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2nd shift lecs > thyroid disorders > Flashcards

thyroid disorders Flashcards

1
Q

inadequate hormones, manifested as tired

A

Hypothyroidism

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2
Q

too much secretion of thyroid hormones → fast metabolism + uses energy → tiring
(pagod pa rin)

A

Hyperthyroidism

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3
Q

One of the largest endocrine glands

A small organ located in front of the neck, wrapped around the windpipe or trachea

A

Thyroid gland

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4
Q

Butterfly-shaped, smaller in the middle with two wings or lobes that extend around the side of the throat

Two cone-like lobes or wings

A

Thyroid gland

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5
Q

_____________ (right lobe) and _____________ (left lobe) connected via the ___________ (the bridge between the lobes of the thyroid)

A

lobus dexter; lobus sinister; isthmus

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6
Q

Hypothalamus releases ______________ which stimulates the anterior pituitary gland

A

thyrotropin releasing hormone (TRH)

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7
Q

Pituitary gland releases __________________ which stimulates the thyroid gland

In the presence of TRH

A

thyroid stimulating hormone (TSH)

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8
Q

Thyroid gland releases ___ and ___, which perform the thyroid functions

A

T3 and T4

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9
Q

Regulate the rate of metabolism and physiological functions (heart rate, sweating
and energy consumed)

Affect the growth and rate of function of many other systems in the body

A

T3 and T4

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10
Q

If thyroid hormone levels are adequate, T3 and T4 signals the hypothalamus and anterior pituitary gland to stop stimulating = no thyroid hormone production (t or f)

A

T

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11
Q

Thyroid hormones (T3 and T4) is regulated by

A

TSH

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12
Q

Low levels: Hypothalamus releases _________ that triggers TSH release from the pituitary gland

A

TRH

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13
Q

High levels: Hypothalamus _______ TRH release and anterior pituitary gland ________TSH release

A

stops

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14
Q

system that regulates the levels of TRH, TSH, T3 and T4

A

Negative feedback system

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15
Q

85% - 90% (majority)

A

T4

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16
Q

Majority is converted into T3 (removal of ___________)

A

1 iodine – deiodination

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17
Q

10% - 15% (more active)

A

T3

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18
Q

T3 bulk is derived by deiodination of T4 in ____________

A

peripheral tissues (liver, kidneys)

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19
Q

Deiodination of T4 yields __________ T3
■ a molecule with no known metabolic
activity

A

Reverse

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20
Q

Two principal thyroid hormones:

A

Thyroxine (T4)
Triiodothyronine (T3)

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21
Q

L-3,5,3’,5’-tetraiodothyronine

A

Thyroxine (T4)

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22
Q

T3 and T4 are derivatives of _________ bound covalently to iodine

A

Tyrosine

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23
Q

L-3,5,3’-triiodothyronine

A

Triiodothyronine (T3)

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24
Q

“pro-hormone of T3”
is better for transport through the body

A

T4

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25
Q

more stable and durable molecule (due to many iodine attachments); must travel through the circulatory system to get to the tissues

A

T4

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26
Q

Once in the tissues, T4 needs to convert to T3, the less biologically active, through deiodination (removal of iodine) (t or f)

A

F; more

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27
Q

sourced from diet

A

Iodine

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28
Q

The lobes of the thyroid contain hollow, spherical structure called __________, which are the functional units of the thyroid gland

A

follicles

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29
Q

Interspersed between the follicles are ____________, secreting calcitonin

A

parafollicular C-cells

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30
Q

Another hormone released by thyroid gland responsible for modulating blood calcium levels
in conjunction with PTH (Parathyroid hormone)

A

calcitonin

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31
Q

Each follicle is filled with a thick sticky substance called __________

A

colloid

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32
Q

The major constituent of colloid is a large glycoprotein called ____________, produced by follicle cells

A

thyroglobulin

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33
Q

site of thyroid hormone synthesis

A

colloid

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34
Q

Thyroid hormone synthesis and secretion is regulated by two main mechanisms:

