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Joeli Unit 4 > Thyroid phys > Flashcards

Thyroid phys Flashcards

1
Q

gastrulation

A

the formation of the ectoderm, endoderm, mesoderm

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2
Q

mesoderm becomes

A

muscles and skeleton

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3
Q

endoderm becomes

A

respiratory tract, digestive tract, liver, pancreas

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4
Q

ectoderm becomes

A

outer layer of the skin, hair, lining of nose and mouth, nervous system

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5
Q

facial cleft, auricular atresia, and micrognathia are due to

A

1st branchial arche and/or 2nd branchial arche

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6
Q

branchial cleft cyst is due to

A

failure of one of the four branchial arches to involute

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7
Q

one of the most common congenital abnormalities of the head and neck

A

branchial cleft cyst

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8
Q

when will a branchial cleft cyst get larger

A

respiratory infection
grow through life

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9
Q

where is a branchial cleft cyst found

A

lateral
anterior to the sternocleidomastoid

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10
Q

branchial cleft cyst versus lymph node

A

branchial - fluctuant
lymph node - firm

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11
Q

most common branchial cleft cyst

A

2nd branchial cleft cyst

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12
Q

where does tongue originate

A

between 1st and 2nd pharyngeal arch

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13
Q

outpouching between 1st and 2nd pharyngeal arch

A

foramen cecum; where the thyroid originates

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14
Q

3rd pharyngeal pouch becomes

A

inferior parathyroid

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15
Q

4th pharyngeal pouch becomes

A

superior parathyroid

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16
Q

when does the thymus atrophy

A

with age

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17
Q

most common place for thyro-glossal duct cyst

A

infra hyoid (inferior parathyroid has to traverse a further area)

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18
Q

what is a sinus tract

A

an opening with drainage

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19
Q

can a branchial cleft cyst or a thyroid-glossal duct cyst become a sinus tract

A

yes, they both can

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20
Q

when does a thyro-glossal duct cyst move

A

when you stick out your tongue (remember than the foramen cecum is connected to the tongue originally)

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21
Q

branchial cleft cysts are closely associated with

A

carotid arteries

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22
Q

are branchial cleft cysts or thyro-glossal duct cysts generally painful

A

no

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23
Q

where is the thyroid located

A

in the neck anterior to the cricoid cartilage

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24
Q

what does the thyroid require for production of active hormone

A

iodine

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25
Q

where is thyroid hormone stored

A

extracellulary in the thyroid colloid

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26
Q

is thyroid hormone stored in the thyroid cells?

A

no; it’s stored in extracellularly in the colloid

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27
Q

function of follicular cells

A

produce and secrete thyroglobulin into thyroid colloid
uptake of iodine via Na/I transporter

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28
Q

function of thyroglobulin

A

important for transport of tyrosine
important for iodinating tyrosines to develop into T3 and T4

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29
Q

parafollicular cells are also called

A

C cells

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30
Q

function of parafollicular cells

A

synthesize calcitonin

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31
Q

step 1 when creating T3 and T4

A

iodine comes into follicular cell via Na/I transporter

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32
Q

2nd step when creating T3 and T4

A

amino acids come in to form thyroglobulin (which is a protein)

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33
Q

3rd step when creating T3 and T4

A

thyroglobulin and iodine are transported into the colloid

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34
Q

4th step when creating T3 and T4

A

thyroid peroxidase (TPO) iodinates tyrosines within the thyroglobulin (we are still in the colloid now)

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35
Q

5th step when creating T3 and T4

A

iodinated tyrosines couple to make T3 and T4 (we are still in the colloid)

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36
Q

6th step when creating T3 and T4

A

thyroglobulin with iodinated tyrosines are endocytosed back into follicular cell

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37
Q

7th step when creating T3 and T4

A

thyroglobulin is digested by lysozymes –> release of T3, T4, rT3
release of amino acids and extra iodine for recycling

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38
Q

8th step when creating T3 and T4

A

T3, T4, and rT3 are diffused into systemic circulation

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39
Q

which steps are NOT stimulated further by TSH

A

-amino acids forming thyroglobulin
-thyroglobulin and iodine are transported in a vesicle to colloid

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40
Q

TSH exerts what type of effect

A

growth factor effect –> hyperplasia of thyroid

increased TSH –> growth of thyroid

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41
Q

which has a larger half life between T4 and T3

A

T4

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42
Q

once T3 and T4 are diffused into systemic circulation, what do they bind to

A

thyroid binding globulin

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43
Q

does thyroid binding globulin have a high affinity for T3 and T4

A

yes

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44
Q

what percent of T4 is bioavailable/free

A

0.02%

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45
Q

what percent of T3 is bioavailable/free

A

0.5%

46
Q

Where is T4 converted to T3

A

in the periphery

47
Q

what percent of circulating T3 arises from peripheral conversion

A

~75%

48
Q

half life of T4

A

~8 days

49
Q

half life of T3

A

24 hours

50
Q

thyroid binding globulin significantly evaluates during

A

pregnancy
oral estrogen therapy
hepatitis
chronic heroin abuse

51
Q

elevated thyroid binding globulin leads to what in regards to TOTAL T3 and T4

A

total T3 and T4 will increase

52
Q

elevated thyroid binding gluten leads to what in regards to BIOAVAILABLE T3 and T4

A

nothing; stays the same; does not change

53
Q

T4 is converted peripherally to T3 via enzymatic activity with

A

deiodinases

54
Q

T3 has a HIGHER affinity for

A

thyroid nuclear receptors

55
Q

Between T3 and T4, which is considered more potent?

