Unit 12 - Metabolism (Thyroid & Adrenals/Cushings) Flashcards
_____ is more potent and more rapid-acting than _____. _____ is contained in thyroid hormone
T3 is more potent and more rapid-acting than T4. Iodine is contained in thyroid hormone
_____ is secreted in response to high plasma calcium level and increases calcium deposition in bone
Calcitonin
_____ from the anterior pituitary controls the release of thyroid hormone
TSH
_____ from the hypothalamus controls the release of TSH
TRH
_____ hormone controls cellular metabolic activity
Thyroid
Hyperthyroidism is caused by excessive delivery of _____
TH
Hyperthyroidism:
- (Increases, Decreases) metabolic rate
- (Increases, Decreases) HR and SV = (Increases, Decreases) CO = hyperdynamic circulatory state.
- Protein synthesis and degradation are (Increases, Decreases) = negative nitrogen balance d/t breakdown exceeds buildup
- Hyperglycemia results d/t (Increases, Decreases) glucose tolerance
- Fat metabolism (Increases, Decreases)
- (Increases, Decreases) sympathetic nervous system’s response
- Increases metabolic rate
- Increased HR and SV = Increased CO = hyperdynamic circulatory state.
- Protein synthesis and degradation are increased = negative nitrogen balance d/t breakdown exceeds buildup
- Hyperglycemia results d/t decrease glucose tolerance
- Fat metabolism increased
- Heightens sympathetic nervous system’s response
Hyperthyroidism:
- _____ to heat
- _____
- weight _____
- intolerance to heat
- sweating
- weight loss
Enlarged thyroid might be called a goiter but usually goiter refers to _____
hypothroidism
Treatment of thyroid storm (thyrotoxicosis crisis)
- administer…
- _____ to inhibit the conversion of triiodothyronine to T4 and replace depleted cortisol
- administer thyroxin blocking meds
- corticosteroid
T/F: relapse of hyperthyroidism is common
T
Treatment of Hyperthyroidism: Pharmacologic: - \_\_\_\_\_ medications - Reduce \_\_\_\_\_ production - Therapeutic effects in \_\_\_\_\_ weeks
- Antithyroid medications
- Reduce TH production
- Therapeutic effects in several weeks
Treatment of Hyperthyroidism: Radioactive iodine (RAI) therapy - Thyroid gland takes up \_\_\_\_\_ - \_\_\_\_\_ concentrates in thyroid - \_\_\_\_\_ thyroid cells - Results in \_\_\_\_\_ weeks
- Thyroid gland takes up iodine
- RAI concentrates in thyroid
- Destroys thyroid cells
- Results in 6–8 weeks
Treatment of Hyperthyroidism:
Surgery
- Thyroid gland enlarged: Pressure on _____, trachea/Problems with breathing, swallowing
- Thyroidectomy
1. Remainder of gland produces adequate _____
2. Total thyroidectomy for cancer -> requires _____ hormone replacement
- Thyroid gland enlarged: Pressure on esophagus, trachea/Problems with breathing, swallowing
- Thyroidectomy
1. Remainder of gland produces adequate TH
2. Total thyroidectomy for cancer -> requires lifelong hormone replacement
Hyperthyroidism in older clients is most often caused by _____ disease or toxic nodular goiter, which is diagnosed by subnormal or undetectable levels of _____ (thyroid-stimulating hormone). The treatment of choice is the ingestion of _____ _____, which is picked up by the thyroid tissue and then destroys the tissue. This treatment avoids surgery, anesthesia, and hospitalization. Surgical removal is reserved for clients with symptoms too severe for treatment with radioactive iodine or nodules suspicious for malignancy.
Graves
TSH
radioactive iodine
Foods high in _____, such as soy sauce, can influence the effectiveness of medication therapy for clients who are diagnosed with hyperthyroidism. High-calorie foods are important for clients with hyperthyroidism in order to meet metabolic demands. There is (reason, no reason) to restrict caffeine-free soda. _____ products should be included in the diet for the client with hyperthyroidism because they are high in protein and calcium.
. A partial thyroidectomy is a surgical procedure, for which the client (is, s not) a candidate
iodine
no reason
Milk
is not
Preoperative goals
- Reduction of _____ and _____ to avoid precipitation of thyroid storm
stress & anxiety
Postoperative care:
- monitor for _____
hypocalcemia (related to injury)
Injury or removal of the parathyroid glands may produce a disturbance in _____ metabolism and result in a decline of calcium levels (_____). As the blood calcium levels _____, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as _____ and must be reported to the physician immediately, as _____ may occur and obstruct the airway.
calcium hypocalcemia fall tetany laryngospasm
Juvenile Hyperthyroidism:
- _____ (PTU) levels must be checked frequently
- Carefully monitor for side effects of drug
- If sore throat and fever arise may indicate _____, should be seen by practitioner.
- Propylthiouracil (PTU) levels must be checked frequently
- Carefully monitor for side effects of drug
- If sore throat and fever arise may indicate leukopenia, should be seen by practitioner.
A client with Graves’ disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works?
- “The radioactive iodine stabilizes the thyroid hormone levels before thyroidectomy.”