A
  • “autoregulation” mechanism which reflects the available levels of iodine
  • regulation by the hypothalamus and anterior pituitary regulation of thyroid hormone levels
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35
Q

TH are highly _________

A

lipophilic

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36
Q

Less than ____% of T3 and T4 are in unbound form, unattached to TBG protein

A

1%

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37
Q

unbound form of TH = __________

A

biologically active

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38
Q

An indispensable component of the thyroid hormones - ____% of T4 and ______% of T3 weights

A

iodine; 65%, 58%

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39
Q

The thyroid hormones are one of few iodine-containing hormone

A

F; the ONLY iodine containing hormone

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40
Q

Minimum requirement of iodine per day

A

75 micrograms

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41
Q

iodine deficiency =

A

goiter

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42
Q

Lack of thyroid hormone during development results in short stature and mental deficits __________

A

cretinism

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43
Q

Cardiovascular:

______ heart rate
______ cardiac contractility
______ cardiac output
______ vasodilation

A

all increase; promotes

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44
Q

CNS:

both increased and decreased thyroid hormone concentrations leading to alteration in mental state
too low: __________
too high: _________

A

feel mentally sluggish; anxiety and nervousness

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45
Q

Reproductive:
normal reproductive behavior and physiology is dependent on essentially normal levels of thyroid
hormones

hypothyroidism is commonly associated with __________

A

infertility

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46
Q

signals hypothalamus to stop TRH secretion → decreased TSH

A

High T3, T4

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47
Q

signals hypothalamus to produce TRH →
high TSH

A

Low T3, T4

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48
Q

secondary and tertiary

A

central hypothyroidism

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49
Q

Primary hypothyroidism

A

Thyroid gland problem

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50
Q

Secondary hypothyroidism

A

problem with the pituitary gland

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51
Q

Tertiary hypothyroidism

A

problem with the hypothalamus

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52
Q

To differentiate between secondary and tertiary check:_____-

A

T3 levels

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53
Q

Thyroid function tests

A
  • TSH test
  • T4 test
  • T3 test
  • Thyroid antibody test
    > thyroid peroxidase
    > thyroglobulin
  • Radioactive iodine uptake
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54
Q
  • Most appropriate test
  • Very sensitive and specific parameter to assess thyroid function
  • Differentiates primary (thyroid gland problem) from secondary (pituitary gland problem) and tertiary (hypothalamus problem) hypothyroidism
    ● In most healthy individuals, a normal ______value means that the thyroid is functioning properly.
A

TSH test

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55
Q

equal or normal TSH value

A

euthyroid

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56
Q

thyroid gland is not making enough thyroid hormone (primary hypothyroidism) → low T3, T4

A

Increased TSH

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57
Q

thyroid gland is producing too much thyroid hormone (hyperthyroidism); → high T3, T4

A

Decreased TSH

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58
Q
  • Often useful to diagnose hyperthyroidism, determine the severity of the hyperthyroidism, assess abnormal protein binding disorders, monitor thyroid replacement and suppressive therapies
  • Rarely helpful in hypothyroidism
    ○ It is the last test to become abnormal
    ○ Patients can be severely hypothyroid with a high TSH and low Free T4 or Free T4 Index (FTI),
    but have a normal _____
A

T3 test

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59
Q

A more sensitive indicator of hyperthyroidism than Total T4

A

T3 test

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60
Q

Hypothyroidism: T3 is often normal even when the T4 is low (t or f)

A

T

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61
Q

Increased T3: in almost all cases of hyperthyroidism (T3 usually goes up before T4) (t or f)

A

T

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62
Q

Decreased T3: during acute illness and starvation, affected by several medications: ___________________

A

beta blockers, steroids, and amiodarone

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63
Q

● The main form of thyroid hormone circulating in the blood
● Important element in routine clinical diagnosis and in suspected thyroid function disorders (with TSH)

A

T4 test

64
Q

measures the bound and free hormone and can change when binding proteins differ

A

Total T4

65
Q

measures what is not bound and able to enter and affect the body tissues

A

Free T4

66
Q

hyperthyroidism, subacute thyroiditis in its first stage and with thyrotoxicosis due to Hashimoto’s
disease