A

T3

56
Q

deiodinase enzymes

A

D1
D2
D3

57
Q

where is D1 found

A

LIVER
KIDNEY
thyroid
skeletal muscle

58
Q

D1 function

A

primarily responsible for export to plasma T3

59
Q

what inhibits D1

A

calorie restriction
severe stress

60
Q

what happens when D1 is inhibited

A

decreased conversion to T3 –> decreased basal metabolic rate

61
Q

where is D2 found

A

CNS
pituitary
placenta

62
Q

function of D2

A

primarily local effects

63
Q

effects of calorie restriction on D2

A

essentially no change
D2 is found on the pituitary so local T3 will still be normal –> normal feedback loop –> no changes in TSH

64
Q

where is D3 found

A

placenta
pregnant uterus
fetal tissue
brain (except pituitary)

65
Q

function of D3

A

only creates rT3 which is biologically inactive

66
Q

what hormone requirements are increased during pregnancy

A

thyroid hormone requirements are increased

67
Q

when are thyroid disorders common in relation to pregnancy

A

during and following pregnancy

68
Q

hCG is structurally similar to

A

TSH

69
Q

since hCG is similar to TSH, it stimulates production of

A

thyroid hormones

70
Q

when do we see a higher hCG

A

multiple gestations

71
Q

since we have a higher hCG in multiple gestations, what can happen in regards to thyroid

A

hyperthyroidism (hCG is structurally similar to TSH)

72
Q

what do we need to do with medication for patients with hypothyroidism who are pregnancy

A

usually increase dose

73
Q

thyroid hormones primarily exert their effects through what pathway

A

genomic pathway

74
Q

genomic pathway for thyroid hormones

A

thyroid hormones bind to thyroid nuclear receptors and alter gene transcription

75
Q

thyroid hormones can also act through non-genomic pathway to enhance

A

mitochondrial oxidative phosphorylation –> increases energy expenditure

76
Q

how do thyroid hormones raise basal metabolic rate

A

either heat production or O2 consumption

77
Q

effects of thyroid hormones are glucose production

A

increased glucose production due to hepatic gluconeogenic activity

78
Q

why do thyroid hormones not increase plasma glucose levels

A

pancreas increases insulin

79
Q

how do we have increased amino acids and glycerol, which can be used for gluconeogenesis

A

proteolysis

80
Q

thyroid hormones and proteolysis

A

thyroid hormones increase proteolysis

81
Q

thyroid hormones and protein synthesis

A

thyroid hormones increase protein synthesis

82
Q

which is increased more by thyroid hormones: proteolysis or protein synthesis

A

proteolysis > protein synthesis

83
Q

effect of thyroid hormones on triglycerides

A

thyroid hormones increase degradation of triglycerides –> release of FA and glycerol

84
Q

what are FA used for

A

fuel for liver

85
Q

thyroid hormones and effect of lipogenesis

A

thyroid hormones increase lipogenesis

86
Q

which is increased more by thyroid hormones: lipolysis or lipogenesis

A

lipolysis > lipogenesis

87
Q

thyroid hormones and effect on sodium/potassium pump

A

thyroid hormones increase transcription of and stabilization of sodium/potassium pumps

88
Q

how do we get heat intolerance in hyperthyroidism

A

increased hormone –> increase sodium/potassium pump –> increased ATP consumption –> increased oxygen consumption –> heat

89
Q

thyroid hormones and effect on beta adrenergic receptors

A

increase expression and sensitivity of beta-adrenergic receptors

90
Q

how do we get tachycardia in hyperthyroidism

A

increased sensitivity and expression of beta adrenergic receptors –> increased temperature and increased heart rate

increased myosin heavy chains —> increased heart rate

91
Q

so what chains are increased which can increase heart rate along with beta-adrenergic receptors

A

MYOSIN HEAVY CHAINS

92
Q

hypothyroidism has a high chance of what in regards to lipids

A

high cholesterol

due to decreased lipolysis

93
Q

what signals TRH in negative feedback loop

A

T3 and T4 but primarily T3!!!!

94
Q

TSH is often ordered as

A

TSH with reflex to free T4

95
Q

what is the last thyroid hormone to drop in value

A

T3

96
Q

thyroglobulin is only produced by

A

thyroid cells and thyroid cancer cells

97
Q

what lab test is best for monitoring for thyroid cancer recurrence after thyroidectomy

A

thyroglobulin

98
Q

what lab value is present in graves disease

A

thyroid stimulating immunoglobulins
thyrotropin receptor antibodies

99
Q

function of thyroid stimulating immunoglobulins

A

act to stimulate TSH receptors

can cause hyperplasia in graves disease

100
Q

what lab value is present in hashimotos

A

thyroid peroxidase antibodies

101
Q

function of TPO antibodies

A

prevent function of thyroid peroxidase –> decreased iodination of tyrosines

102
Q

function of thyrotropin cells

A

responsible for production of TSH

103
Q

function of thyrotropin receptor antibodies

A

decreases negative feedback loop (TRH and TSH do not get signal) –> increased thyroid hormone –> present in grave’s disease

104
Q

what is radioactive iodine imaging used when

A

when TSH is low and thyroid goiter or nodule are present

105
Q

function of radioactive iodine imaging

A

determines if solitary nodule is hot or cold
determines if hyperthyroidism is due to thyroiditis or grave’s
treatment of hyperthyroidism or thyroid cancer

106
Q

iodine uptake in thyroiditis

A

minimal uptake due to decreased TSH

107
Q

iodine uptake in graves

A

increased iodine uptake due to TSI mimicking TSH

108
Q

most nodules are hot or cold?

A

cold nodules

109
Q

which nodule type has a higher risk of malignancy

A

cold nodules

110
Q

damage to recurrent laryngeal nerve in thyroidectomy

A

hoarseness, changes in swallowing

Joeli Unit 4 (6 decks)

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