- “The radioactive iodine reduces uptake of thyroxine and thereby improves your condition.”
- The radio active iodine lowers the levels of thyroid hormones by slowing your body’s production of them.”
- The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced
- The radio active iodine destroys thyroid tissue so that thyroid hormones are no longer produced
* Sodium iodide. Destroys the thyroid follicular cells, and thyroid hormones are no longer produced. RAI is commonly recommended for clients with Graves disease especially the elderly. The treatment result is a “medical “ thyroidectomy. RAI is given in lieu of surgery, not before surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAI
Hypothyroidism:
_____: Gland itself: loss of thyroid tissue, antithyroid medication, thyroiditis, endemic iodine deficiency
Primary
Hypothyroidism:
_____: Failure to stimulate normal thyroid function or failure of target tissue to respond to normal blood levels of thyroid hormones/ i.e. pituitary TSH or peripheral resistance to TH
Secondary
Either type of Hypothyroidism may lead to _____
myxedema
Hypothyroidism is the deficiency of _____ or _____/_____
T3 or T4/TSH
Metabolic processes _____ _____ with hypothyroidism
slow down
Treatment of Hypothyroidism: _____ (on an empty stomach)
levothyroxine
Risk factors of Hypothyroidism:
- Women over _____ years
- Close relative with _____ condition
- Thyroid surgery, _____ to neck
- _____ deficiency
- _____ thyroiditis
- Women over 50 years
- Close relative with autoimmune condition
- Thyroid surgery, radiation to neck
- Iodine deficiency
- Hashimoto thyroiditis
Risk factors of Hypothyroidism:
- Women over _____ years
- Close relative with _____ condition
- Thyroid surgery, _____ to neck
- _____ deficiency
- _____ thyroiditis
- Women over 50 years
- Close relative with autoimmune condition
- Thyroid surgery, radiation to neck
- Iodine deficiency
- Hashimoto thyroiditis
The underlying mechanism of iodine-induced hypothyroidism remains unclear, but could be attributable to failure to adapt to the acute _____-_____ effect, probably because of a damaged thyroid as a result of previous pathological insults. Exposure to high concentrations of iodine might also decrease the release of thyroid hormone, as reported in several small studies that show mild decreases in serum levels of thyroid hormone and increases in the serum level of TSH to the upper limit of the normal range. Administration of iodine to patients with severe hyperthyroidism or thyroid storm is efficacious, as it results in an acute _____ in the release of thyroid hormones.
Wolff–Chaikoff
decrease
Hypothyroidism:
- Goiter/Thyroid tissue (may, may not) be easily palpable unless goiter is present
- _____ speech and hoarseness from…
- Goiter/Thyroid tissue may not be easily palpable unless goiter is present
- Slow speech and hoarseness from thick dry tongue
Hypothyroidism:
_____/weak pulse hypotension
Bradycardia
Integumentary with Hypothyroidism:
cold, hair dry, edema, nails thick/brittle
CNS with Hypothyroidism:
forgetfulness
Gi with Hypothyroidism:
anorexia, constipation
Reproductive with Hypothyroidism:
heavy, irregular menses, decreased libido
musculoskeletal with Hypothyroidism:
backache, weak muscles
metabolic with Hypothyroidism:
cold intolerance, fatigue
_____ goiter: compensates by becoming larger to produce more harmone:which usually overcomes mild deficiencies of thyroid hormone..
_____ goiters groups of people living in geographical areas with iodine-depleted soil, usually regions away from the sea coast/ might not get enough iodine in their diet (iodine is vital to the formation of thyroid hormone).
iodized table salt in the United States prevents this deficiency
simple
Endemic
In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are _____; special caution is necessary in administering these agents to elderly patients because of concurrent changes in liver and renal function
prolonged
_____ _____/also known aschronic lymphocytic thyroiditis
Hashimoto’s Thyroiditis
Lymphocytic infiltration of gland, inflammation,
fibrous tissue
Hashimoto’s Thyroiditis
Most common cause of primary hypothyroidism in US
Hashimoto’s Thyroiditis
Hashimoto’s Thyroiditis can progress to _____
myxedema
Medical Management of Hypothyroidism:
_____ _____-_____ _____ (_____)
- SAME TIME, EVERY MORNING on empty stomach /WAIT 30 MINUTES TO 1 HOUR BEFORE BREAKFAST
- Take Synthroid once a day at the same time every day./TAKE SYNTHROID ALONE
- Take Synthroid 4 hours before or after taking iron or calcium supplements, or antacids. Soy, cottonseed meal, walnuts, fiber, and grapefuit juice can affect the absorption . If you eat any of these on a regular basis, talk to your doctor to see if your Synthroid dose should be adjusted.
- Effects of hypnotic and sedative agents; reduce dosage
- Taking too much levothyroxine has been associated with increased bone loss, especially in women after menopause.
Synthetic levothyroxine-replacement therapy ( Synthroid)
_____ may result from impaired water excretion and from poor regulation of ADH secretion.
Hyponatremia
_____ _____ is a medical emergency and management is to reverse the condition to save the client’s life keeping the patient warm and closely monitoring the VS
event that precipitated the coma (surgery, infection, noncompliance) must be evaluated and treated.
