Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
77 Cards in this Set
- Front
- Back
|
Thyrotropin-releasing hormone (TRH) is secreted by the _____________.
|
Thyrotropin-releasing hormone (TRH) is secreted by the hypothalamus
|
|
|
Thyrotropin-releasing hormone (TRH) is secreted by the hypothalamus and stimulates the _______ ________ to synthesize and release ____________
|
Thyrotropin-releasing hormone (TRH) is secreted by the hypothalamus and stimulates the anterior pituitary to synthesize and release thyrotropin, which is commonly referred to as thyroid-stimulating hormone or TSH.
|
|
|
Thyrotropin is commonly referred to as _______ ________ hormone or (xxx).
|
Thyrotropin is commonly referred to as thyroid-stimulating hormone or TSH.
|
|
|
TSH**
|
Thyroid-stimulating Hormone = TSH
|
|
|
delete
|
delete
|
|
|
The released TSH stimulates the thyroid gland to synthesize and secrete the thyroid hormones -- ______ and ______________.
|
The released TSH stimulates the thyroid gland to synthesize and secrete the thyroid hormones --- thyroxine and tri-iodo-thyronine.
|
|
|
thyroxine and tri-iodo-thyronine, often abbreviated as __-__ and __-__ respectively
|
thyroxine and triiodothyronine, often abbreviated as T-4 and T-3 respectively
|
|
|
_________and _________ often abbreviated as T-4 and T-3 respectively
|
thyroxine and triiodothyronine, often abbreviated as T-4 and T-3 respectively
|
|
|
thyroxine = T-___
|
thyroxine and triiodothyronine, often abbreviated as T-4 and T-3 respectively
|
|
|
triiodothyronine,= T-____
|
thyroxine and triiodothyronine, often abbreviated as T-4 and T-3 respectively
|
|
|
Approximately _____ % of the circulating T-3 is derived from the hepatic conversion of T-4 to T-3.
|
Approximately _____% of the circulating T-3 is derived from the hepatic conversion of T-4 to T-3.
|
|
|
Approximately 80 % of the circulating thyroxine is derived from the hepatic conversion of T-4 to T-3.
|
Approximately 80 % of the circulating thyroxine is derived from the _______ conversion of T-4 to T-3.
|
|
|
Biologically, T-___ is about 4 times more potent than T-____.
|
Biologically, T-3 is about 4 times more potent than T-4.
|
|
|
Biologically, T-3 is about ____ times more potent than T-4.
|
Biologically, T-3 is about 4 times more potent than T-4.
|
|
|
normal euthyroid state, where _____ is secreted by the pituitary gland and stimulates the ______ to release T-4 and T-3, which in turn feedsback negatively on pituitary _____ secretion.
|
normal euthyroid state, where TSH is secreted by the pituitary gland and stimulates the thyroid gland to release T-4 and T-3, which in turn feedsback negatively on pituitary TSH secretion.
|
|
|
situation where the thyroid gland is failing to secrete adequate amount of T-4 and T-3. The resulting lower serum concentrations of thyroid hormones have impaired their negative feedback on pituitary TSH release. Therefore, serum TSH concentrations will rise progressively as thyroid gland failure advances in severity. This is referred to as _______ _______ _________
|
The situation where the thyroid gland is failing to secrete adequate amount of T-4 and T-3. The resulting lower serum concentrations of thyroid hormones have impaired their negative feedback on pituitary TSH release. Therefore, serum TSH concentrations will rise progressively as thyroid gland failure advances in severity. This is referred to as primary gland failure.
|
|
|
Primary Thyroid Gland failure = thyroid gland failing to secrete adequate T-4 and T-3. then lower concentrations of thyroid hormones impairs _____________ and serum _____ concentrations rise progressively .
|
Primary Thyroid Gland = the thyroid gland is failing to secrete adequate T-4 and T-3. then lower concentrations of thyroid hormones impairs negative feedback and serum TSH concentrations rise progressively .
|
|
|
_______ Gland Failure is situation where the _____ ________ gland is losing its capacity to secrete _____.
|
Pituitary Gland Failure is situation where the anterior pituitary gland is losing its capacity to secrete TSH.
|
|
|
Diminishing TSH leads to diminishing T-4 and T-3 then to overt hypothyroidism = called _______ or _________ hypothyroidism.
|
Diminishing TSH leads to diminishing T-4 and T-3 then to overt hypothyroidism = called central or secondary hypothyroidism.
