Thyroid and Adrenal Disease Flashcards
(123 cards)
1
Q
The thyroid and adrenal gland both get stimulation from
A
pituitary gland
2
Q
More common, thyroid or adrenal disease?
A
thyroid
3
Q
Fxns of thyroid:
A
metabolism, growth/ maturation of tissues, cell turnover, nutrients
4
Q
Calcitonin comes from:
A
thyroid
5
Q
What regulates serum Ca and P?
A
calcitonin, parathyroid hormone, V. D
6
Q
Fxns of calcitonin:
A
Blood Ca, P levels, skeletal remodeling
7
Q
Active form T3 or T4?
A
T4
8
Q
Wo sufficient iodine, a person will develop:
A
goiter
9
Q
Where is T3 produced?
A
follicular cells of thyroid
10
Q
What regulates the release of T3?
A
pituitary TSH
11
Q
Fxn of T3:
A
metabolic processes, O2 use
12
Q
What is needed for T3 to fxn?
A
iodine
13
Q
Hyperthyroid results in:
A
excessive thyroid hormone
14
Q
Symptoms of hyperthyroidism:
A
SWEATING, heat intolerance, inc bowel movements, tremor, nervousness, agitation, rapid HR, weight loss, fatigue, dec concentration, irregular/ scant menstrual flow
15
Q
Most common cause of endogenous hyperthyroidism:
A
Graves’ disease
16
Q
Other causes of hyperthyroidism:
A
Toxic multinodular goiter, Toxic adenoma, Pituitary adenoma, Metastatic tumors, Thyroiditis, Overmedication (synthetic thyroid hormone, hypo to hyper possible)
17
Q
How can adenoma lead to hyperthyroidism?
A
acc release of TH, pituitary gland TSH inc, too much
18
Q
Symptoms of Graves Disease:
A
hyperthyroidism, enlarged thyroid, lymphocytic infiltration, ophthalmopathy, exophthalmos
19
Q
What causes Grave’s disease?
A
AI
20
Q
Hyperthyroidism leads to:
A
enlargement of thyroid, lymphocytic infiltration
21
Q
TF? Most cases of exophthalmos due to Graves disease resolve after the disease is managed.
A
T
22
Q
Tx for hyperthyroidism:
A
radioactive iodine uptake, 6-18mo
23
Q
Indications that hyperthyroidism is poorly controlled:
A
Inc HR & BP
24
Q
TF? Pulse rate is a measure of thyroid function.
A
T, hyperthyroidism: above 100
25
Caution for treating pts w uncontrolled hyperthyroidism:
don't use epi
26
Goal of surgery for hyperthyroidism:
leave enough thyroid for normal function, too much excised is better
27
The use of epi w a pt w hyperthyroidism could lead to:
Palpitations, Arrhythmias, Chest pains
28
Mgmt of pts w hyperthyroidism:
limit psychological / surgical stress, aggressive infections tx (reserve is not great)
29
TF? Infections should be treated aggressively in pts w DM or hyperthyroidism.
T
30
Ppl most likely to enter thyrotoxic crisis:
elderly women
31
Incidence of thyrotoxic crisis a overt hyperthyroid.
1-2%
32
Mortality rate of thyrotoxic crisis:
10-20%
33
Thyrotoxic crisis is aka:
thyroid storm
34
presentation, thyrotoxic crisis:
Inc HR, BP, fever, neurological / GI symptoms, N, abdominal pain, anxiety, seizures
35
Decompensated state of TH-induced hypermetabolism:
thyrotoxic crisis
36
symptoms of hypothyroid:
weight gain, lethargy, cold intolerance, bradycardia, EDEMA, SWEATING
37
Causes of hypothyroid:
Hashimoto's, lymphocytic thyroiditis, thyroid destruction, pituitary or hypothalamic disease, meds, iron deficiency (severe)
38
Hashimoto's disease leads to __ and Grave's disease leads to ___.
hypo, hyper
39
TF? Hashimoto's and Graves disease are both AI diseases.