A

inc T4

67
Q

hypothyroidism and in the third stage of subacute thyroiditis

A

dec T4

68
Q

Tests measuring free T4:

A

either a free T4 (FT4) or free T4 index (FTI) - more accurately reflect how the thyroid
gland is functioning when checked with a TSH

69
Q

TSH: High
FT4: Low

(Thyroid Panel Test)

A

Primary Hypothyroidism

70
Q

TSH: Low
FT4: Low

(Thyroid Panel Test)

A

Secondary Hypothyroidism

71
Q

TSH: Low
FT4: High

(Thyroid Panel Test)

A

Hyperthyroidism

72
Q

“Total” =

A

Protein bound + free thyroid hormones

73
Q
  • Provide a reliable index of thyroid gland activity if levels of thyroid binding proteins are normal
    ● Changes in serum concentration of thyroid-binding proteins (TBP) or the presence of drugs that affect the binding of T3 and T4 to TBP will modify total hormone levels, but not the biologically active free T3 and T4 levels
A

Total T3 and T4

74
Q

-A protein produced by normal thyroid and thyroid cancer cells
● Not a measure of thyroid function, do not diagnose thyroid cancer when the thyroid gland is still present
>Precursor only
● Most often used in patients who have had surgery for thyroid cancer to monitor them after treatment
● Tg is not a primary measure of thyroid hormone function

A

Thyroglobulin (Tg)

75
Q
  • Thyroid peroxidase (TPO) (or antimicrosomal (TMAb) and antithyroglobulin (TgAb) antibodies
    > Produced in patients with hypothyroidism or hyperthyroidism when lymphocytes react against thyroid and make antibodies against the thyroid cell proteins
    > Measured to confirm, diagnose or rule out autoimmune thyroid disease, not specific for the type of a disease
    ● High titers of these antibodies are present in 97% of patients with Grave’s disease or Hashimoto’s thyroiditis
A

Thyroid Autoantibodies

76
Q

Thyroid Scan or Thyroid Imaging
● Oral administration of Iodine-123 by swallowing the isotope
● Measure radioactivity over the thyroid area after 4 or 6 hours and after 24 hours
● The normal uptake at 6 hours is 5-15% and at 24 hours 8-30%

A

Radioactive Iodine Uptake (RAIU)

77
Q

High RAIU

A

hyperthyroidism (overactive thyroid gland)
= overperforming

78
Q

Low RAIU

A

hypothyroidism (underactive thyroid gland)
= not enough iodine from the blood

79
Q

Thyroid Imaging

A

○ Radionuclide Imaging
○ Radioisotope Scanning
○ Fluorescent Scanning
○ Thyroid Ultrasonography
○ Magnetic Resonance Imaging

80
Q

Gland Destruction

A

Hypothyroidism

81
Q

Under-production of thyroid hormones, Myxedema (Gull Disease), Cretinism, Thyroiditis

A

Hypothyroidism

82
Q

Thyrotoxicosis

A

Hyperthyroidism

83
Q

Over-production of thyroid hormone, Grave’s Disease

A

Hyperthyroidism

84
Q

Diffuse and multi-nodular

A

Goiter

85
Q
  • Weight Gain
  • Decreased Appetite
  • Cold Intolerance Increased Sensitivity to Cold
  • Bradycardia
  • Constipation
  • Fatigue, Depression, Impaired Memory, Impaired Concentration, “Mental Fog”
  • Hair Loss and Thin Nails Dry Skin
A

HYPOTHYROIDISM

86
Q
  • Weight Loss
  • Increased Appetite
  • Heat Intolerance Increased Sensitivity to Heat
  • Tachycardia, Palpitations, Arrhythmias
  • Diarrhea
  • Anxiety, Nervousness, Irritability, insomnia, Tremors
  • Increased Hair and Nail Growth Increased Sweating
A

HYPERTHYROIDISM

87
Q
  • A condition in which the thyroid gland is underactive resulting in low levels of thyroid hormone in the blood
  • May be congenital, primary or central (secondary or tertiary)
A