|
|
|
Graves Disease = where the thyroid gland is autonomously secreting ________ amounts of T-4 and T-3; due a diffusely _______ gland,
|
Graves Disease = where the thyroid gland is autonomously secreting excessive amounts of T-4 and T-3; due a diffusely enlarged gland,
|
|
|
Common name for Grave's Disease =
|
Common name for Grave's Disease = Toxic goiter
|
|
|
Whether Grave's disease ( ie. toxic goiter) ot ________ ________ , T-4 and T-3 are secreted in excessive amounts which suppresses _____ secretion
|
Whether Grave's disease ( ie. toxic goiter) or _Discreet nodules , T-4 and T-3 are secreted in excessive amounts which suppresses TSH secretion
|
|
|
The synthesis of _______ and tri-iodo-thyronine and the thyroid uptake of _______ iodide are significantly reduced in the elderly.
|
The synthesis of thyroxine and triiodothyronine and the thyroidal uptake of radioactive iodide are significantly reduced in the elderly.
|
|
|
Because the decreased ______ of thyroid is balanced by decreased ________ , the net effect is ______ concentrations in the elderly.
|
Because the decreased synthesis of thyroid is balanced by decreased degradation, the net effect is normal concentrations in the elderly.
|
|
|
The elimination half-life of thyroxine in the elderly is about __ days compared to ___ days in younger persons.
|
The elimination half-life of thyroxine in the elderly is about 9 days compared to 7 days in younger persons.
|
|
|
With levothyroxine replacement therapy in elderly, protracted half-life of ____ days mandates about ___ to ____ week of therapy to achieve a _______ ________ __________
|
With levothyroxine replacement therapy in elderly, protracted half-life of 9 days mandates about 4 - 6 week of daily therapy to achieve steady-state serum concentration.
|
|
|
It is best to evaluate the effects of a dosage adjustment in levothyroxine,. only after ______ weeks of continuous use.
|
It is best to evaluate the effects of a dosage adjustment in levothyroxine,. only after 4 - 6 weeks of continuous use.
|
|
|
The capacity inactivate thyroxine continuously declines c ageing , therefore levo-thyroxine dose will need to be ________ _______ as the patient advances in age.
|
The capacity inactivate thyroxine continuously declines c ageing , therefore levo-thyroxine dose will need to be adjusted downward as the patient advances in age.
|
|
|
Thyrotoxicosis = _____ _______ concentrations of thyroxine (T-4) and triiodothyronine (T-3) ; due to a __________ gland or inability to __________ _______ ________.
|
Thyrotoxicosis = elevated serum concentrations of thyroxine (T-4) and triiodothyronine (T-3) ; due to a hyperfunctioning gland or inability to store thyroid hormone.
|
|
|
hyperfunctioning gland is called ___________ism.
|
hyperfunctioning gland = (hyperthyroidism)
|
|
|
Iinability to store preformed thyroid hormones is ___________
|
Iinability to store preformed thyroid hormones = (thyroiditis)
|
|
|
Thyrotoxicosis occurrence in the general population, up to ___% of women and ____ % of men; prevalence in the elderly , regardless of gender is ________ %.
|
Thyrotoxicosis occurrence in the general population, up to 2% of women and 0.2% of men; prevalence in the elderly , regardless of gender is 0.2 – 0.3 %.
|
|
|
Hypo-thyroidism: Low serum concentrations of _______ and _________ due to a ______-functioning thyroid gland.
|
Hypo-thyroidism: Low serum concentrations of thyroxine and tri-iodo-thyronine due to a hypofunctioning thyroid gland.
|
|
|
Prevalence of hypothyroidism in patients over 60 yrs was _____ % in women and _____ % in men.
|
Prevalence of hypothyroidism in patients over 60 yrs was 5.9 % in women and 2.3 % in men.
|
|
|
________ hypothyroidism is the most common cause in the younger general population.
|
Autoimmune hypothyroidism is the most common cause in the younger /general population
|
|
|
The incidence of ______- thyroidism increases with age but the risk of ________ type decreases
|
The incidence of hypothyroidism increases with age but the risk of autoimmune type decreases
|
|
|
Initial screening : If an abnormal serum TSH is found, follow-up with an ______ or serum free T-4 and a total ______.
|
Initial screening : If an abnormal serum TSH is found, follow-up with an unbound or serum free T-4 and a total T-3.
