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Flashcards in 2 Endocrine Workshop Deck (35):
1

What is the purpose of cortisol

Maintains BP - water and salt homeostasis

2

What are the three main hormones secreted by the thyroid and their actions

T3 - main hormone
T4 - pro-hormone
Calcitonin - reduced blood calcium for bone turnover - opposing effect to parathyroid hormone

3

t 3 or t 4 is more powerful?

T 3

4

More t 3 or 4 is produced

80% t 4 - converted peripherally to t3 in the liver etc.

5

How is thyroid hormone regulated

Hypothalamus releases trh
Pituitary releases TSH
Thyroid releases thyroid hormones

6

What is trh

Tyroppid releasing hormone

7

How does iodine in affect thyroid funciton

Thyroid hormone is synthesised from circulating iodine. Excessive or insufficient causes dysfunction

8

What are 2 main physiological functions of thyroid hormone

Growth and development
Metabolism

9

Name three drugs that can induce thyroid diseases

Lithium
Amioderone
Cholestyramine p

10

How does amioderone affect thyroid function

Hypo caused by blocking conversion of T4 to T3
Hyper due to iodine content of the drug

11

How does lithium affect thyroid function

Hypo – inhibits iodine uptake and thyroid hormone release
Hyper – unknown mechanism

12

How does cholestyramine affect thyroid funciton?

Affects absorbtion of levothyroxine

13

Signs of hypothyroidism

Fatigue
Cold sensitivity
Dry skin and hair
Depression
Impaired concentration and memory
Muscle pain and weakness
Horse voice
Pernicious anaemia (megloblstic b12 deficient)

14

Treatment for hypo thyroidism

T four is treatment of choice.
(Exclude hyhpopituitaryism)

15

Signs of hyperthyroidism

Insomnia
Tremor
Irritability
Weight loss
Decreased appetite
AF
Diarrhoea

16

Treatment for hyperthyroidism

Antithyroid drugs - propylthiouracil, thiamazol, carbimazole

17

Symptoms of Cushings

Weight gain
Thinning skin, brides easily
Purple stretch marks
Moon face, buffalo hump
Decreased interest in sex
Oestoperosis

18

Treatments for Cushings

Eradicate tumours
Reduce steroid dose
Metyropone/ketoconazole

19

Symptoms of addisons diseases

Fatigue
Lethargy
Muscle weakness
Low mood
Loss of appetite
Frequent urination
Thirst
Hyperpigmentation
Craving salty food

20

Treating Addisons diseases

Glucocorticoid replacement : hydrocortisone
Mineralocorticoid replacement: fludrocortisone

21

Signs of over and under replacement in addisons

Over - hypertension, glucose intolerance, thin skin, hyperglycaemia, electrolyte abnormalities
Under - fatigue, postural hypotension, weight loss, salt craving.

22

Goals of hypothyroidism treatment

symptom relief
Normal TSH levels - not too low as osteroperosis risk

23

When to monitor TSH levels?

Change slowly so 4-6 weeks after initiating therapy and then annually.

24

Laxative guidelines

exercise, fibre, fluids

1: bulk forming
2: osmotic if hard, stimulant if soft
Opioid- osmotic or docusate

25

Whilst waiting for hyperthyroidism therapy to kick in how can we treat symptoms

Beta blocker e.g. Propanolol

26

Monitoring for hyperthyroidism treatment

Free t4 and TSH during and after carbimazole treatment

27

Before starting carbimazole check

LFTs for liver tox
Full blood count (affects WBC so infection and platelets to bruising)

28

Give in patients with respiratory infection....

Oxygen

29

When someone with addisons has a temperature over 37.5....

Double the hydrocortisone dose

30

When done with addisons voms or is injured

20mg HC and ORT

31

If someone with addisons vomits twice

Use emergency HC injection and seek help

32

If someone with addisons uses antibiotics

Double the HC dose throughout therapy

33

Monitoring in addisons admission for infection 7

Fever
HR and RR
BP (postural is sign of insufficiency)
CRP/WBC
O2 stats
Na and k
Glucagon

34

Generally monitoring for addisons 7

BP
BG
Adrenal function
Thyroid function
U and e
Signs and symptoms
Pt wellbeing

35

What is Addisons?

Deficiency of aldosterone and cortisol
Primary adrenal insufficiency