Hypothyroidism

88
Q

In areas of iodine sufficiency, autoimmune disease _______________ and iatrogenic causes
(treatment of hyperthyroidism) are most common

A

Hashimoto’s thyroiditis

89
Q

Congenital: in children, hypothyroidism leads to delay in
growth _____________, and intellectual development _______________

A

dwarfism, cretinism

90
Q

measurement of TSH or T4 levels at birth through heel-prick blood specimens

A

Neonatal screening programs

91
Q

preferred form of thyroid hormone replacement in all patients with hypothyroidism

A

Levothyroxine

92
Q

can be crushed and mixed into a baby’s milk, formula or water

A

Thyroid hormone pills

93
Q

Classification of Hypothyroidism

A
  1. Primary
  2. Secondary
  3. Tertiary
94
Q

Most common type due to thyroid gland diseases, high TSH levels
Causes:
- Autoimmune thyroiditis (Hashimoto’s thyroiditis)
■ Congenital hypothyroidism (thyroid aplasia or hypoplasia, thyroid hormone synthesis defect, genetic abnormalities)
■ Iatrogenic (radioiodine therapy, total thyroidectomy)
■ Iodine deficiency (most common cause worldwide)
■ Thyroid ablation or surgery (removal of part or whole)
■ Taking excess goiterogenic food (broccoli, cauliflower, cabbage, cassava, soybeans, kale, brussels
sprouts) → inhibits iodine uptake
■ Drugs (lithium, amiodarone, iodine, antithyroid agents)

A

Primary

95
Q

Hypothyroidism due to insufficient stimulation by the TSH of an otherwise normal thyroid gland
○ Low TSH to differentiate it from primary (high TSH)
■ Secondary – disease in the pituitary gland
■ Tertiary – disease in the hypothalamus

A

Central (secondary and tertiary)

96
Q

Absence of associated deficiencies

(Pituitary Hormone Deficiencies)

A

Primary

97
Q

Associated with multiple pituitary hormone deficiencies (amenorrhea, infertility, hypoglycemia,
hyponatremia, anorexia, weight loss, and diabetes)

(Pituitary Hormone Deficiencies)

A

Central

98
Q

Usually present

(Goiter)

A

Primary

99
Q

Absence

(Goiter)

A

Central

100
Q

Invariably present

(Antithyroid Antibodies)

A

Primary

101
Q

Normal, low, sometimes high
(TSH)

A

Central

101
Q

Usually above

(TSH)

A

Primary

102
Q

Invariable absent

(Antithyroid Antibodies)

A

Central

103
Q

Normal

(TRH Stimulation Test)

A

Primary

104
Q

Abnormal

(TRH Stimulation Test)

A

Central

105
Q
  • is usually irregular and firm in consistency.
  • puffy face, edematous eyelids, non-pitting pretibial edema
A

goiter

106
Q

A physical exam usually reveals a small (_____________) or an enlarged (____________) thyroid gland

(signs and tests)

A

central; primary

107
Q

Vital signs

(signs and tests)

A

a slow heart rate, low blood pressure, and low temperature

108
Q

A chest x-ray may reveal ________________

(signs and tests)

A

cardiomegaly

109
Q

Laboratory tests to determine thyroid function include

A
  • Free T4 test
    ○ Total T3
    ○ Serum TSH
110
Q
  • An autoimmune disorder involving chronic thyroid inflammation characterized by the destruction of thyroid cells by various cell and antibody-mediated immune processes
  • Over time, the ability of the thyroid gland to produce thyroid hormones often becomes impaired and leads to a gradual decline in function and eventually an underactive thyroid
A

Hashimoto’s Thyroiditis

110
Q

No adverse effects if taken in the appropriate dose
■ Underdose: elevated serum TSH
(____thyroidism)
■ Overdose: suppressed serum TSH
(____thyroidism)

A

hypo; hyper

111
Q
  • Also known chronic lymphocytic thyroiditis
    ● The most common cause of hypothyroidism in iodine-sufficient regions (most common cause
    worldwide: iodine deficiency)
    ○ In places with sufficient iodine, the most common cause is autoimmune or sometimes
    iatrogenic
A

