nizmos71's 2016-04-09 06:58
What is Hashimotos thyroiditis Gradual thyroid failure w/ or w/out goiter.
Death of thyroid epithelial cells
Destruction leads to decreased T3 and T4
Most common cause of hypothyroidism.
Causes for Hashimotos Autoimmune.
Risks for Hashimotos family hx, older, Caucasian, Female, Other autoimmune disorders
S/Sx for Hashimotos Similar to Goiters, Hypothyroidism sx's (fatigue, contipation wt gain, puffy face), Diff swallowing, depression
Tx for Hashimotos NSAIDS, Corticosteroids, surgical drainage of goiter, synthetic hormones.
Labs for Hashimotos Low T3 and T4 and increased TSH
Major Complications Goiters, mental halth issues, Myexdma (skin swelling), addisons, graves, pernicious anemia
Goiter and Graves
What is a goiter Enlarged thyroid gland, results in hypo or hyperthyroidism,
What causes goiter Lack of iodine, In U.S.A. r/t underproduction of thyroid hormones, nodules in the gland itself (goiterogens).
Risk factors for goiter femate, age, hx of autoimmune, low iodine diet, preg and menopause, meds, radiation
S/Sx for goiter throat tightness, cough, hoarsness, dysphagia, dyspnea
Tests TSH and T4, Thyroid peroxidase (TPO) antibody (antiboies that exist if you have thyroiditis), bx
Tx tyroid hormones, surgery to remove goiter, ASA, iodine, Goitrogens foods.
What is Graves disease Thyroid overproduction of hormones and antibodies atack thyroid and produce excess thyroxine causing thyroid swelling
Labs for Graves vs Goiter Lower TSH and High serum thyroid hormone
What is hypothyroidism thyroid gland not producing enough thyroid hormone leading to slow metabolic rate.
Primary HypoThy Destruction of thyroid tissue or decreased hormone synthesis (Increased TSH)
Secondary HypoThy Pituitary/hypothalmic dysfunction (decreased TSH)
2 common causes A) Ongoing inflammation of thyroid gland leading to (l/t) large percentage of thyroid gland cells damaged l/t decreased hormone production (i.e. Hashimotos). B) tx of hyPERthyroidism w/ surgery l/t post post decreased thyroid production (OVERCORRECTION from surgery).
S/Sx (think everything slows down) fatigue, bradycardia, weight gain, coarse/dry hair, hairloss, cold intolereance, muscle cramps, constipation, depression, irritability, memory loss, abn menstrual cycle.
Complication Myexdema (thyroid storm = coma, low temp, hyPOtension, HyPOventilation, MEDICAL EMERGENCY), cardiac problems, goiter, neuropathy.
Risk factors women >60, autoimmune, fam hx, thyroid surg, radiation, preg.
Dx H&P, TSH and T4, thyroid antibodies, increase cholesterol-triglycerides-CK, decrease in RBC
Tx L Low calorie diet, levotyroxine
What is Hyperthyroidism Hyperactivity of thyroid glands. sustained increase and release if thyroid hormones
Most common form Graves dz = 80% of cases (diffuesed thyroid enlargement and excessive thyroid hormone secreation),
Other causes Toxic nodular goiter, thyroiditis (e.g. Hashimotos), too much iodine intake, pituitary tumors, thyroid CA
S/Sx sudden wt loss w/o trying, tachycardia w/ arrhythmia + palpitations, increased appetite, nervousness, tremor, sweating, change in menstrual patterns-bowl patterns, goiter, fatigue, diff sleeping, skin thinning, brittle hair.
Complications THYROID STORM (Emergency)
WTF is Thyroid storm excessive hormones released in the body.
Causes hyperthyroidism, truma, injury from thyroidectomy,
S/Sx severe tachycardia, hyperthermia (105.3) restlessness, shock, seizures, delirium, vomiting.
Tx for Storm in ICU, meds to block thyroid hormone production, Beta Adrenergic Receptor Blockers.
Nx considerations monitor dysrhythmias, and F&E imbalance/fever.
Risk Factors chicks 20-40, Graves Dz, infection, stressful life event, genes smoking
Dx TSH decrease, free T4 increase, Radioactive Iodine Uptake (RAIU) helps differentiates from Graves.
Tx Meds (antithyroid, iodine, beta blockers), Radioactive iodine therapy, surgery (thyroidectomy), high calorie diet (4-5 Kcal/day).
What Is acromegaly Too much GH. 40-45 y/o
Cause benign pituitary tumor ( adenoma)
Patho too much GH secretion l/t overgrowth in soft tissue bones (hands, feet, face. No arms and legs). If happens in adolescence, result will be gigantism
S/Sx Big/thick everything, slanting forehead, lower body muscle weakness and periphreal neuropathy, HA, visual issues, INCREASED Insulin l/t hyperglycemia l/t DM (polydipsia and polyurea), free fatty acids (think atherosclerosis).
