Week 2- Thyroid and Adrenals

Question 1

is a normal thyroid visible?

Answer 1

no

Question 2

The thyroid gland is composed of follicles composed of ____________

Answer 2

follicular cells

Question 3

follicular cells in the thyroid secret

Answer 3

thyroid hormone

Question 4

hormone cascade thyroid

Answer 4

-Hypothalamus releases TRH
-Anterior Pituitary releases TSH
-TSH binds with TSH receptor sites located on the plasma membrane of the thyroid follicular cells
-Thyroid makes T3 and T4

Question 5

Effects of TSH on Thyroid

Answer 5

-increase ease in the release of stored thyroid hormones
-Increase in iodide uptake and oxidation
-Increase in thyroid hormone synthesis
-Increase in the synthesis and secretion of prostaglandins by the thyroid.
-Stimulating the growth and maintenance of the thyroid gland by stimulating thyrocyte hypertrophy and hyperplasia and decreasing apoptosis.

Question 6

The thyroid gland normally produces how much T3 vs T4

Answer 6

90% T4 and 10% T3

Question 7

T3 and T4 are primarily transported bound to one of three carrier proteins:

Answer 7

1. thyroxine binding globulin (TBG)
2. thyroxine-binding prealbumin (transthyretin)
3. albumin

Question 8

In the body tissues, T4 is converted to T3 by a_________ dependent process
-what mineral

Answer 8

selenium

Question 9

another name for hyperthyroid

Answer 9

thyrotoxicosis

Question 10

Primary hyperthyroidism causes

Answer 10

include Graves disease, toxic multinodular goiter, a solitary toxic adenoma and, very rarely, follicular thyroid carcinoma

Question 11

Central (secondary) hyperthyroidism is less common and is caused by

Answer 11

TSH-secreting pituitary adenomas

Question 12

hyperthyroid sxs

Answer 12

-increased metabolic rate
heat intolerance
increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system
Diarrhea, heart palpitations, warm skin/sweaty palms, anxiety

Question 13

hyperthyroid tx

Answer 13

-antithyroid drug therapy (methimazole or propylthiouracil)
- radioactive iodine therapy
-surgery

A major complication of all forms of treatment for hyperthyroidism is hypothyroidism.

Question 14

autoimmune hyperthyroid

Answer 14

graves disease

Question 15

in graves disease is TSH production stopped

Answer 15

Yes… but the antibodies are still bound to the thyroid receptors hence the thyroid keeps making hormones

Question 16

Graves sxs

Answer 16

Increased secretion of hyaluronic acid, orbital fat accumulation, inflammation, and edema of the orbital contents result in exophthalmos (protrusion of the eyeball). Periorbital edema and extraocular muscle weakness lead to diplopia (double vision).

Question 17

pretibial myxedema (Graves dermopathy)

Answer 17

subcutaneous swelling on the anterior portions of the legs and by indurated and erythematous skin

Question 18

Thyrotoxic Crisis - “Thyroid Storm

Answer 18

-death can occur within 48 hours
-hyperthermia; tachycardia, especially atrial tachydysrhythmias; high-output heart failure; agitation or delirium; and nausea, vomiting, or diarrhea, contributing to fluid volume depletion.

Question 19

myxedema

Answer 19

happens in severe long term hypothyroid
-swelling of the skin/tissues
-waxy appearance

Question 20

myxedema sxs

Answer 20

Non-pitting, boggy edema, especially around the eyes, hands, and feet and in the supraclavicular fossae. Myxedema is also responsible for thickening of the tongue and the laryngeal and pharyngeal mucous membranes. This results in thick, slurred speech and hoarseness, both of which are common in hypothyroidism.

Question 21

Levothyroxine is only ____. Desiccated thyroid (Armour thyroid, NP Thyroid, Nature Throid) contains both T4 AND T3 (the active form of thyroid)

Answer 21

T4

Question 22

gradual inflammatory destruction of thyroid tissue by infiltration of lymphocytes and circulating thyroid autoantibodies (antithyroid peroxidase and antithyroglobulin antibodies - Anti TPO Antibodies, Anti TG Antibodies)

Answer 22

gradual inflammatory destruction of thyroid tissue by infiltration of lymphocytes and circulating thyroid autoantibodies (antithyroid peroxidase and antithyroglobulin antibodies - Anti TPO Antibodies, Anti TG Antibodies)

Question 23

The parathyroid glands produce parathyroid hormone (PTH), which works in concert with vitamin D to__________ serum calcium concentration and decrease __________-

Answer 23

increase calcium
decrease phosphate

Question 24

In the kidneys, PTH acts on its plasma membrane receptor in the distal tubules of the nephron to increase reabsorption of calcium

Answer 24

In the kidneys, PTH acts on its plasma membrane receptor in the distal tubules of the nephron to increase reabsorption of calcium

Question 25

Hyperparathyroidism

Answer 25

greater than normal secretion of parathyroid hormone (PTH) and hypercalcemia

Question 26

hallmarks of primary hyperparathyroidism.

