic Adenoma -single nodule
treatment
Used iodine 131 for radioiodine therapy
In radioiodine therapy what precautions
do not go around pregnant women or young children for 3 days…your radioactive
Treatment for Thyroid Storm
Beta blockers
Thionamides
Glucocorticoids
Parathyroid hormone and vitamin D work to raise or lower the calcium level
raise
Calcitonin works to raise or lower the calcium level
lower
blood calcium is regulated by what hormone
parathyroid hormone (PTH)
How does PTH regulate Ca+
stimulates osteoclasts to break down bone to release Ca+
Kidneys reabsorb Ca+
synthesizes Calcitriol (active vit D) gets the GI tract to absorb Ca+
What syndrome causes hypoparathyroidism
DiGeorge syndrome
Chvostek’s sign and Trousseau’s sign are symptoms of
hypocalcemia
Calcium and phosphorous have what kind of relationship
inverse
treatment for hypoparathyroidism
Calcium and Vitamin D supplement
if that doesn’t work recombinant human parathyroid hormone
which hyperparathyroidism is the parathyroid the problem
primary
hyperparathyroidism which the parathyroid is normal but the gland makes excess PTH
secondary
who have had secondary hyperparathyroidism for years …..make parathyroid hormone independently of blood calcium levels
Tertiary
Symptoms of primary hyperparathyroidism
“stones”
- kidney and gallbladder
“thrones”
-polyuria
“Bones”
pain
“Groans”
Constipation
muscle weakness
“psychiatric overtones”
Depressed mood
Confusion
Diagnosis for Primary hyperparathyroidism
High calcium
low phosphate
High PTH
Diagnosis for secondary hyperparathyroidism
Low calcium
high phosphate
low vit D
High PTH
diagnosis for tertiary hyperparathyroidism
High calcium
Hight PTH
secondary hyperparathyroidism is usually called by
chronic kidney disease
the most common congenital cause of hypoparathyroidism
DiGeorge syndrome
Low PTH level
Serum and urinary calcium decreased
Hyperphosphatemia
EKG - Shortened or prolonged QTc
Hypoparathyroidism
hypercalcemia abd pain vomiting constipation bone pain parasthesias renal stones HTN elevated PTH Hypercalcemia hypophosphatemia alkaline phosphatase normal or elevated
Primary hyperparathyroidism
• 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.
secondary hyperparathyroidism
treatment for hyperparathyroidism
aggressive hydration and diuretics
Restrict calcium and vit d intake
hydrocortisone
calcitonin
Pt in thyroid storm cant have what med
ASA - it competes for protein with T3/T4 so increases levels
