thyroid/adrenal Flashcards
(132 cards)
1
Q
NORMAL thyroid hormone cycle: the _______ releases _____ which signals the _______ to release ________ which signals the _______ to produce ______ & _______
A
- hypothalamus
- TRH (thyroid releasing hormone)
- anterior pituitary
- TSH (thyroid stimulating hormone)
- thyroid gland
- T3 & T4
2
Q
the thyroid hormone cycle depends on proper functioning of which three endocrine glands
A
- hypothalamus
- pituitary
- thyroid
3
Q
the hypothalamus produces which thyroid hormone?
A
Thyroid releasing hormone
TRH
4
Q
they anterior pituitary secretes _______ in response to TRH?
A
TSH thyroid stimulating hormone
5
Q
TSH signals the thyroid gland to produce ______
A
T3 & T4
6
Q
increased concentrations of T3 &/or T4 signal the hypothalamus to do what?
A
decrease TRH
7
Q
decreased concentrations of T3 &/or T4 signal the hypotalamus to do what?
A
INCREASE TRH
8
Q
true or false. thyroid dysfunction can be caused by congenital issues
A
TRUE
9
Q
true or false. thyroid dysfunction can be caused by infections issues?
A
TRUE
10
Q
true or false. thyroid dysfunction can be caused by necrosis
A
TRUE.. of what? they thyroid? like after irradiation? I dk
11
Q
true or false. thyroid dysfunction can be caused by autoimmune issues
A
TRUE
12
Q
true or false. thyroid dysfunction can be idiopathic
A
TRUE
13
Q
______ is the most sensitive lab for both HYPO and HYPERthyroid
A
TSH
14
Q
subclinical hypothyroid #’s are TSH >_____ & ______ T4?
A
TSH > 4
NORMAL T4
15
Q
what does T4 measure? what does FREE T4 measure?
A
- the level of bound and free T4.
* free (unbound) T4
16
Q
T3 is also known as? & measures?
A
Tri-iodo-thyronine
*the level of total (free and bound) T3 in the blood
17
Q
Tri-iodo-thyronine is the metabolically active form of _____ ?
A
T4
18
Q
when do you want to measure a T3?
A
when HYPERthyroidism is suspected but T4 is normal
19
Q
antiTHYROglobin and antiTHYROperoxidase antibodies are both INCREASED in what thyroid disorder?
A
GRAVES
20
Q
thyroid stimulating immunoglobulin & TSH receptor antibody are both usually _______ in ______ disease
A
positive
graves
21
Q
name that disorder: intolerance to cold
A
hypo
22
Q
name that disorder: anorexia
A
hypo
23
Q
name that disorder: brittle hair & nails
A
hypo
24
Q
name that disorder: menstrual disturbances
A
hypothyroid
25
name that disorder: constipation
hypo
26
name that disorder: dry skin
hypo
27
name that disorder: lethargy
hypo
28
name that disorder: intolerance to heat
hyper
29
name that disorder: bulging eyes
hyper
30
name that disorder: facial flushing
hyper
31
name that disorder: enlarged thyroid
hyper usually but can be both
32
name that thyroid disorder: muscle wasting
hyper
33
name that disorder: finger clubbing
hyper
34
both hypo & hyper thyroid are more common in which sex?
female
35
people w down's syndrome are at an increased risk of developing which thyroid disorder?
hyper
36
people who smoke are at increased risk for which thyroid disorder?
hyper
37
peopl who have other autoimmune diagnoses (DM1, RA, pernicious anemia, Sjogren's) are at increased risk for which thyroid disorder?
hyper
38
most common cause of hypothyroidism is?
hashimotos thyroiditis (autoimmune)
39
hypothyroidism is associated with what abnormal lipid labs?
increased LDL
| decreased HDL
40
acute psych probs may cause what thyroid marker to be high?
T4/T3
41
AIDS may cause what thyroid marker to be high?
T4/T3
42
morning sickness & hyperemesis gravidarum secondary to pregnancy may cause which thyroid marker to be high?