T
40
Types of inflammation that Hashimoto's and Graves leads to:
lymphocytic and AI inflammation (in gland and autoantibody production)
41
Hashimoto's can lead to:
myxedema
42
TF? Hashimoto's disease can lead to Grave's disease.
F. vice versa
43
Hypothyroidism in infancy can cause:
cretinism, developmental delay, frontal bossing (swelling) , big tongue, small jaw, short, hypertelorism (inc distance bw eyes)
44
Oral manifestations of hypo:
delayed eruption, enamel hypoplasia, ant open bite, small jaw, big tongue
45
How to treat hypo:
No tx if euthyroid w autoantibodies, Levothyroxine (Synthroid, replacement hormone)
46
Which is more common, hypo or hyper?
hypo
47
Dental mgmt of pt w hypo:
Inc subcutaneous mucopolysaccharides --> red capillary constriction --> red hemostasis, dec fibroblast activity --> delayed wound healing
48
causes delayed wound healing in hypo:
dec fibroblast activity
49
Causes red hemostasis in pts w hypo:
excess subcutaneous mucopolysaccharides --> red capillary constriction --> red homeostasis
50
anticoagulated, hypo or hyper and why?
Hypo, CV effects
51
What to be aware of if pt is taking Levothyroxine:
inc Warfarin effects, dec oral hypoglycemics effects
52
Warfarin is what type of drug?
anticoagulant
53
Why do pts w hypo on thyroid replacement hormones need to be monitored?
they can become hyper
54
TF? If BP & P are elevated in a pt w hypo you should avoid epi.
T
55
Is elevated TSH hyper or hypo?
Hypo, body putting out more TSH since it isn't getting response.
56
neoplasms that can occur in the thyroid?
adenomas: benign, can produce hormones and cause hyper, usually nonfunctional, toxic adenomas produce hormones
57
TF? Toxic adenomas do not produce hormone.
F. They do
58
elevated if too much thyroid hormone is produced, t3 or T4?
T4
59
problem if TH is tool low?
Pituitary or thyroid
60
Cause of many thyroid neoplasms:
ionizing radiation
61
First familial form of thyroid neoplasm?
yes, genetic variant, 70% get cancer
62
Tx for pts with genes for familial form of thyroid neoplasm.
Remove thyroid
63
% of pts w genetic predisposition to thyroid neoplasm that get cancer:
70%
64
this indicates an underactive thyroid:
elevated TSH
65
This indicates overactive thyroid:
elevated T4
66
Effects of low T4:
damage thyroid or pituitary
67
low T4 and elevated TSH indicates:
thyroid problem
68
Low T4 and low TSH indicates:
pituitary problem (both are low, in the pits)
69
What are found on top fo kidneys:
adrenal glands
70
Adrenal glands, endocrine or exocrine?
endocrine
71
Produced by the cortex of the adrenal glands:
glucocorticoids, mineralocorticoids, androgens
72
Aldosterone is a:
mineralocorticoid
73
Testosterone is a:
androgen
74
Cortisol is a:
glucocorticoid
75
Produced in the medulla of the adrenal glands:
epi and NE
76
TF? There is a lot of overlay bw the adrenal glands and the thyroid.
T
77
Fxns of cortisol:
regulate protein, fat, carb metabolism, homeostasis, vascular reactivity, inhibition of inflammation
78
TF? Cortisol is an insulin antagonist.
F. insulin agonist
79
Fans of both cortisol and TH:
homeostasis
80
Steroids are prescribed for/
allergies, inflammation
81
HPA axis sf:
Hypothalamus, anterior Pituitary, Adrenal cortex
82
To where does cortisol exert negative feedback?
hypothalamus, ant pituitary gland
83
How does the hypothalamus exert influence over the anterior pituitary?
corticotropin releasing hormone. (-CRH)
84
anterior pituitary exerts influence over adrenal cortex via:
ACTH
85
WHat is released from the pituitary?
both TSH and ACTH
86
What is Addison's disease?
