Endocrine deck 2 Flashcards
(32 cards)
What is Hyperthyroidism
condition of excessive levels of thyroid hormones. This overabundance of thyroid hormones results in a hypermetabolic state. The incidence is higher in women than in men. Older age and smoking are risk factors
what diagnostic test is used in hyperthyroidism?
24-hour radioiodine uptake scan
24-hour radioiodine uptake scan
Cannot use in pregnant patients
used to test for hyperthyroidism
measure the amount of radioactive iodine that is taken up by the thyroid gland after oral administration.
presence of uptake usually indicates that there is new hormone synthesis. No uptake indicates a destroyed or inflamed thyroid gland,
A Normal or High Radioiodine Uptake in a 24-hour radioiodine uptake scan could indicate what problems?
- Graves disease
- Thyroid adenomas/toxic multinodular goiter
- Excessive iodine
A Near-Absent Radioiodine Uptake in a 24-hour radioiodine uptake scan could indicate what problems?
- Thyroiditis
- Excess thyroid hormone replacement
- Ectopic production
symptoms of hyperthyroidism in older patients
Older patients tend to have predominant cardiovascular manifestations such as tachycardia or atrial fibrillation, dyspnea, and edema
Clinical manifestations of hyperthyroidism
hormone levels are increased and so are all the clinical manifestations (e.g., tachycardia, hypertension, anxiety, and diarrhea), with the exception of weight loss.
What is thyroid storm and what causes it?
Medical emergency- sudden worsening of hyperthyroid symptoms
Can be from long time untreated hyperthyroid or precipitated by infection, surgery or stress
What are the symptoms of a thyroid storm?
high temperature (e.g., 104 to 106° F), tachycardia (> 140 beats per minute), decreased mental alertness, abdominal pain, and an exaggeration of any hyperthyroid manifestations (Table 10-6). Additional complications of hyperthyroidism include cardiomyopathy, heart failure, and osteoporosis.
Diagnostics for a thyroid storm?
history, physical examination, serum thyroid hormone levels, and serum TSH
In hyperthyroidism what do the serum TSH, T3 and T4 levels look like?
the serum TSH will be low and the T4 and T3 will be high. The T3 increases more than the T4. Central hyperthyroidism will result in a low TSH and normal T3 and T4.
What immuneglobulin is positive in Graves disease?
Thyroid-stimulating immunoglobulin
anti-TPO antibody may also be positive with Graves syndrome but not as often as in chronic autoimmune thyroiditis (Hashimoto’s thyroiditis).
How is hyperthyroidism managed?
Medications and surgery
What is used to manage used to manage symptoms such as tachycardia, anxiety, and heat intolerance in hyperthyroidism?
Beta Blockers
Medication and surgical treatment of hyperthyroidism
radioactive iodine (which shrinks the gland) as well as antithyroid agents, such as methimazole (the primary drug), to decrease hormone production or propylthiouracil which is safe during pregnancy. Surgical removal of the thyroid (thyroidectomy) with subsequent hormone replacement is warranted when the patient does not respond to or tolerate medications.
Even with treatment, _______remains in hyperthyroidism. What is done for comfort?
exophthalmos usually remains. Strategies to improve the discomfort associated with exophthalmos include cool compresses, wearing sunglasses, eye lubricants, and elevating the head of the bed
Dietary management for hyperthyroidism
Increasing caloric and calcium intake is crucial to maintain weight and prevent bone loss.
For hyperthyroidism with near-absent radioiodine uptake due to thyroiditis………
hormone-synthesis-blocking agents will not be effective since new hormones are not being produced. The treatment, therefore, is symptom control (e.g., via a beta blocker) or anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs.
What is Cushings syndrome/Disease
condition characterized by excessive amounts of glucocorticoids, specifically cortisol.
is ACTH dependent, which refers to ACTH stimulating excess cortisol production while the negative feedback mechanism is impaired. Normal pulsatile cortisol secretion or increased cortisol response during stress is impaired.
What is the most common cause of excessive glucocorticoids in Cushings syndrome?
hypercortisolism, is iatrogenic, resulting from ingestion of glucocorticoid medications. underreported. When these medications are ingested, they mimic the body’s own hormones
What is the second most common cause of Cushings syndrome?
excess ACTH production, usually from a pituitary adenoma. this state is termed Cushing disease
ectopic non-pituitary tumor
another form of ACTH-dependent hypercortisolism. Benign or malignant adrenal gland tumors that secrete cortisol are a form of ACTH-independent hypercortisolism.
What is least common cause of Cushing syndrome
Adrenal carcinoma is the cause of 50% of childhood Cushing syndrome
metabolic manifestations of Cushings
- Glucose intolerance—insulin resistance from obesity; cortisol stimulation of gluconeogenesis
- Delayed growth and development
- Obesity (especially around the trunk)
- A fatty pad between the shoulders known as a buffalo hump; fat accumulation in the cheeks known as moon face