T4/T3 AND TSH
43
nemonic for issues & meds that increase T4/T3:
| HARP TABLE HAM
"HARP" (syndromes or whatever)
* H = hyperemesis gravidarum/morning sickness
* A = AIDS
* R = refetoff syndrome
* P = psych problems (acute)
"TABLE" (rx drugs)
* T = tamoxifen (breast cancer drug)
* A = amiodarone
* B = biotin
* L = levothyroxine (or any thyroid replacement)
* E = estrogens (oral)
"HAM" ("hard" drugs)
* H = heroin
* A = amphetamines
* M = methadone
44
nemonic for isses & meds that decrease TSH:
| HOP'N LSD CAB
"HOP'N" (syndromes or whatever)
* H = hypoPITUITARism
* O = OLD
* P = pregnant (morning sickness)
* N = nodule (thyroid)
"LSD" (drugs)
* L = levothyroxine (or any thyroid replacement)
* S = steroid use (acute)
* D = dopamine
"CAB" (drugs)
* C = ccb's
* A = amphetamines
* B = biotin
45
labs that indicate hypo: ____ TSH & _____ T4
increased TSH
| decreased T4
46
what other labs do you wanna check in a hypothyroid pt
CBC for anemia
| lipid panel for low HDL, or high LDL
47
6 common causes of hyperthyroidism
1. graves
2. toxic multinodular goiter (elderly women)
3. toxic adenoma (single adenoma)
4. thyroiditis
5. subacute (deQuervain) thyroiditis (viral usually)
6. hasimotos thyroiditis
48
MOST common cause of hyperthyroid
GRAVES (autoimmune)
49
graves more commonly affects which sex between what ages?
women 20-40's
50
toxic multinodular goiter is most commonly seen in _______
older women. also known as plummers disease
51
toxic adenoma is a
autonomously functioning thyroid nodule
52
thyroiditis typically causes hyperthyroidism followed by ________
hypo
53
sub acute "de Quervain" thyroiditis may occur in response to an ______
infection
54
in hyperthyroidism, radioactive iodine (RAI) uptake is usually high or low?
high
55
what dx test may be useful and cost effective to evaluate nodules?
ultrasound
56
raynauds syndrome may be seen in which thyroid disorder?
hypo
57
muscle cramps may be seen in which thyroid disorder?
hypo
58
hyporeflexive DTRs may be noted in which thyroid disorder?
hypo
59
goiter may be present in which thyroid disorder?
both hyper and hypo
60
thyroiditis may cause _____ on palpation
tenderness
61
afib may be a s/s of which thyroid disorder?
hyper
62
before beginning thyroid replacement what two other issues do you want to assess for?
* adrenal insufficiency
| * angina
63
what is the initial dose of synthroid?
25-50mcg/day and increase slowly until euthyroid
64
how do you adjust levothyroxine? by how many mcg and how often?
25mcg every 1-3w until euthyroid
65
what is considered euthyroid for pts on replacement therapy?
TSH 0.4 - 2
66
do elderly require more or less thyroid hormone replacement?
less
67
dose pregnancy require more or less thyroid hormone?
more, increase as pregnancy progresses
68
recheck TSH every ______ when changing dose or brand
4-6w
69
pts w CAD and newly diagnoses hypothyroidism need what before initating meds? do you know why?
cardiac consult
- i didnt either... apparently thyroid hormones and the CV system are intricately partnered and starting TSH can mess up a lot of things.... vascular tone, etc...T3 is v important for heart apparently....
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318631/
70
symptomatic treatment for hyperthyroid
* beta blockers
* propanolol 60mg 1-2x/d PRN, max 320/d
* reduce dose as s/s resolve and FT4 normalizes
* if intolerant of BB can do CCB
71
methimazole treats what? how?
hyperthyroidism
blocking the synthesis of T4 & T3
(class: thionamide)(MOA: thyroperoxidase inhibitor)
"It interferes with the step that causes the iodination of tyrosine residues in thyroglobulin, mediated by the enzyme thyroid peroxidase, thus preventing the synthesis of thyroxine (T4) and triiodothyronine(T3).
"https://www.ncbi.nlm.nih.gov/books/NBK545223/
72
what is the dose range of methimazole?
30-60mg/day
73
______ is the preferred drug for hyperthyroid if the patient is going to receive thyroid eradicating treatment (surgery or iodine)
methimazole
74
how many days before thyroid eradication surgery do you want to stop methimazole
4d
75
methimazole is safe for pregnancy yes or no?
NOOOOO. AW birth defects
76
what does PTU treat? how?
hyperthyroidism
blocking synthesis of T3 & T4
(class: thionamide)(MOA: thyroperoxidase inhibitor)
https://www.ncbi.nlm.nih.gov/books/NBK549828/
77
what is the dose of PTU?
300-600mg/day DIVIDED to QID (FOUR)
78
can PTU be taken during pregnancy? breastfeeding?
yes, and yes
79
PTU reduce dose as _____ resolve and ____ normalizes
symptoms resolve and T4 normalizes
80
adrenal glands produce _______ (general name)
glucocorticoids
81
what three glucocorticoids are produced by the adrenal glands?