Not enough hormone secretion from adrenal cortex
87
What can cause the insufficiency in hormone secretion from adrenal cortex in Addison's disease?
AI, infection, hypovolemia, tumor, meds
88
Infection that can bring about Addison's disease:
TB, HIV, fungal
89
How can hypovolemia bring about?
shut down communication bw pituitary and adrenal gland
90
Meds that can bring about Addison's disease:
anticoagulants
91
How can anticoagulants bring about Addison's disease?
dec circulating cortisol/steroid in system (?)
92
Signs and symptoms of Addison's disease:
change in pulse and dec BP, GI symptoms inc D, N, V, weakness, fatigue, confusion, pigmentation of skin and oral mucosa
93
Oral manifestation of Addison's disease:
pigmentation of skin and oral mucosa, brown spots on lips and spotches inside
94
Tx for Addison's disease:
replacement corticosteroids
95
What is Cushing syndrome?
too much cotisol
96
Can lead to Cushing syndrome:
overmedication, excessive ACTH production from pituitary, adrenal tumors
97
TF? Cushing syndrome and Addison's disease can both be medically induced.
T
98
Diseases that are treated with steroids:
Lupus, Sarcoid, Sjogren's syndrome, MS, Cushing syndrome (all immunosuppressants, AI components)
CMLSS
99
Steroid use can lead to problems of the:
skeletal system (dm, hyperglycemia, too, right?)
100
Most steroids we use are:
topical
101
Most obvious sign of Cushing syndrome:
moon face
102
Signs and symptoms of Cushing syndrome:
hypertension, obesity, moon face, slow growth rate, bone pain/ fractures, muscle weakness, mental status change, fat deposition on back "Buffalo hump"
103
Cancer pts can be on high doses of these for a short period of time.
Steroids
104
Tx for Cushing syndrome:
wean from excessive meds, remove or radiate tumor
105
What is adrenal crisis?
acute adrenal insufficiency, rare, liffe-threatening, requires immediate tx
106
What type of pt with Addison's is at highest risk for adrenal crisis?
1' Addison's
107
Adrenal crisis can be precipitated by:
inc stress --> inc need for cortisol --> adrenal gland can't provide it
108
Normal output of cortisol from adrenal cortex:
25mg hydrocortisone (or 7.5mg prednisolone)
109
How can high dose steroids induce adrenal crisis:
high dose shuts down ability to produce steroids, more stress than the pills will compensate for, system shuts down
110
TF? We must treat Addison's pts w steroid augmentation for routine dentistry.
F
111
TF? Pts taking endogenous steroids have adrenal function suppressed.
F. exogenous
112
Adrenal suppression may occur if:
pt took at least 20mg hydrocotisone for at least 2wk within past 2yr
113
Rule of 2's applies to what disease?
Addison's
114
What is the Rule of 2's?
pt took at least 20mg hydrocotisone for at least 2wk within past 2yr
115
Effects of low cortisol on body:
dec liver fxn/ stomach digestive enzymes, V, D, cramps, very low sugar, coma, death
116
Levels of what will be low in the body if the adrenal glands aren't functioning:
cortisol, aldosterone
117
Affects of aldosterone being very low in body:
water and Na loss in kidney, irregular heart beat and output, low fluid, low BP, shock, coma, death
118
Explain the premise of steroid augmentation:
pt taking steroids at a high enough dose for even a brief period, endogenous steroid production will be suppressed, unable to produce steroid if under additional stressor, adrenal crisis
119
When to consider steroid augmentation:
general anesthesia, extensive surgery, anticipate significant post-op pain
120
All cases of adrenal crisis in dentistry involved:
general anesthesia, 1.5-5h post-op, only 4 cases in 35y, no controls
121
Why is pain management important for pts w impaired adrenal function?
bc pain is a major stressor and wo steroid augmentation, they may go into adrenal crisis
122
This is the target dose for hydrocortisone equivalent:
50-100mg/d
123
Freq req for pts w adrenal insufficiency for surgical proc:
double dose of steroid on day of, and maybe day after, surgery