Myxedema coma
T/F: a myxedema coma is life-threatening
T
What is myxedema
a severe metabolic disorder
- One of the most common endocrine problems of childhood = congenital or acquired
- Decreased secretion of TH
Juvenile Hypothyroidism
Hypothyroidism affects _____ organ systems
all
Adrenal medulla functions as part of the…
autonomic nervous system
Adrenal Medulla:
- epinephrine & norepinephrine
catecholiamines
Adrenal Cortex:
- effects on the metabolism of almost all organs
glucocorticoids
name the glucocorticoids
cortisol
name the mineralcorticoids
aldosterone
male sex hormones
androgens
- Survival without functioning adrenal cortex is only possible with replacement _____ _____
- _____ _____ lobe pituitary gland affects release of hormones
- Survival without functioning adrenal cortex is only possible with replacement adrenocortical hormones
- ACTH anterior lobe pituitary gland affects release of hormones
T/F: most cases of cushings is treated and cured
T
Cushings:
- with treatment, life expectancy is usually _____
normal
Cushings:
- women are affected _____ (more, less) often than men
3x more
Cushing’s syndrome was first described by _____ _____ in 1932.Cushing’s syndrome may also occur in other animals including cats, dogs, and horses.
Harvey Cushing
Actual Cushing disease more common in women age _____-_____ 5X more likely than men
20-40
excessive adrenocortical activity or corticosteroid medications
cushings syndrome
_____ is a condition in which women develop male-pattern hair growth and other masculine physical traits.
virilization
Cushings:
When medications are given (glucocorticoids), adrenal cortex _____ and it suppresses the adrenal glands to produce _____ _____ hormones.
atrophy
their own
Cushings:
Excessive protein catabolism occurs producing muscle _____ and osteoporosis / _____ backache compression fractures of vertebrae may result.
wasting
kyphosis
most common cause of adrenal cortical insufficiency
corticosteroids
T/F: corticosteroids can create Cushing’s disease
T
corticosteroids:
- _____ function of adrenocortical
- May suppress for up to _____ year even after a short 2 week course of the med
- Wean off meds so adrenal glands will start functioning on own
- Stops function of adrenocortical
- May suppress for up to one year even after a short 2 week course of the med
- Wean off meds so adrenal glands will start functioning on own
If you stop corticosteroids suddenly, may create _____ lik _____
Addisonian like crisis
Therapeutic use of _____ is the most common cause of adrenocortical insufficiency
corticosteroids
If corticosteroid dose’s missed, could cause acute _____ _____
Addison’s disease
Should you or should you not take oral corticosteroids with food
you should!!!
Corticosteroids:
- The patient is at increased risk of _____ and masking of signs of infection.
- The cardiovascular effects of corticosteroid therapy may result in development of _____ or thromboembolism.
- Diet should be high in _____ with limited _____.
- Changes in _____ ( side effects of meds ) usually disappear when therapy is no longer necessary.
- The patient is at increased risk of infection and masking of signs of infection.
- The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism.
- Diet should be high in protein with limited fat.
- Changes in appearance ( side effects of meds ) usually disappear when therapy is no longer necessary.
disease name for adrenocortical insufficiency and not enough glucocorticoids
Addison’s
Etiology of Addison’s
autoimmune
When the body is under stress (e.g. fighting an infection), this deficiency of cortisol can result in a life threatening _____ _____ characterized by low blood pressure.
Addisonian crisis
When the body is under stress (e.g. fighting an infection), this deficiency of cortisol can result in a life threatening Addisonian crisis characterized by _____ _____ _____.
low blood pressure
crisis, a severe illness which may include very low blood pressure and coma
Addisonian or acute exacertbation to a stressor
Diagnosis for Addison’s
lab tests for hormone levels
Treatment for Addison’s
lifelong corticosteroid replacement/may need to increse dosage during periods of stress
Addison’s occurs in people of _____ ages and in both sexes and can progress to adrenal crisis.
all
Addison’s disease is the result of insufficiencies of the _____ (aldosterone) and _____ (cortisol)
mineralocorticoids
glucocorticoids
adrenal insufficiency, occurs in two forms-_____ and _____
primary and secondary.
_____-originates with the adrenal glands. It is characterized by decreased mineralocorticoid, glucocorticoid and androgen secretion.
Primary
_____-caused by a disorder outside the gland, such as a pituitary tumor with corticotropin deficiency. Aldosterone secretion may be unaffected. May result from hypopitiutarism, removal of a nonendocrine corticotropin-secreting tumor, disorders in the hypothalamic-pituitary function that diminishes the production of corticotropin
Secondary
patchy areas of skin that lack pigmentation. Possibly due to decreased melanocye-stimulating hormone activity
vitiligo
Signs of conditions that often occur together with Addison’s
goiter & vitiligo
An adrenal crisis often occurs if the body is subjected to _____, such as an accident, injury, surgery, severe infection or illness; _____ may quickly follow
stress
death
_____ _____ can occur if steroids are stopped abruptly
Addisonian crisis