* cortisol
* aldosterone
* androgens
82
most cases of addisons are due to?
autoimmune destruction of adrenal gland
83
infections such as: _______ can also cause addisons secondary to destruction of the adrenal gland
TB, HIV, some fungal
84
secondary causes of addisons include:
* problems at the hypothalamus/pituitary (tumors, etc)
| * abrupt cessation of steroids after long term use (TAPER)
85
name that adrenal disorder: bronze pigment of skin
addisons
86
name that adrenal disorder: changes in distribution of body hair
addisons
87
name that adrenal disorder: GI disturbances
addisons. both really...
88
name that adrenal disorder: weakness
addisons & cushings
89
name that adrenal disorder: weight loss
addisons
90
name that adrenal disorder: hypoglycemia
addisons
91
name that adrenal disorder: postural hypotensions
addisons
92
name that adrenal disorder: personality changes
cushings
93
name that adrenal disorder: hyperglycemia
cushings
94
name that adrenal disorder: moon face
cushings
95
name that adrenal disorder: fat deposits on back (buffalo hump)
cushings
96
name that adrenal disorder: sodium and fluid retention
cushings
97
name that adrenal disorder: thin extremities
cushings
98
name that adrenal disorder: purple striae on legs
cushings
99
name that adrenal disorder: bruises and petichiae
cushings
100
name that adrenal disorder: osteoporisis
cushings
101
name that adrenal disorder: CNS irritability
cushings
102
name that adrenal disorder: oligomenorrhea/amenorrhea
cushings
103
name that adrenal disorder: ED
cushings
104
whats the difference between cushings syndrome and cushings disease?
you can have cushings syndrome due to overuse of steroids which can be fixed by removing the steroids. cushings disease is ST a tumor, usually adrenal adenoma.
105
causes of cushings disease:
* benign pituitary tumor causing hypersecretion of ACTH (most common cause)
* adrenal adenoma
* ectopic adenoma (usually ST lung CA)
106
addisons dx test: ______ levels fall and fail to rise after administration of corticotropin
cortisol
107
addisons dx test: cortisol levels _________ after administration of corticotropin
fall and fail to rise
108
ACTH will be increased or decreased in addisons?
increased
109
sodium increased or decreased in addisons?
decreased
110
potassium increased or decreased in addisons?
increased
111
calcium increased or decreased in addisons?
increased
112
BUN increased or decreased in addisons?
increased (dehydration)
113
how do we treat addisons? replace what?
corticosteroids and mineralocorticoids
114
what is first line med for addisons?
hydrocortisone 15-30mg/day divided to BID
115
what is the dose for hydrocortisone and what is it used for?
15-30mg/day divided to BID
| addisons
116
what is an alternative to hydrocortisone? for what disease?
prednisone (4-6mg/day- divided dose)
| addisons
117
what is the treatment for addisons induced hyponatremia?
fludrocortisone acetate
118
med doses need to be increased in addisons during periods of ?
increased stress... physical or mental. infection, surgery, trauma....
119
K increased or decreased in cushings?
decreased
120
blood glucose increased or decreased in cushings?
increased... glucose may even be in urine
121
in cushings what lab will be elevated?
cortisol
122
how can we measure cortisol? (3 sources)
serum, saliva, 24h urine
123
in cushings caused by an adrenal tumor will the ACTH be high or low?
decreased
124
in cushings caused by a pituitary tumor will ACTH be increased or decreased?
increased
125
DEXA scan results for a pt with cushings will reveal increased or decreased bone density?
decreased.... RF osteoporosis
126
what is the dx test for cushings?
dexamethasone suppression test (dexamethasone is manmade cortisol.... it should suppress cortisol production by the body... in cushings it does not.... cortisol level is still high the morning after dosing)
127
how do we treat cushings syndrome?
limit long-term high-dose steroids. taper dosing.
128
how do we treat cushings disease?
surgical resection of tumor
129
what supplements do people with cushings disease need?
calcium and vitamin D for bone support
130
in normal adrenal function the hypothalamus secretes _______ which tells the anterior pituitary to secrete ________ which tells the adrenal glands to secrete _______
* Corticotrophin releasing hormone (CRH)
* adrenal corticotrophic hormone (ACTH)
* glucocorticoids & mineralocorticoids (cortisol & aldosterone)
131
addisons mainly affects the cortex or the medulla of the adrenal gland?
cortex (outer part that produces glucocorticoids and mineralocorticoids
132
addisonian crisis s/s: profound _____, ________ (volume status), vascular ________, and ______ failure
* fatigue
* dehyration
* vascular collapse
* renal failure
