Week 6 Flashcards
what is hyperthyroidism
overproduction of thyroid hormones
what is another name for hyperthyroidism?
graves disease
WHat causes hyperthyroidism?
- Thyroid Stimulating Hormone (TSH) immunoglobulin antibodies that bind to TSH receptors, which may develop as a result of autoimmune reaction against thyroid tissue.
- Thyroid tumours, (most common cause of hyperthyroidism)
What are the S&S of hyperthyroidism?
Intolerance to heat Graves Disease Fine, straight hair Bulging eyes Facial flushing Enlarged Thyroid Tachycardia Increased systolic BP Breast enlargement Weight loss Muscle wasting Localised edema Finger clubbing Tremors Diarrhoea Menstrual Changes
What is a thyroid storm?
an exaggerated or florid state of thyrotoxicosis, it is a life threatening sudden onset of thyroid hyperactivity.
How common is a thryoid storm?
Thyroid storm may occur in 1% of patients with hyperthyroidism
WHat is hypothyroidism?
underproduction of thyroid hormones
WHat causes hypothyroidism?
- Autoimmune reaction that destroys the gland;
- Iodine deficiency (goiter) where uninhibited TSH production leads to increase in precursor molecule (thyroglobulin) but without iodine T3 and T4 cannot be formed.
What are the S&S of hypothyroidism?
Intolerance to coldhypothtroidism Receding hairline Facial and eyelid edema Dull-blank expression Extreme fatigue Thick tongue Slow speech Anorexia Brittle nails and hair Menstrual disturbances Hair loss Apathy Lethargy Dry skin Muscle aches and weakness Constipation
What is addisons disease?
aused by insufficient amounts of hormones from your adrenal glands.
WHat are the causes of addisons disease?
- Primary cause is autoimmune destruction (Addison’s Disease).
- Secondary adrenocortical insufficiency from ACTH deficiency from pituitary and hypothalamic disease.
- Other causes include hypothalamic – pituitary – adrenal gland suppression from exogenously administered corticosteroid
What are the S&S of addisons disease?
Bronze pigmentation to skin Changes in distribution of body hair GI disturbances Hypoglycemia Postural hypotension Weight loss
What is pre-hospital treatment for addisons disease?
Supportive care
Oxygen if required
Fluids
Some systems - Hydrocortisone / dexamethasone
What is Cushing’s syndrome?
caused by high levels of the hormone cortisol.
What causes cushings syndrome?
- tumour
- steroid use side effect
what are the S&S of cushings syndrome?
Personality changes Moon face Increased susceptibility to infection Males – gynecomastia Fat deposits on face and back of shoulders Osteoporosis Hyperglycemia CNS irritability NA and fluid retention (edema) Thin ectremities GI distress Females – Amenorrhea, hirsutism Thin skin with purple striae Bruises and petechiae
What is and what causes Phaechromocytoma?
caused by benign tumour releasing hormones in an adrenal gland.
Adrenomedullary hyper function caused by tumour of adrenal medulla (chromaffin cells), which secretes catecholamines (adrenaline/ noradrenaline) on a continual or episodic basis.
What are the S&S of Phaechromocytoma?
Persistent hypertension Severe headache Diaphoresis Tachycardia Palpitations Pallor Nausea and vomiting Epigastric / chest pain
What is Hyperpituitarism?
Hyperpituitarism causing overproduction of pituitary hormones.
What causes hyperpituitarism?
Caused by Pituitary adenoma (benign tumour)
- Gigantism - young - epiphyseal / grown plates open > enlarged long bones
- Acromegaly - older - epiphyseal / grown plates fussed > enlarged face, hands & feet.
- Prolactinoma - overproduces prolactin, decrease in levels of some sex hormones.
- > S&S - Female - breast discharge, irregular menstrual periods.
- > S&S - Male - Decreased sexual drive, breast enlargement.