Hashimoto’s Thyroiditis

111
Q
  • A term generally used to denote severe hypothyroidism
    ● Also used to describe the dermatologic changes that occur in hypothyroidism
A

Myxedema

112
Q
  • Treatment of choice for Hashimoto’s Thyroiditis
    ○ Thyroid hormone replacement usually for life
A

Levothyroxine sodium

113
Q
  • Myxedema Crisis
    ● A rare, life-threatening clinical condition that represents
    severe hypothyroidism with physiologic decompensation
    ● Occurs in long-standing, undiagnosed hypothyroidism
    ● Most often precipitated by infection, cerebrovascular
    disease, heart failure, trauma or drug use
A

Myxedema Coma

114
Q

Management for Myxedema Coma

A
  • Supportive therapy for airway and rewarming
    ○ Hydrocortisone
    ○ Levothyroxine sodium (T4)
    >With or without T3 supplementation, no clinical and pharmacologic significance
115
Q
  • A synthetic version of one of the body’s natural thyroid hormones: thyroxine (T4)
  • Recommended as the preparation of choice for the treatment of hypothyroidism due to its efficacy in resolving the symptoms of hypothyroidism, long-term experience of its benefits, favorable side effect profile, ease of administration, good intestinal absorption, long serum half-life, and low cost
A

Levothyroxine

116
Q
  • Major hormone secreted from the thyroid gland
    ■ Chemically identical to the naturally secreted T4
    ■ Increases metabolic rate, decreases thyroid-stimulating hormone (TSH) production from the anterior lobe of the pituitary gland, and, in peripheral tissues, is converted to T3
A

Levothyroxine: Thyroxine (T4)

117
Q
  • Treatment of primary, secondary, and tertiary hypothyroidism
    ■ Adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer
A

Levothyroxine: Oral Form

118
Q

Treatment of myxedema coma or severe hypothyroidism

A

Levothyroxine: Injectable

119
Q

Do not administer levothyroxine in conjunction with __________ or ___________

A

antacids or proton pump inhibitors

120
Q

Oral levothyroxine: Administer on an full (acidity increases
absorption), at least 30 to 60 minutes before breakfast or 3 to 4 hours after
dinner. (t or f)

A

F; empty stomach

121
Q

Do not administer levothyroxine within 4 hours of administration of products that may contain _________ or _________

A

iron or calcium

122
Q

○ An autoimmune disorder that causes hyperthyroidism or overactive thyroid
○ Immune system attacks the thyroid and causes it to make more thyroid hormones than the body needs

A

Grave’s disease (Toxic Goiter)

122
Q

Hyperthyroidism caused by Graves’ disease, accounts for _______% of thyrotoxicosis

A

60- 80%

122
Q
  • A synthetic form of the natural thyroid hormone (T3) converted from T4.
    ○ It is not intended for use as sole maintenance therapy, but in rare cases it can be used together with LT4 in small doses (5-15 µg/day).
A

Liothyronine (LT3)

123
Q
  • A condition in which the thyroid gland is overactive resulting in high levels of thyroid hormone in the blood
    ● Thyrotoxicosis is a state of thyroid hormone excess and is not synonymous with hyperthyroidism, which is the result of excess thyroid function
A

Hyperthyroidism

124
Q

Causes of Hyperthyroidism

A
  • Grave’s disease (Toxic Goiter)
  • Toxic multinodular goiter (Plummer’s disease)
  • Toxic adenoma
125
Q

○ Thyroid gland nodules produce too much thyroid hormones
○ Seldom causes bulging of the eyes or exophthalmos

A

Toxic multinodular goiter (Plummer’s disease)

126
Q

A single nodule making the extra amount of thyroid hormone

A

Toxic adenoma

127
Q

Antithyroid medication

A
  • Methimazole
  • Propylthiouracil
128
Q
  • Belong to the class of thionamides
    ○ Initial treatment for hyperthyroidism
A

