Gero Endocrine

Front 1

Themetabolic state resulting from inadequate amounts of thyroid hormone is

Back 1

hypothyroidism

Front 2

Trueor False…….Theprevalence of thyroid dx rises with age and is more common men than in women?

Back 2

False…..Theprevalence rises with age, but is more common in women than in men!

Front 3

When the thyroid gland is not functioning correctly, what 3 body systems are primarily affected in OA?

Back 3

1. Cardiovascular system2. Hematologic system3. CNS

Front 4

True/False

Thes/s of thyroid dysfunction often occur rapidly and may just be attributed tonormal changes of aging?

Back 4

False…..Changes occur GRADUALLY but may be perceived as normal changes of aging

Front 5

The metabolic state resulting from excessive amounts of thyroid hormone is

Back 5

HYPERTHYROIDISM

Front 6

Which 2 hormones are produced by the thyroid gland that play a major role in regulating the body’s energy levels and metabolic function?

Back 6

T4= ThyroxineT3= Triiodothyronine

Front 7

Which hormone, produced by the anterior pituitary gland, stimulates the thyroid to produce T3 and T4?

Back 7

TSH

Front 8

True/False…..High levels of T3 and T4 provide a (–) feedback to the pituitary gland and hypothalamus thus decreasing the production of TSH and TRH?

Back 8

TRUE

Front 9

True/False…..If T3 and T4 levels are low, feedback to the pituitary gland and hypothalamus decreases production of TSH and TRH so less hormone is produced?

Back 9

FALSE…..If free T3 and T4 levels are LOW feedback to the pituitary gland and hypothalamus stimulates increased production of TRH and TSH, which stimulates the thyroid to produce more hormone!

Front 10

If an OA has hypothyroidism will their TSH be elevated or decreased?

Back 10

HYPOthyroidism= Elevated TSH

Front 11

If an OA has hyperthyroidism will their TSH be elevated or decreased?

Back 11

HYPERthyroidism= Decreased TSH

Front 12

Practice Pearl

Back 12

Deficient amounts of thyroid hormones (T3 & T4) (HYPOthyroidism) STIMULATEs the secretion of TSH, whereas excess levels of T3 & T4 (HYPERthyroidism) inhibits TSH secretion….

Front 13

True/FalseT3 is the main hormone produced by the thyroid (80%)?

Back 13

FalseT4 is the MAIN hormone produced by the thyroid (80%)

Front 14

What is the “active” form of thyroid hormone?T3 or T4

Back 14

T3

Front 15

Which of the following remains the BEST test for thyroid function?T3T4TSHTRH

Back 15

TSH

Front 16

In general, what is the most common cause of Hypothyroidism?

Back 16

Hashimoto’s Thyroiditis

Front 17

Hashimoto’s Thyroiditis

Back 17

An autoimmune dx with a subtle onset and minimal symptoms…. Causes progressive inflammatory destruction….

Front 18

Deficiency in which nutrient can also lead to hypothyroidism?

Back 18

iodine

Front 19

True/False OA have clinical s/s of thyroid disease?

Back 19

false

Front 20

In OA, what is the most common cause of hypothyroidism?

Back 20

Primary dysfunction of the gland!

Front 21

What are the risk factors assoc with hypothyroidism? (5)

Back 21

Female. Hx of thyroid dx such as goiter, nodules, thyroiditis, hyperthyroidism. External radiation tx. Family hx of dx. Medications.

Front 22

What are the common s/s of hypothyroidism (10)

Back 22

Thyroid hormone deficiency results in a reduction in metabolic rate: hence s/s: Weight gain, Cold Intolerance, Constipation, Hair loss, Fatigue, Bradycardia, Dry Skin, Hearing loss, Ataxia/balance difficulty, Depression

Front 23

What are the s/s of hypothyroidism in OA? (5)

Back 23

Chronic non-specific complaints, Falls, Poor coping patterns, Decline in mental fx, New onset incontinence, Decreased mobility

Front 24

What are the complications of hypothyroidism in OA?

Back 24

HTN and Hyperlipidemia

Front 25

Long standing and untreated hypothyroidism is a risk factor for

Back 25

CAD

Front 26

What life threatening emergency can result from untreated hypothyroidism and critically low levels of thyroid hormone?

Back 26

Myxedema coma

Front 27

Myxedema coma

Back 27

Results in confusion, stupor, and coma, hyponatremia, hypoglycemia, and hypercapnia

Front 28

How is Myxedema Coma Treated?

