Thyroidism

Question 1

Metabolism & Thyroid

Answer 1

• Metabolism = process of breaking down substances in body to use for energy/fuel
• Thyroid gland = controls body temp, metabolism, and HR
• Thyroid hormones = T3, T4, and calcitonin
• Anterior pituitary gland produces TSH (thyroid stimulating hormone) — this gland also produces ACTH which is related to cushings disease (tumor on this gland causes increase in cortisol which increases glucose and calcium and increase in aldosterone which increases water and sodium content)

Question 2

Hypothyroidism Definition

Answer 2

• Underperforming of thyroid gland
• Primary hypothyroidism — congenital defect in TSH production, congenital defect in thyroid size, autoimmune thyroiditis (hashimotos), iodine deficiency, most cases)
• Secondary hypothyroidism — anterior pituitary gland dysfunction, less common

Question 3

Hypoparathyroidism Associated Conditions

Answer 3

• Carpal tunnel syndrome** — increased water retention and swelling in limbs
• CHF — diminished HR and SV which decreases CO leading to CHF
• Rhabdomyolysis — reduced metabolism and muscle contraction causes body to rapidly break down muscle tissue releasing proteins into blood
• Fibromyalgia

Question 4

Hypothyroidism and Exercise

Answer 4

• These patients present with activity intolerance, weakness, and apathy
• Exercise does improve mood and energy levels and reduces constipation — however no specific PT interventions assist in lasting impacts on this condition without use of hormone replacement first (med = thyroxin)
• RPE should be used (13-14 max)

Question 5

Hypothyroidism Patient Profile

Answer 5

• Female > male
• 30-60 years of age

Question 6

Hypothyroidism Signs & Symptoms

Answer 6

• “MOMS USE SICD” (SICD = sequential intermittent compression device)
• Myxedema — excessive swelling
• Obesity and weight gain
• Memory loss and forgetfulness
• Slurred speech — swelling can settle in mouth
• Unable to breath / dyspnea
• Slowed GI mobility
• Excessive fatigue
• Slowed HR (bradycardia)
• Increased BP (because hypothyroidism slows heart down so CO and SV are decreased so body compensates for this with vasoconstriction which increased systolic BP)
• Cold intolerance (because metabolism is not functioning properly) and carpal tunnel syndrome due to swelling issue
• Delayed DTRs (due to neuro system is slower)

Question 7

Hypothyroidism Goiter Development

Answer 7

• Enlarged thyroid gland
• Found mostly with iodine deficit
• Iodine is critical component of T3 and T4 hormone
• Decreased release of T3 and TT4 signals for anterior pituitary to produce more TSH

Question 8

Hyperthyroidism Definition

Answer 8

• Excessive secretion of thyroid hormones causing a dramatic increase in body’s metabolism
• Graves’ disease (autoimmune overexcitation / same thing as hyperthyroidism)
• Hypermetabolism results with increases in sympathetic nervous system

Question 9

Hyperthyroidism Patient Profile

Answer 9

• Females > males
• 30-60 years of age

Question 10

Hyperthyroidism Signs & Symptoms

Answer 10

• “THYROIDISM”
• Tachycardia
• Heat intolerance
• Yawning or fatigue
• Restlessness or hyperkinesis
• Ophthalamous (exophthalmos) — swelling, building eyes due to excess swelling accumulating behind eyes
• Increased appetite and weight loss
• DTRs increased
• Increased CO
• Severe polyuria — increased kidney filtration because heart is pumping more blood so then kidneys are getting to filter more)
• Muscle weakness — proximal (thyrotoxic myopathy)

Question 11

Hyperthyroidism Associated Conditions

Answer 11

• Blood thinning and decreased osteoblasts causes osteopenia or osteoporosis
• Adhesive capsulitis
• Diabetes — excessive production of glucose and absorption of glucose leading to insulin resistance
• Acute calcification tendinitis and peri-arthritis — abnormal thyroid hormone levels (calcitonin) can cause calcium to be deposited into tendons and muscle
• Myasthenia gravis — thyroxin destroys motor end plates which causes a decrease of Ach and loss of neuro signaling
• Goiter can happen with hyper or hypo!!

Question 12

Hyperthyroidism and Exercise

Answer 12

• Associated with exercise intolerance and reduce exercise capacity
• RPE should be used
• Proximal muscle weakness can dramatically impact exercise capacity
• Exercising in a warm pool is a precaution
• Thyroid storm — patient with this condition is not treated and body temp rises too high
• Thyrotoxic myopathy — can be another word for this condition

Question 13

Hypothyroidism Quick Check

Answer 13

• Slowed HR (bradycardia)
• Cold intolerance
• Obesity and weight gain
• Delayed DTRs
• Excessive fatigue
  — Myxedema (severe hypothyroidism that is untreated, leads to altered mental status and lack of body temp control)
  — Carpal tunnel syndrome
  — Slurred speech
  — Slowed GI mobility
  — Increased BP

Question 14

Hyperthyroidism Quick Check

Answer 14

• Tachycardia
• Heat intolerance
• Increased appetite and weight loss
• Increased DTRs
• Restlessness or hyperkinesia
  — Opthtalamos / Exophthalamos (eye building due to swelling)
  — Increased CO
  — Severe polyuria (heart pumping more blood so kidneys getting more to filter)