|
|
|
______ _______T-4 (reflecting mostly bound T-4) is not useful in the elderly because of significant ______ _______
|
Total serum T-4 (reflecting mostly bound T-4) is not useful in the elderly because of significant serum binding .
|
|
|
_____ ______, _____ _______ and ___________effect the production of thyroxine binding proteins.
|
Protein malnutrition, chronic illness and medications effect the production of thyroxine binding proteins.
|
|
|
Protein malnutrition, chronic illness and medications effect the production of _______ ________ _________.
|
Protein malnutrition, chronic illness and medications effect the production of thyroxine binding proteins.
|
|
|
Serum total T-3 concentrations are not helpful in diagnosing hypothyroidism because :
|
Serum total T-3 concentrations are not helpful in diagnosing hypothyroidism because : many non-thyroidal illnesses or conditions decrease its concentration.
|
|
|
Serum TSH levels are not useful in suspected hypothyroid patients who have _______ ________ ________.
|
Serum TSH levels are not useful in suspected hypothyroid patients who have underlying pituitary dysfunction.
|
|
|
TMNG**
|
Toxic multinodular goiter (TMNG)
|
|
|
Reactive hyperthyroidism can occur in patients with underlying _____ _______ _______ when given iodide containing medications .This is called the ______________ effect.
|
Reactive hyperthyroidism can occur in patients with underlying nontoxic multinodular goiter when given iodide containing medications . This is called the Jod-Basedow effect.
|
|
|
6 ( six) symptoms of hyperthyroidism :
|
6 Symptoms of hyperthyroidism : Hyperactivity , Irritability , Heat intolerance/ sweating, Palpitations, Fatigue/ weakness , Loose stools
|
|
|
6 Signs of hyperthyroidism:
|
Signs of hyperthyriodism : Tachycardia, Tremor , Warm / moist skin , Stare , Goiter , Proximal muscle dysfunction (both upper and lower limbs)
|
|
|
Many aged patients who are hyperthyroid exhibit ( vague) symptoms including - ______, ______loss, _______ and ___________ wasting referred to as _______ or "apathetic” form of the disease.
|
Many aged patients who are hyperthyroid exhibit ( vague) symptoms including - anorexia, weight loss, weakness and proximal muscle wasting referred to as “masked” or "apathetic” form of the disease.
|
|
|
Cardiac signs may be the only hyperthyroidism signs present; including _____ _______, _______ and _________ heart failure
|
Cardiac signs may be the only hyperthyroidism signs present; including atrial fibrillation, angina and refractory heart failure
|
|
|
Thyrotoxic atrial fibrillation should be treated with ________ to avoid the risk of _______ events.
|
Thyrotoxic atrial fibrillation should be treated with anti-coagulants to avoid the risk of embolic events
|
|
|
Psychiatric manifestations of _____, _________, and _________ may predominate in aged patients.
|
Psychiatric manifestations of confusion, agitation and dementia may predominate in aged patients.
|
|
|
Hyperthyroidism accelerates ______ _______in the elderly and may lead to severe _________ with an attendant risk of ___________.
|
Hyperthyroidism accelerates bone loss in the elderly and may lead to severe osteoporosis with an attendant risk of fractures
|
|
|
In the majority of aged pat. the thyroid gland ( is / is not ) palpable...
|
In the majority of aged patients the thyroid gland is non-palpable
|
|
|
(true or false) Eye signs , ie Stare , is often present in the elderly.
|
( false) Eye signs , ie Stare , is often ABSENT in the elderly.
|
|
|
The treatment of choice for elderly patients with either Graves' disease or toxic multinodular goiter is ______ ________.
|
The treatment of choice for elderly patients with either Graves' disease or toxic multinodular goiter is radioactive iodide
|
|
|
How does radioactive Iodide work to result in euthyroid and how long does it take to induce euthyroid???
|
Once incorporated in the thyroid gland, radioactive iodide slowly destroys it, requiring from 6-18 weeks to induce an euthyroid state.
|
|
|
______ gland inflammation and _______ pain are potential adverse effects of radioactive iodide
|
Salivary gland inflammation and neck pain are potential adverse effects of radioactive iodide
|
|
|
Iodides ( usually SSKI ) are administered prior to surgery in order to reduce ____ _____ __ ____ _____.
|
Iodides ( usually SSKI ) are administered prior to surgery in order to reduce the vascularity of the thyroid gland.
|
|
|
Surgery is rarely performed in elderly patients, but may be necessary for patients with toxic goiters causing ____ _______ or _________ _________.
