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nizmos71's version from 2016-04-09 06:58


Question Answer
What is Hashimotos thyroiditisGradual 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 HashimotosAutoimmune.
Risks for Hashimotosfamily hx, older, Caucasian, Female, Other autoimmune disorders
S/Sx for HashimotosSimilar 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 HashimotosLow T3 and T4 and increased TSH
Major ComplicationsGoiters, mental halth issues, Myexdma (skin swelling), addisons, graves, pernicious anemia

Goiter and Graves

Question Answer
What is a goiterEnlarged thyroid gland, results in hypo or hyperthyroidism,
What causes goiterLack of iodine, In U.S.A. r/t underproduction of thyroid hormones, nodules in the gland itself (goiterogens).
Risk factors for goiterfemate, age, hx of autoimmune, low iodine diet, preg and menopause, meds, radiation
S/Sx for goiterthroat tightness, cough, hoarsness, dysphagia, dyspnea
TestsTSH and T4, Thyroid peroxidase (TPO) antibody (antiboies that exist if you have thyroiditis), bx
Txtyroid hormones, surgery to remove goiter, ASA, iodine, Goitrogens foods.
What is Graves diseaseThyroid overproduction of hormones and antibodies atack thyroid and produce excess thyroxine causing thyroid swelling
Labs for Graves vs GoiterLower TSH and High serum thyroid hormone


Question Answer
What is hypothyroidismthyroid gland not producing enough thyroid hormone leading to slow metabolic rate.
Primary HypoThyDestruction of thyroid tissue or decreased hormone synthesis (Increased TSH)
Secondary HypoThyPituitary/hypothalmic dysfunction (decreased TSH)
2 common causesA) 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.
ComplicationMyexdema (thyroid storm = coma, low temp, hyPOtension, HyPOventilation, MEDICAL EMERGENCY), cardiac problems, goiter, neuropathy.
Risk factorswomen >60, autoimmune, fam hx, thyroid surg, radiation, preg.
DxH&P, TSH and T4, thyroid antibodies, increase cholesterol-triglycerides-CK, decrease in RBC
Tx L Low calorie diet, levotyroxine


Question Answer
What is HyperthyroidismHyperactivity of thyroid glands. sustained increase and release if thyroid hormones
Most common formGraves dz = 80% of cases (diffuesed thyroid enlargement and excessive thyroid hormone secreation),
Other causesToxic nodular goiter, thyroiditis (e.g. Hashimotos), too much iodine intake, pituitary tumors, thyroid CA
S/Sxsudden 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.

Thyroid Storm


Question Answer
ComplicationsTHYROID STORM (Emergency)
WTF is Thyroid stormexcessive hormones released in the body.
Causeshyperthyroidism, truma, injury from thyroidectomy,
S/Sxsevere tachycardia, hyperthermia (105.3) restlessness, shock, seizures, delirium, vomiting.
Tx for Stormin ICU, meds to block thyroid hormone production, Beta Adrenergic Receptor Blockers.
Nx considerationsmonitor dysrhythmias, and F&E imbalance/fever.
Risk Factorschicks 20-40, Graves Dz, infection, stressful life event, genes smoking
DxTSH decrease, free T4 increase, Radioactive Iodine Uptake (RAIU) helps differentiates from Graves.
TxMeds (antithyroid, iodine, beta blockers), Radioactive iodine therapy, surgery (thyroidectomy), high calorie diet (4-5 Kcal/day).

Acromegaly (Giganitism)


Question Answer
What Is acromegalyToo much GH. 40-45 y/o
Causebenign pituitary tumor ( adenoma)
Pathotoo 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/SxBig/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).
DxOral 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.


Question Answer
What is hypopituitarismdecrease in one or more of the tropic hormones, pituitary hormones are sent as messengers to the endocrine glands.
most common hormone deficienciesGH and Gonadotropins (LH, FSH).
CausesMost likely pituitary tumor (ademona)
DxH&P, MRI, CT (ID tumor) Labs to measure TSH
TxSurgery 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"

Question Answer
What is hyperaldosteronismAdrenal gland makes too much aldosterone
Primary Hyper AldUnilateral or BL hyperactivity if the adrenal glands cause by samll benign tumor
seconday Hyper Aldrenin secreting tumors, CKD, or renal artery stenosis.
S/SxHypernatremia 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.
DxLabs 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+.
TxSurgery (adrenalectomy) , Meds (calcium channel blockers- htn meds, K sparing diuretics, dexamethasone, and K+ sparing diuretics = decreased renal hyperplasia, aminoglutethimide (blocks aldosterone synthesis)


Question Answer
What is hemochromocytomarare 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/SxPHE!!! Palpitations, Headache, Episodic sweating (diaphoresis), maybe abd pain.
Dx24 hr urine looking for catecholamines and catecholmaine metabolites (metanephrine)
TxSurgery w/ BP meds (alpha and beta adrenergic blockers). Metyrosin (Demser) to decrease catecholamine production.


Question Answer
Desc of cushingschronic exposure to excess cotricosteroids.
Causes exogenouscorticosteroids (ex. Prednisone). Most common
Causes EndogenousACTH 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 manifestationsCentripetal (truncal) or generalized obesity, Moon face, purple-red striae on abd/breast/butt, Hirusutism and menstrual disorder, HTN, unexplained Low K+.
Dxelevated 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 carePituitarty 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.

Question Answer
What is addisons dxinsufficient amounts of certain hormones produced by your adrenaral glands
CauseUS= Autoimmune, worldwide =TB, Infarction, fungal, AIDS, CA, <60 y/o both genders.
S/Sxnot evident intil 90% adrenal cortex is gone. INSIDIOUS onset, progressive weakness, fatigue, wt loss, anorexia, bronze skin.
DxDepressed 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 CareCaily glucocorticoid replacement, daily mineralcorticoid, salt additives


Question Answer
TriggersStress, sudden withdrawal of corticosteroid hormone therapy, adrenal surgery or sudden pituitary glad destruction.
ManifestationsHypOtension (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.