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medsurg exam 2
endocrine
| Question | Answer |
|---|---|
| endocrine system affects | almost every cell, organ, body function |
| endocrine system major glands | Pituitary Thyroid - Parathyroids Adrenals - Pancreatic Islets Ovaries, Testes |
| what does the thyroid control | metabolic activity |
| thyroid anatomy | Butterfly shaped Two lobes Isthmus |
| how many hormones does the thyroid secrete and what are they | Secretes 2 hormones: Triiodothyronine (T3) and Thyroxine (T4) |
| major use of iodine in the thyroid gland | biosynthesis of thyroid hormones |
| regulation of thyroid gland is a | negative feedback that regulates body functions |
| what features are involved in thyroid regulation | hypothalamus, pituitary, thyroid |
| Hypothalamus secretes | TRH (thyrotropin releasing hormone) |
| secretion of TRH stimulates what | pituitary to secrete TSH |
| pituitary secretes | TSH (thyroid stimulating hormone) |
| secretion of TSH stimulates what | thyroid gland to secrete T3 and T4 |
| hypothyroid means the thyroid secretes | less T3/T4 |
| the secretion of less T3/T4 causes | Pituitary to secrete more TSH but T3/T4 remains low |
| hyperthyroid means the thyroid secretes | too much T3/T4 |
| the secretion of too much T3/T4 causes | pituitary to secrete less TSH but T3/T4 remains high |
| primary hypothyroidism | dysfunction of the thyroid gland, seen in 95% of pts |
| diagnosis of primary hypothyroidism | serum THS is going to be high because pituitary gland is trying to increase the low T3/T4 |
| Secondary or Central hypothyroidism | failure of hypothalamus or pituitary gland |
| diagnosis of Secondary or Central hypothyroidism | low T3/T4 but not elevated TSH |
| hypo = | slowing of metabolism |
| when is hypothyroidism prevelant | more in women than men, 30-70 years |
| common signs and symptoms of hypothyroidism | cold intolerance, weight gain, fatigue, heavy menstrual periods, slow tendon reflexes, decreases temp, decreases HR |
| why do hypothyroidism patients gain weight | because their metabolism is slowed! |
| hasimoto's disease is the most common cause of what | hypothyroidism in iodine sufficient areas |
| hasimoto's disease is more common in | women (7:1 ratio) |
| what is hasimoto's disease | Autoimmune disease that leads immune system to attack thyroid which causes destruction of thyroid tissue |
| hasimoto's disease has | presence of serum thyroid autoantibodies |
| endemic hypothyroidism causes | Iodine Deficiency Geographic Cretinism |
| iodine deficiency has been corrected by | adding iodine to salt (iodized salt) |
| geographic cause of endemic hypothyroidism | there was a deficiency of iodine in soil so men had symptoms of enlarged thyroids affected mainly himalayans, alps, and andes because the salt was washed away |
| cretinism is a | congenital iodine-deficiency syndrome |
| cretinism is seen in | children |
| cretinism can cause | neuro and physiological issues, affected intellectual development |
| goal for treating hypothyroidism | restore normal metabolism |
| how would you restore normal metabolism | giving synthetic T4: Synthyroid and Levothyroxine |
| why is T4 given to restore normal metabolism | T4 half life is 7 days and T3 half life is only 24 hrs |
| cautions with treating hypothyroidism | Starting dose Timing dose Adjustments T3 plus T4 therapy Drug interactions |
| Starting dose for hypothyroidism | low dose because don't want to speed up metabolism too fast |
| timing doses for hypothyroidism | an hour before they eat, normally 6am |
| adjustments for hypothyroidism | watch TSH and T4 levels |
| drug interactions of synthetic T4 | potentiate effects of digitalis, may have to adjust dose of insulin |
| pt teaching for hypothyroidism | Life long replacement Take before breakfast, empty stomach, no food 1 hour May needs labs if change formulation How to monitor over / under treatment Many drug-drug interaction |
| hyper = | overactive metabolism |
| when is hyperthyroidism prevelant | occurs more in women than men, 30-40 years old |