|
Surgery is rarely performed in elderly patients, but may be necessary for patients with toxic goiters causing airway obstruction or swallowing problems.
|
|
|
( 2 types of blood pressure medications ) used to attenuate some of the sympathomimetic-like features of hyperthyroidism.
|
Beta-adrenergic blockers or calcium channel blockers may be used to attenuate some of the sympathomimetic-like features of hyperthyroidism.
|
|
|
Beta-blockers or calcium channel blockers may be used to attenuate some of the ______________ features of hyperthyroidism.
|
Beta-blockers or calcium channel blockers may be used to attenuate some of the sympathomimetic-like features of hyperthyroidism.
|
|
|
2 examples of thioamides used in hyperthyroidism are:
|
2 examples of thioamides used in hyperthyroidism are: Methimazole and propylthiouracil
|
|
|
PTU**
|
propylthiouracil
|
|
|
_________ are inhibitors of biosynthesis of thyroxine and triiodothyronine and usually _____ weeks ; ....Once euthyroid, ______ _______ doses are needed.
|
Thioamides are inhibitors of biosynthesis of thyroxine and triiodothyronine and usually 6 weeks ; ....Once euthyroid, smaller maintenance doses are needed.
|
|
|
Large thioamide requirements suggest ______ _________.
|
Large thioamide requirements suggest poor compliance
|
|
|
The following are rare but significant adverse possibilities with PTU: (4 )
|
The following are rare but significant adverse possibilities with PTU: agranlulocytosis, hepatitis, Hypo-prothrombinemia, and Lupus.
|
|
|
The following are rare but significant possible adverse reactions to methimazole: (2)
|
The following are rare but significant possible adverse reactions to methimazole: agranulocytosis, and Cholestatic jaundice
|
|
|
Common side effects of tioamides include: (7)
|
Common side effects of tioamides include: RASH,URTICARIA,ARTHRALGIA,ARTHRITIS, FEVER, MYALGIAS, NAUSEA/VOMITING
|
|
|
Why ? use thioamides to induce euthyroid prior to radioactive iodide ??
|
Radiation-induced thyroiditis is sometimes a complication of radioactive iodide ; from uncontrolled release of stored thyroid hormones ,ie. a brief worsening of the thyrotoxic state.
|
|
|
Elderly patients with hyperthyroidism due to Graves' disease or toxic multinodular goiter can be restored to a euthyroid state with _________ alone.
|
Elderly patients with hyperthyroidism due to Graves' disease or toxic multinodular goiter can be restored to a euthyroid state with thioamides alone.
|
|
|
Thioamide induced agranulocytosis is not easily reversed. ( true/ false)
|
( False) because Thionamide-induced agranulocytosis IS rapidly reversible when the medication is stopped.
|
|
|
Filgrastim ( does or does not) improve recovery outcome when PTU is used and agranulocytosis ensues.
|
Filgrastim administration does not improve recovery outcome in thioamide induced agranulocytosis.
|
|
|
Define : ablative therapy
|
"ablative therapy" includes treatments that remove a tissue or stop its functioning.
|
|
|
"ablative therapy" includes treatments that ______ tissue or _______ its functioning.
|
"ablative therapy" includes treatments that remove a tissue or stop its functioning.
|
|
|
When or why to treat sub-clinical Hyperthyroidism ( re:test results in normal limits) ?? -- A scan would probably reveal a ________.
|
Treatment of sub-clinical ( re:test results) Hyperthyroid -- if symptoms of weight loss, psychiatric problems, fatigue or risk for aggravating underlying medical problems such as osteoporosis, cognitive loss and heart disease are apparent. a scan would probably reveal a nodule.....
|
|
|
If you suspect that subclinical hyperthyroidism : and observe contributing to progressive osteoporosis, cognitive loss and heart disease in the older patient, (what type of therapy) should be discussed with the family.
|
Ablative therapy with radioiodide ...
|
|
|
( True/ False) In patients with autonomous thyroid nodules, spontaneous normalization of the serum TSH is likely.
|
In patients with autonomous thyroid nodules, spontaneous normalization of the serum TSH is UNUSUAL > overt hyperthyroidism is considered a strong possibility.
|
|
|
( true/ false) In patients without thyroid nodules, spontaneous normalization of the serum TSH is likely possible.
|
TRUE>> In patients without thyroid nodules, spontaneous normalization of the serum TSH is possible , especially if non-thyroidal illness that suppresses TSH is present....
|
