Week 6 - Endocrine System Flashcards
Hypothyroidism
Deficient production of TH by the thyroid gland.
Most common thyroid disorder. More prevalent in women and the elderly.
Treatment for hypothyroidism
Levothyroxine
Secondary hypothyroidism
Caused by pituitary or hypothalamic failure to stimulate thyroid to produce TH
What causes hypothyroidism?
1.Usually caused by autoimmune thyroiditis (Hashimoto’s disease)
2. Loss of thyroid tissue after surgery
3. chemo/radiation
5. Medications
6. Iodine deficiency
Symptoms of hypothyroidism
Affects all body systems and occurs insidiously over months/years
Symptoms dependent on degree of deficiency
1. Low energy levels
2. Low basal metabolic rate
3. Cold intolerance
4. Lethargy
5. Tiredness
6. Lowered body temp
7. Diastolic hypertension
8. Goiter
9. weight gain
Myxedema
Myxedema coma – low level of consciousness
Evaluation for hypothyroidism
- clinical symptoms
- increase in TSH levels and decrease in TH levels
Thyroid stimulating hormone
Synthesized and stored in the anterior pituitary gland, circulates to bind with the TSH receptor. Effects include:
i. Immediate increase in release of stored thyroid hormones
ii. Increase in iodine uptake and oxidation
iii. Increases TH synthesis
iv. Increase in synthesis and secretion of prostaglandins by the thyroid
Function of the thyroid
Controls the body’s metabolic processes
Secondary hypothyroidism
Caused by the pituitary’s failure to synthesize adequate amounts of TSH or a lack of TRH.
Pituitary tumors that compress surrounding pituitary cells or the consequences of their treatment are the most common causes
- TBI
- subarachnoid hemorrhage
- pituitary infection
Feedback loop for primary thyroid malfunction
- thyroid doesn’t produce enough TH
- no negative feedback to pituitary and hypothalamus
- .Low TH and high TSH, TRH levels
Feedback loop for pituitary malfunction
- lack of negative feedback to hypothalamic release of TRH by TSH and TH
- low levels of TSH and TH and high levels of TRH
Feedback loop for hypothalamic function
- Decreased TRH due to defect in hypothalamic function
- Low levels of TRH, TSH, and TH
Hyperthyroidism
Excess amounts of TH from the thyroid gland
Causes of hyperthyroidism
- Graves’ disease (an immune system disorder that results in the overproduction of thyroid hormones)
- Toxic multinodular goiter
- Solitary toxic adenoma
- Follicular thyroid carcinoma
Central (secondary) hyperthyroidism
caused by TSH secreting pituitary adenomas
Clinical manifestations of hyperthyroidism
Attributable to the metabolic effects of increased circulating levels of TH
a. Increased metabolic rate
b. Heat intolerance
c. Sensitivity to stimulation by the sympathetic division of the ANS
Diagnostic criteria for primary hyperthyroidism
Diagnosed with elevated T3 and T4 levels and decreased serum TSH
Diagnostic criteria for secondary hyperthyroidism
Normal TSH levels despite increase TH concentrations
(TSH secreting pituitary tumor)
Treatment for hyperthyroidism
Aimed at controlling TH production, secretion or action
Includes radioactive iodine therapy (drug is absorbed by the thyroid tissue causing cell death - goal to kill overactive thyroid tissue), antithyroid drug therapy (methimazole or propylthiouracil) and surgery
What are the two most distinguishing factors of hyperthyroidism?
Pretibial myxedema (a waxy, discolored induration of the skin—classically described as having an orange peel appearance—on the anterior aspect of the lower legs, spreading to the dorsum of the feet, or as a non-localised, non-pitting edema of the skin in the same areas)
Exophthalmos (he protrusion of one or both eyes anteriorly out of the orbit)
Functional abnormalities of hyperthyroidism
Result from hyperactivity of the sympathetic division of the ANS
1. lag of the globe on upward gaze 2. lag of the upper lid on downward gaze
Grave’s Disease
An immune system disorder that results in the overproduction of thyroid hormones
Infiltrative abnormalities of hyperthyroidism
Involving the orbital contents with enlargement of the ocular muscles. Affect more than ½ of individuals with the disease.
- Increased secretion of hyaluronic acid, adipogenesis, inflammation, and edema of the orbital contents result in
- exophthalmos (protrusion of the eyeball)
- periorbital edema
- extraocular muscle weakness leading to strabismus (crossed eyes) and diplopia (double vision)
Environmental Risk Factors for Type 1 Diabetes
- Viral infections (enterovirus), coxsackievirus, other infectious microorganisms
- H pylori
- Exposure to cow’s milk proteins
- Lack of Vitamin D