Pathophys Exam 2

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Anonymous
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40551
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Pathophys Exam 2
Updated:
2010-10-07 19:29:38
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Thyroid Disorders
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Thyroid Disorders
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  1. Cellular mechanism of Thyroid Hormones
    • Iodine is transfered into cell
    • Iodine is transfered out of cell with Thryoglobulin
    • T3 and T4 are synthesized and moved back into cell
    • T3 and T4 are secreted
  2. T4
    • must be converted to T3
    • 90% of thyroid hormone
  3. T3
    • 10%
    • ready to use form
  4. Protein binding of T3 and T4
    99% is protein bound
  5. Hypothalamus
    • secretes TRH to the Anterior Pituitary gland
    • Inhibited by T3 and T4
  6. Anterior pituitary
    Releases TSH when stimulated by TRH from the hypothalamus
  7. Thyroid gland
    Releases T3 and T4 inresponse to TSH from the anterior pituitary gland.
  8. Actions of thyroid hormones are in all tissues except
    • spleen
    • retina
    • lungs
    • testes
  9. Actions of thyroid hormones include increased metabolism of:
    • glucose
    • protein
    • fat
    • vitamins
  10. Thyroid hormones are important in children for
    growth and development
  11. metabolism of thyroid hormones in cardiovascular tissue
    • oxygen
    • vasodilation
  12. metabolism of thyroid hormones in the GI tract
    • motility
    • secretions
    • appetite
    • activity
    • weight loss
  13. Metabolism of thyroid hormones in the neuromuscular system
    • Skeletal muscle tone
    • Sympathetic activity
    • tachycardia
    • palpitations
    • sweating
  14. Tests of thyroid function screening
    • T3 level
    • T4 level
    • Free T4 level
    • TSH level
  15. Test of known thyroid problem
    • Anti-TPO
    • Radioiodine uptake
  16. Hypothyroidism
    underactive thyroid characterized by not producing enough hormone
  17. Congenital Hypothyroidism
    • Prenatal
    • 1/5000 births
  18. Acquired Hypothyroidism
    • Primary, Secondary and Tertiary
    • 4-10% of Americans
  19. Primary Hypothyroidism
    Thyroid gland misfunction
  20. Secondary and Tertiary Hypothyroidism
    Anterior Pituitary or hypothalamus problem
  21. Metabolic changes with Hypothyroidism
    • weight gain
    • fatigue
    • cold intolerance
  22. Skin changes with hypothyroidism
    • cool, pale rough, cracked
    • coarse hair
    • brittle nails
    • potential hair loss
  23. Changes in eyes with hypothyroidism
    Graves' opthalmopathy
  24. Cardiovascular changes in hypothyroidism
    • Reduced cardiac output
    • decreased exercise capacity
    • shortness of breath
  25. GI changes with hypothyroidism
    constipation
  26. Hallmark sign of thyroid issues
    goiter
  27. thyrotoxicosis
    dangerously high levels of T3
  28. Complications of a goiter
    • swallowing
    • blood flow
    • breathing
  29. Risk factors for hypothyroidism
    • age
    • family history of thyroid or autoimmune problems
    • pregnancy
    • smoking
    • radiation exposure
    • iodine exposure
    • neck trauma
    • stress
  30. Women vs. men hypothyroidism
    • Women 5:1
    • Men 8:1
  31. Diagnosis of Hypothyroidism
    • History
    • Physical Exam
    • Lab tests
  32. Lab test for Hypothyroidism
    • TSH and T4
    • T3 and Free T4
  33. Low Levels in Hypothyroidism
    • T3
    • T4
    • Free T4
  34. High levels in hypothyroidism
    TSH
  35. Hypothyroidism Treatments
    • Synthetic T3 and T4
    • mostly T4
    • Start low and go slow
    • Do not change brands
  36. Monitoring TSH
    • every 6-8 weeks until normalized
    • every 8-12 weeks after dosage changes
    • every 6-12 months througout therapy
    • watch for hyperthyroidism
  37. Hyperthyroidism
    • Overactive thyroid characterized by producing too much hormone
    • thyrotoxicosis
  38. Types of Hypothyroidism
    • Graves' disease
    • Goiter
    • Thyroid Storm
  39. