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47 Cards in this Set

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The Endocrine System?
-The endocrine system is a complex network of glands, hormones, and receptors
What else about the endocrine system?
-Provides key communication and control link between the NS and Bodily FXNS such as reproduction, immunity, metablolism, and behavior
-The NS works in TANDEM with the endococrine system to control all bodily fxns and processess
6 Essential Hormone FXNS?
-DIFFERENTAION of reproductive and CBS in the developing fetus
-STIMULATION of sequential growth and development during childhood and adolescence
-COORDINATION of male and female reproductive systems, which makes sexual reproduction possible
-MAINTENANCE of an optimal internal enviornment t/o the life span
-INITIATION of collective adaptive responses when emergency demands occur
-REGULATION of responses(in conj with CNS) to the internal and external enviornment
Throid anatomy?
-15-20 gms
-The Thryorid secretes moslty T4 and very little T3
-Iodine is essential to maintain euthroid fxn
FXN of Thyroid hormone?
-Diurnal pattern
-Increases metabolic rate and protein synthesis
-Inc bone, protein, and fat turnover
-Increases response to catecholamines
-Nec for fetal and infand G and D
FXNS of Thyroid Gland cont:
-Metabolic rate
-CV/respiratory fxn
-GI FXN
-NM effects
notes pg 2
Goiter?
-increase in size of thyroid
-usu palpable
-can occur in hypothyroid, euthyroid, hyperthyroid states
-diffused or nodular
-hypertrophy of tissue from thyroid hormone out malfunction
What can Goiters do?
* Large goiters can compress the esophagus, trachea, superior vena cave in extreme cases!
Hypothyroidism?
-Congenital
-prev cause of mental retard
-1:5000 births
Due to lack of thyroid gland or insufficient prod of hormone (TH or TSH)
-Infants may appear normal at first due to maternal hormones
-Results in CRETINISM
Causes of Hypothyroidism?
-Pituitary
-Hypothalamic dysfn
-Post-menopausal women (Commonly seen)
Signs and sxms of Cong. hypothyroidism?
-Mental retard
-Growth impair
-Poor psycomotor development
Labs of Hypothyroidism?
-Thyroxine (T4) is low to normal
-TSH is high
-Increased serum chol, liver enzymes, creatine kinase, hypoglycemia, and anemia
Tx for hypothyroidism?
Levothyroxine(T4)
-take in am with water and no food or Fe+++
-initial dose 50-100 MCG daily
-SUPP contiues for life!
Thryoiditis?
-Inflammation of the thyroid gland
-May occur post pregnancy
-Hashimotos Thyroiditis
Hashimoto's Thyroiditis?
-**Most common form of Thyroiditis
-Most common thyroid disorder in US
-Familial
-Greater in Women
-Freq increased by dietary iodine supplements and some medications
Hashimoto's Thyroiditis signs and sxms:?
-Diffuse PAINLESS ENLARGEMENT of thyroid gland
-Depression, chronic fatigue
-Neck tightness, dry mouth
-Lost of natural skin lub with sebum
What does Hashimotos progress to?
Lab findings too?
-Transient hyperthyroidism

follow with serial labs
Labs:
Increased circulation levels of anti thyroid peroxidase
-Increased levels of anti-thyroglobulin
Tx of Hashimoto's?
-if hyperthyroid is present tx with Propanalol then once conv to hypothyroid state = Levothyroxine
Myxedema Coma?
-Hypothyroidism with edema due to infiltration of a glycosaminoglycan that traps H20 into connective tissue and dermis.
Signs and symptoms:
-Hypothermic, stuperous state with dull expressionless face, sparce hair, periorbital puffiness, large tongue, and pale, doughy, cool skin
-Brought on by illness or cold exposure
*Severe form of hypothyroidism
Hyperthyroidism?
-Tactile temp
-Elevated heart rate
-Anxious/Nervous
-Diarrhea
-WT loss
-Palpatations
-Menstrual irregularities
Physical:
-warm,moist skin
-Tachycardia
-A fib**
-Exophthalmia
-Eyelid lag or staring
-Fine tremor
-+/- Goiter
-Chronic, long term can reslut with Osteoporosis
DX Hyperthyroidism?