Syndrome of inappropriate antidiuretic hormone secretion
-Cause increased levels of ADH > electrolyte in balance
What are S&S of hyperpituitarism?
Water retention, N&V, headache, confusion, weakness and / or fatigue.
WHat is hypopituitarism?
caused by low levels of certain hormones made by the pituitary gland.
What are the S&S of hypopituitarism?
Fatigue weight loss sensitivity to cold decreased appetite facial puffiness anemia irregular or no periods short stature in children.
What is diabetes Insipidus?
Diabetes Insipidus caused by decreased levels of vasopressin (antidiuretic hormone) which is made by the hypothalamus and stored in the posterior pituitary gland.
What are the S&S of diabetes insipidus?
large amount of dilute and odourless urine
increased thirst
large fluid intake
What are the organs and glands of the endocrine system?
Hypothalamus pituitary gland pineal gland throid gland parathyroid gland Thymus Pancreas Adrenal gland Gonads
WHat hormones does the thyroid gland produce?
Tyroid gland secretes thyroxine (T4) and
triiodothyronine (T3), under the influence of
TSH.
What effect on metabolism does T4 and T3 from the thyroid gland have?
-lack of thyroid secretion can reduce basal
metabolic rate by 50%,
-whereas increased levels of hormone can
increase metabolism by 100%.
How do thyroid hormones affect carbohydrate metabolism?
Rapid uptake of glucose by the GIT and by cells;
Increased glycolysis;
Increased insulin secretion.
How do thyroid hormones a=increase fat metabolism?
Reduced fat stores;
Increased free fatty acid levels, while decreasing plasma
cholesterol, triglycerides and phospholipids.
What does hyperthyroidism (graves disease) cause in the body?
Decreased body weight;
Increased cardiac output (to meet metabolic needs);
Increased minute volume;
CNS stimulation leading to nervousness, anxiety and
paranoia.
What are some differentials for a thyroid storm?
- Hypoxia
- Sepsis
- Encephalitis / meningitis
- Hypertensive encephalopathy
- Alcohol withdrawal
- Benzodiazepine / barbiturate withdrawal
- Opioid withdrawal
- Heat stroke
WHat is the mortality rate of a thyroid storm?
90% if untreated
5% if treated
What is the clinical presentation of a thyroid storm?
Abrupt onset.
Restlessness.
Confusion.
Fever.
Tachycardia (rate 200-300), atrial fib common.
Vomiting and diarrhea
Altered LOC, leading to delirium, coma and seizures.
What can a thyroid storm be precipitated by?
- surgery
- trauma
- infection
- thyroxine ingestion
What hormones are made by adrenal gland?
- Medulla – adrenaline/noradrenaline
- Cortex – corticosteroids:
-> Mineralocorticoids (aldosterone)
—–> Cause the conservation of sodium, secretion of potassium,
increased water retention, and increased blood pressure.
-> Glucocorticoids (cortisol)
—-> Primary functions:
—–> To increase blood sugar through gluconeogenesis
—–> Aid in fat, protein and carbohydrate metabolism
->Androgens
What are the clinical symptoms of adrenocortical insufficiency? (addisons disease)
Hypotension (unresponsive to fluid therapy) – due to lack
of aldosterone and consequent polyuria;
Dehydration – Abdominal pain & vomiting;
Weakness, anorexia, altered mentation
When do you sustpect adrenocorticol insufficiency (addisons disease)
Sudden hypotension in response to precipitating factors,
and does not correct with initial IV fluids +/- raising legs
What are some of the precipitating factors for addisonian crisis?
Acute infection, especially pneumonia Acute MI Pulmonary embolus Trauma / burns Surgery Heat exposure Vomiting / diarrhea Dehydration Blood loss Rapid cessation or reduction of chronic steroid therapy
What are 4 pituitary diseases?
- syndrome of inappropriate antidiuretic hormone secretion
- Hyperpituitarism
- hypopituitarism
- diabetes insipidus