Antithyroid medication

129
Q

■ Drug of choice in the first trimester of pregnancy
■ Inhibits thyroid hormone synthesis and T4 to T3 conversion
> Won’t illicit effects of T3
■ Higher risk of causing severe liver injury

A

Propylthiouracil

130
Q

■ Preferred antithyroid medication
> Drug of Choice
■ Except in the first trimester of pregnancy, since it may cause birth defects, and in patients with an adverse reactions
■ Inhibit thyroid hormone synthesis

A

Methimazole

131
Q

○ Taking radioactive oral iodine one time
○ Iodine is taken up by the thyroid gland
○ Radioactive iodine destroys most or all tissues in thyroid gland, but does not harm any other body parts

A

Radioactive iodine ablation of the thyroid gland

132
Q

contraindicated in severe Grave’s orbitopathy and in patients who are pregnant or nursing

A

Radioactive iodine

133
Q

Do not approach or stay near the vicinity of a patient receiving radioactive therapy (t or f)

A

T

134
Q

Removal of all or part of the hyperfunctioning thyroid tissues

A

Surgical thyroidectomy

135
Q

Beta-blockers used

A

Propranolol and Atenolol

136
Q

■ inhibits 5’-monodeiodase
■ blocking peripheral conversion of T4 to T3

A

Propranolol

137
Q

■ safer than propranolol in patients with asthma and COPD
■ allows once daily dosing for better compliance

A

Atenolol

138
Q
  • First-line treatment for children, adult and pregnancy
    ■ Initial treatment in severe cases or preoperative preparation

(Hyperthyroidism caused by Grave’s Disease)

A

Methimazole

139
Q
  • Best treatment for toxic nodules and toxic multinodular goiter
A

Radioactive iodine (I-131)

140
Q

■ Rapid, effective treatment, especially in large goiters
■ Potential choice in 2nd trimester pregnancy

A

Surgery

141
Q

Ancillary Agents

A
  • Cholestyramine
  • NSAIDs
  • Supersaturated potassium iodide
142
Q

Treats pain in subacute thyroiditis

A

NSAIDs

142
Q

■ Acute inhibition of thyroid hormone
synthesis and release, reduced
vascularity and T4 to T3 conversion
■ Given at least one hour after
methimazole or propylthiouracil
■ Do not give before radioactive iodine
treatment

A

Supersaturated potassium iodide

142
Q

Binds with the thyroid hormones in the
intestine, increasing fecal excretion

A

Cholestyramine

142
Q

Glucocorticoids

A

Prednisone, Dexamethasone

143
Q

■ No exposure to radiation or to surgical
risks
■ No permanent hypothyroidism
■ PTU is safe for the fetus in the first
trimester of pregnancy

A

Antithyroid Medications (Methimazole and PTU)
benefits

143
Q

Used in severe cases or thyroid storm
to reduce T4 to T3 conversion, and in
severe subacute thyroiditis

A

Prednisone, Dexamethasone

143
Q

■ Agranulocytosis, hepatotoxicity (with
PTU), rash
■ Methimazole can cause aplasia cutis
and other birth defects in the first
trimester of pregnancy

A

Antithyroid Medications (Methimazole and PTU)
Risks

143
Q

Benefits
■ No exposure to potential adverse
effects of an antithyroid medication or
to surgical risks
■ Treatment of choice in the US

A

Radioactive iodine ablation

143
Q

Risks
■ Aggravation of Grave’s orbitopathy,
especially in smokers, permanent
hypothyroidism, radiation exposure,
failure to cure hyperthyroidism if iodine
is insufficient, risk of Grave’s disease
recurrence, contraindicated in
pregnancy

A

Radioactive iodine ablation

144
Q

Benefits
■ No exposure to adverse effects of an
antithyroid medication or to radiation
■ Little chance of Grave’s disease
recurrence

A

Thyroidectomy

145
Q

Risks
■ Risks of general anesthesia, damaging
recurrent laryngeal nerve leading to
hoarse voice (unilateral) or respiratory distress (bilateral), and inadvertent
damage or removal of parathyroid
glands leading to permanent
hypoparathyroidism

A

Thyroidectomy

2nd shift lecs (21 decks)

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