-Increased T3 and T4
-Decreased TSH
-RAIU
-CT scan and US
Unusual causes of Hyperthyroidism?
-TSH secreting tumors
-Normal pregnancy
-Amiodarone, radiographic contrast media, iodine preps
Grave's DZ?
-Occurs at any age, freq middle age
-AUTOIMMUNE DZ with anti-microsomal and anti-thyroglobulin antibodies
-*Most common casue of hyperthyroidisn-80% of all cases
What is the most common cause of
Hyperthyroidism?
Grave's DZ
Myxedema coma is what type of thryoidism?
Hypothyroidsim
What else can you find with Grave's DZ?
-Thyroid bruit
-Visual disturbances, dry eyes
-Pretibial edema(swollen shins)
-Diffuse overactivity of thyroid(Radioiodine scan)
2 important clinical manifestations with Grave's dz?
-Exophthalmoses
-Pre-tibial Myxedema
TX for Grave's?
-Propanolol for symptomatic relief
-Tapizol
-PTU *DOC for Hyperthyroid!
-Iodated contrast agents work by blocking conversion of T4 and T3 (Telepaque, Bilvist)
-Radiation (Radiated Iodine)
-Surgery
Complications of Thyrotoxicosis?
-Cardiac (Tachy, A-fib)
-Decreased libido, impotence, decreased sperm count and gynecomastia
-Osteoporisis
Complications of Grave's:
Thyroid Storm?
-Life threatining complication
-Occurs post physiologic stress
(DKA, emotional stress, trauma, surgery, infxn, labor)
-High mortality
SXMS of Thyroid Storm?
-Tachycardia, AFIB
-Fever
-Confusion
-agitation
-Psychosis
-NV, diarrhea
TX for Thryoid storm?
PTU, Methimazole, Ipodate, Iodine
Subacute Thyroiditis?
AKA de Quervains Thyroiditis
-acute fever with rapid thyroid enlargement
-VERY PAINFUL thyroid**
-Young and middle age women
-Dysphagia, pain may radiate to pts ears
-usu follows viral infxn
Subacute Thyroiditis labs?
-ESR very elevated
-Low anti-tyroid antibodies
-Radioactive iodine uptake low
-asp biopsy reveals granulomatous infiltratio and inflammation
-Low T4/T3
-Euthroid then hypothyroid
Subacute Throiditis tx?
Empirical
-Aspirin 325 mg Q6
-Propanalol 10-40mg Q6
-Sodium Ipodate or Iopanoic acid daily until T4 levels normalize
Levothroxine if symptomatic
Solitary nodules?
-most often ja benign adenoma, nodule or cyst
-Occ a primary thyroid malignancy
-Need to work up for malignancy
#1 cause of Thyroid CA?
Radiation!
A cancerous nodule is?
-non-tender
Low level of suspicion for Thyroid nodules?
-HX family, hyper, hypo
-older women, elderly
-soft nodules-multi nodular
-TSH low or high would help rule out CA
-Thyroid antibodies
-Fine needle aspiration biopsy: Nodule or adenoma
-Thyroxine TX
-Hot nodule is a good sign**
High level of suspicion for Tyroid nodules?
-Rad tx
-Family hx thyroid ca/dz
--Dysphonia with nodule
-young adults
-male
-hard, painless, immobile tyroind nodule
-Thyrotoxicosis
Thyroglobulin is a marker for?
Thyroid CA
Ultrasound?
-determine palpable nodule is solitary or one of many underlying nodules
-directs fine needle aspiration bx
-determine solid vers cystic mass
Papillary carcinoma 75% least aggresive =
Indolent(slow growing)
Anaplastic carcinoma 5%
worst one
Cold nodule?
Malignancy
TX for thyroid Ca?
-Thyroidectomy
-Radioactive iodine (I 131)
-Rad tx
-Brain metastasis-Gamma knife
Multi-nodular goiters?
Usually benign
-Caused by
iod def
preg
graves
Hasimoto
sub acut thyroiditis
infns
-Usu not symptomatic
if it is:
-Propanalol
-Thyroidctomy
-Radioactive Iodine 131