Answer 26

Hypercalcemia and hypophosphatemia -high calcium -low phosphorus -80% to 85% of cases are caused by parathyroid adenomas

Question 27

Hypoparathyroidism (abnormally low PTH levels) most commonly is caused by

Answer 27

damage to the parathyroid glands during thyroid surgery

Question 28

hypoparathyroid labs

Answer 28

decrease calcum increase phosphate

Question 29

hypoparahyroid sxs

Answer 29

-hypocalcemia sis -This creates tetany manifested as muscle spasms, hyperreflexia, tonic clonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation

Question 30

Chvostek sign is elicited by

Answer 30

tapping the cheek, resulting in twitching of the upper lip -associated with hypocalcemia -hypoparathyroid

Question 31

Trousseau sign is elicited by

Answer 31

-inflate BP cuff to a level above the systolic blood pressure -leads to a painful carpal spasm.

Question 32

Chvostek and Trousseau signs are used for what disorder

Answer 32

hypoparathyroid

Question 33

In effect, each adrenal gland functions like____- separate glands

Answer 33

two

Question 34

80% of the adrenal gland is the adrenal _________

Answer 34

cortex

Question 35

3 zones of adrenal cortex

Answer 35

1. **zona glomerulosa** SALT -the outer layer -produces the mineralocorticoid aldosterone. 2. **zona fasciculata** SUGAR -the middle layer -is 78% of the cortex and -secretes the glucocorticoids cortisol, cortisone, and corticosterone. 3. **zona reticularis** SEX -inner layer -secretes mineralocorticoids (aldosterone), adrenal androgens and estrogens, and glucocorticoids.

Question 36

The cells of the adrenal cortex are stimulated by the anterior pituitary hormone _____

Answer 36

ACTH (Adrenocorticotropic)

Question 37

glucocorticoid have direct effects on _________ metabolism

Answer 37

carbohydrate

Question 38

increase blood glucose concentration by promoting gluconeogenesis in the liver and by decreasing uptake of glucose into muscle cells, adipose cells, and lymphatic cells

Answer 38

glucocorticoid

Question 39

In extrahepatic tissues, the glucocorticoids stimulate ______________ and inhibit _________________

Answer 39

stimulate protein catabolism and inhibit amino acid uptake and protein synthesis

Question 40

complications of the use of glucocorticoids in the treatment of disease

Answer 40

infection poor wound healing

Question 41

secretion of cortisol is regulated primarily by the __________-

Answer 41

hypothalamus and the anterior pituitary gland.

Question 42

Three factors that regulate the secretion of ACTH:

Answer 42

1. negative feedback with cortisol in the system 2. diurnal rhythms affect ACTH and cortisol levels- cortisol peaks just before awakening 3. psychologic and physiologic stress increase cortisol levels

Question 43

acts to conserve sodium by increasing the activity of the sodium pump of the epithelial cells in the nephron.

Answer 43

aldosterone

Question 44

Aldosterone synthesis and secretion are regulated primarily by the

Answer 44

renin-angiotensin aldosterone system (RAAS)

Question 45

renin-angiotensin system is activated by

Answer 45

sodium and water depletion, increased potassium levels, and a diminished effective blood volume

Question 45

renin-angiotensin system is activated by

Answer 45

sodium and water depletion, increased potassium levels, and a diminished effective blood volume

Question 46

causes an increase in salt and water reabsorption into the bloodstream from the kidney thereby increasing the blood volume, restoring salt levels and blood pressure

Answer 46

aldosterone

Question 47

what cells secrete the catecholamines epinephrine (adrenaline) and norepinephrine,

Answer 47

Chromaffin cells (pheochromocytes)

Question 48

epinephrine and norepinephrine are made from

Answer 48

amino acid phenylalanine

Question 49

how long do the catecholamines remain in the blood stream

Answer 49

seconds to minutes

Question 50

refers to the complex of clinical manifestations resulting from chronic exposure to excess cortisol

Answer 50

cusshings syndrome

Question 51

overproduction of pituitary ACTH by a pituitary adenoma

Answer 51

cusshings disease

Question 52

excess ACTH stimulates excess production of cortisol and there is loss of feedback control of ACTH secretion

Answer 52

ACTH-dependent hypercortisolism

Question 53

ACTH-independent secreting tumors of the adrenal cortex

Answer 53

tumor on adrenal cortex makes cortisol

Question 54

in what syndrome -increases in bone resorption lead to osteoporosis and can result in pathologic fractures,

Answer 54

cusshings

Question 55

Abnormal dexamethasone suppression test with Cushings

Answer 55

dexamethasone= synthetic cortisol -cortisil production should go down after receiving drug, but it stays high in cusshings

Question 56

antibodies for hashimotos

Answer 56

thyroid peroxidase ab (TPO ab) thyroglobulin ab (TG ab)

Question 57

antibodies for graves

Answer 57

thyroid stimulating immunoglobulins (TSI antibodies) -binds to receptor leads to high thyroid levels

Question 58

what does aldosterone do

Answer 58

-increase sodium retention -increase BP -increase blood volume