Dx Oral glucose tolerance test (OGTT), MRI, CT w/ contrast to detect pituitary tumor.
Tx goal to return back to normal GH levels, surgery (hypophysectomy), radiation therapy, drug therapy or combo.
What is hypopituitarism decrease in one or more of the tropic hormones, pituitary hormones are sent as messengers to the endocrine glands.
most common hormone deficiencies GH and Gonadotropins (LH, FSH).
Causes Most likely pituitary tumor (ademona)
Dx H&P, MRI, CT (ID tumor) Labs to measure TSH
Tx Surgery ro radiation to remove tumor, lifelong hormone therapy. GH replacement (sub q in the pm), estrogen + progesterone replacement, testosterone.
Hyperaldosteroneism (Conn's disease) "Conn's dx"
What is hyperaldosteronism Adrenal gland makes too much aldosterone
Primary Hyper Ald Unilateral or BL hyperactivity if the adrenal glands cause by samll benign tumor
seconday Hyper Ald renin secreting tumors, CKD, or renal artery stenosis.
S/Sx Hypernatremia l/t HTN and HA, Hypokalemia l/t weakness, fatigue, arrhythmias, glucose intolerace, HypoKalemic alkalosis, l/t hypoCalcemic tetany, Activation of RAAS = HTN, vasocontriction, sodium retention.
Dx Labs workup: Low K, high Na+, High serum and urin aldosterone, low plasma renin, ABG, CT scan of adrenal mass, ECG abnormalities r/t low K+.
Tx Surgery (adrenalectomy) , Meds (calcium channel blockers- htn meds, K sparing diuretics, dexamethasone, and K+ sparing diuretics = decreased renal hyperplasia, aminoglutethimide (blocks aldosterone synthesis)
What is hemochromocytoma rare condition. Tumor in adrenal medulla causing chromaffin cells overproduction of cathecolamines (epi and noreepi) l/t severe htn. Attackes precipitated by Anti Htn meds, poiods, and contrast media.
Complications Htn encephalopathy, DM, cardiomyopathy
S/Sx PHE!!! Palpitations, Headache, Episodic sweating (diaphoresis), maybe abd pain.
Dx 24 hr urine looking for catecholamines and catecholmaine metabolites (metanephrine)
Tx Surgery w/ BP meds (alpha and beta adrenergic blockers). Metyrosin (Demser) to decrease catecholamine production.
Desc of cushings chronic exposure to excess cotricosteroids.
Causes exogenous corticosteroids (ex. Prednisone). Most common
Causes Endogenous ACTH secreting pituitary adenoma (cushings dz) 85% of endogenous cause. Adrenal tumor (both common in chicks 20-40). Ectopic ACTH tumors (lungs or pancreas- common in men).
Clinical manifestations Centripetal (truncal) or generalized obesity, Moon face, purple-red striae on abd/breast/butt, Hirusutism and menstrual disorder, HTN, unexplained Low K+.
Dx elevated plasma cortisol levels with diurnal variations, 24 hr urine collection for free cortisol >120 (normal is 80 - 120 mcg/24hr), CT and MRI or pituitary and adrenal gland.
Collab care Pituitarty adenoma (transsphenoid resection, radiation therapy), Adrenocortical adenoma/carcinoma/hyperplasia (ectomy and drug therapy), Ectopic ACTH secreting tumor (surgery removal), Exogenous corticosteroid therpay (d/c or change dose)
Addision Dz (JFK Had this) opposite of Cushings Dz.
What is addisons dx insufficient amounts of certain hormones produced by your adrenaral glands
Cause US= Autoimmune, worldwide =TB, Infarction, fungal, AIDS, CA, <60 y/o both genders.
S/Sx not evident intil 90% adrenal cortex is gone. INSIDIOUS onset, progressive weakness, fatigue, wt loss, anorexia, bronze skin.
Dx Depressed cortisol levels in urine and serum, increased ACTH in primary insufficiency, Decreased ACTH in secondary. Low Aldosterone and free cortisol in the urine, Increased K+, Low CL-, low Na+, Low glucose, anemia, increased BUN, ECG= low voltage and peaked T waves, CT/MRI
Collab Care Caily glucocorticoid replacement, daily mineralcorticoid, salt additives
addisonian crisis (LIFE THREATENING ADRENAL INSUFFICIENCY)
Triggers Stress, sudden withdrawal of corticosteroid hormone therapy, adrenal surgery or sudden pituitary glad destruction.
Manifestations HypOtension (l/t shock), tachycardia, dehydration, Low Na+ , High K+, low sugar, fever, weakness, confusion, Severe vomiting/diarrhea, and abd pain, lower back or legs pain.
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