Back 28

Placement in ICU, Large amounts of IV Thyroid hormone supplementation along with IV adrenal corticosteroids, Tx of hyponatremia and hypoglycemia

Front 29

How is Hypothyroidism Diagnosed

Back 29

Measurement of serum TSH and T4 levels are required to confirm dx, Visual & Manual thyroid gland exam, May need Thyroid US to r/o nodules

Front 30

How is Hypothyroidism Treated

Back 30

Sufficient Thyroid Replacement therapy

Front 31

Sufficient Thyroid Replacement therapy

Back 31

Tailored to meet the needs of the OAStarted cautiously in OA at MUCH lower doses as increased levels of thyroid hormones can increase myocardial O2 demand and result in MI, angina, and arrhythmias

Front 32

Sufficient Thyroid Replacement therapy tx of choice

Back 32

T4, Levothyroxine sodium (brand name is Synthroid)

Front 33

tx with Levothyroxine sodium (brand name is Synthroid)

Back 33

OA >65 start at 25-50 mcg/day PO- Dose is then increased gradually every 4 weeks (usually increased by 25mcg)

If they have a h/o CV dx the dose may be lower initially and gradually increased…

Front 34

Levothyroxine (synthroid) should be taken

Back 34

on an EMPTY stomach at the same time everyday! Typically taken in the early am

Front 35

levothyroxine (synthroid): advise patient to avoid drugs that

Back 35

can decrease absorption

Front 36

What lab(s) do we monitor when initiating and when making changes to Levothyroxine levels?

Back 36

TSH!!!!!

Front 37

TSH levels and levothyroxine if TSH is below normal

Back 37

the dose needs to be decreased

Front 38

TSH levels and levothyroxine if TSH is above normal

Back 38

the dose needs to be increased

Front 39

AfterTSH has stabilized with replacement therapy TSH levels should be monitored every

Back 39

6-12 months

Front 40

Hyperthyroidism in the OA is primarily due to what 3 processes?

Back 40

Graves’ Disease, Toxic Goiter, Medications

Front 41

Meds

Back 41

amiodarone, high doses of Levothyroxine

Front 42

Do OA typically display the common s/s of hyperthyroidism such as anxiety/nervousness, hyperactive DTRs, heat intolerance, excessive sweating, diarrhea, or enlarged thyroid gland that younger adults do?

Back 42

no

Front 43

What are the s/s of Hyperthyroidism in OA?

Back 43

Tachycardia/ArrhythmiasTremorsWeight Loss/Decreased appetiteSleep DisturbancesChanges in vision- photophobia, diplopia, eye irritationFatigue/muscle weakness

Front 44

main s/s of hyper in OA

Back 44

Tachycardia/Arrhythmias, Weight Loss/Decreased appetite, Fatigue/muscle weakness

Front 45

In the OA a HR of > _____ is considered tachycardia due to the age related bradycardia that is typically seen?

Back 45

HR >90

Front 46

What are the 3 common CV s/s that occur with OA when they have hyperthyroidism

Back 46

AFIB, Heart Failure, Angina

Front 47

What is the RARE but Life-Threatening situation that can occur with Hyperthyroidism that requires IMMEDIATE medical attention?

Back 47

Thyroid Storm

Front 48

What are the s/s of Thyroid Storm in OA that should be reported to the MD ASAP

Back 48

Extreme Tachycardia, fever, N/V, HF, change in LOC

Front 49

What is the Tx for Thyroid Storm

Back 49

Large doses of Propylthiouracil (PTU), IV Propanolol, IV Glucocorticoids

Front 50

PTU dosing

Back 50

150-300 mg/day PO in divided doses every 8 hours or Methimazole 15-40 mg po daily

Front 51

most serious SE of PTU

Back 51

?

Front 52

what may pt complain of if experiencing this serious SE

Back 52

?

Front 53

why give IV Betablocker (propanolol)

Back 53

?

Front 54

IV glucocorticoids to

Back 54

decrease inflammation and lower serum T3 levels

Front 55

What is PTU and Methimazole

Back 55

Medications that decrease the production of thyroid hormones

Front 56

How is Hyperthyroidism Diagnosed

Back 56

Physical assessment, TSH, Thyroid US to r/o nodules, Fine Needle aspiration to r/o cancer

Front 57

Physical assessment for dx hyper

Back 57

WeightCV/VS Exam (including HR, BP, Heart rhythm), Examination of the Thyroid gland, Neuromuscular exam, Eye exam

Front 58

TSH for dx of hyper

Back 58

The BEST screening test for hyperthyroidism and is considered diagnostic

Front 59

Thyroid CA rare in individuals greater than

Back 59

60 yo

Front 60

Will the TSH be elevated or decreased with Hyperthyroidism

Back 60

Hyperthyroidism = Decreased TSH

Front 61

Remember that TSH has an inverse relationship with the DX…. SO….

Back 61

Hypothyroidism = Increased TSH

Hyperthyroidism = Decreased TSH

Front 62

What is the TX of choice for OA with hyperthyroidism

Back 62

Radioactive Iodine (131 I)

Front 63

if the pt refuses this (131 I) they can take

Back 63

the same drugs given for thyroid storm

Front 64

thyroid storm drugs

Back 64

PTU, methimazole