| hyperthyroidism symptoms | Heat intolerance Weight loss Anxiety, irritability Infrequent menstrual periods Brisk tendon reflexes Increased HR, AFib |
| graves disease is the most common type of | hyperthyroidism |
| graves disease is an | autoimmune disorder |
| graves disease is more common in | women than men (8:1) ages 20-40 |
| 2 hallmark symptoms of graves disease | goiter, exophthalamos (bulging eyes) |
| goal of treating hyperthyroidism | restore normal metabolism |
| three approaches to treat hyperthyroidism | #1 Radioactive iodine #2 Anti-thyroid medications #3 Removal of part of thyroid gland |
| how does Radioactive iodine work | destroys gland since thyroid absorbs most iodine in the body, |
| radioactive iodine is so great because | Simple, effective, economical No evidence leads to cancer risk |
| what happens when someone is treated with radioactive iodine | Slowly loose function, become hypothyroid |
| what is required when radioactive iodine is used | Require life long replacement therapy (synthetic T4) |
| use of Anti-thyroid medications | Decrease in activity Short or long term use |
| when is it right to remove thyroid gland | if enlarged thyroid pressing on esophagus or trachea |
| physical exam for hyperthyroidism | palpation: checking size, shape, consistency, symmetrical, tenderness |
| if there is thyroid abnormalities, who needs to be consulted | endocrinologist |
| blood tests for hyperthyroidism | TSH (should be 0.04-6.15) Free T4 T3 and T4 |
| hyperthyroidism blood tests reveal | high TSH, low T4 (and T3 because it goes up with T4) |
| diagnosis of hyperthyroidism through ultra sound to determine | size & location of nodules or tumor |
| ultra sounds of thyroid tells you what | if the nodule is solid or fluid filled |
| ultra sounds of thyroid does not tell you what | if the nodule is cancerous or benign |
| thyroid uptake scan | Swallow capsule of radioactive iodine 24hrs later measure amount retained gland |
| thyroid uptake scan reveals two areas: | hot areas and cold areas |
| hot areas suggest | hyperfunctioning thyroid, taking up most of the iodine |
| cold areas suggest | cancer, thyroid is taking up less iodine |
| graves disease on a thyroid uptake scan | hyperactive suggested by the increased iodine uptake |
| diagnosis of graves disease through Fine Needle Aspiration Biopsy (FNAB) | Small gauge needle to obtain tissue sample |
| results of a Fine Needle Aspiration Biopsy (FNAB) | positive (malignant) negative (benign) indeterminate (suspicious) inadequate (non diagnostic) |
| severe hypothyroidism can result in | Myxedema Coma |
| severe hyperthyroidism can result in | Thyroid Crisis |
| severe hyperthyroidism/hypothyroidism can result in | thyroid cancer |
| Myxedema Coma is caused by | long-standing hypothyroidism or precipitated by infection, MI, cold exposure, sedative drugs |
| Myxedema Coma is a | Rare, Life threatening, High mortality rate |
| (betty said know this) Myxedema Coma is characterized by | Impaired cognition and coma Hypoventilation Bradycardia/low cardiac output/ hypotension Hyponatremia Hypoglycemia Lactic acidosis Hypothermia |
| management of Myxedema Coma | Thyroid hormone replacement Maintaining airway, O2 support Correction of hypothermia (heated blanket) Administration of IV fluid, electrolytes and glucose Addressing precipitating factors Vasopressors if needed for hypotension (if needed) |
| thyroid crisis (thyroid storm) is a | Rare, life threatening condition |
| thyroid crisis results in | Sudden, excessive increase in signs and symptoms of hyperthyroidism |
| thyroid crisis is seen in | undiagnosed hyperthyroidism |
| thyroid crisis is often precipitated by | infection, physical or emotional trauma, manipulation of thyroid during surgery |
| thyroid crisis diagnosis is based upon | clinical findings |
| management of thyroid crisis | Fluids, glucose and electrolyte replacement Place in room limited stimulation Beta blocker Anti-thyroid med Iodine solution after initiation of anti-thyroid medication (block hormone release) Hypothermia blanket, ice packs, acetaminophen O2 therapy |
Created by:
leh195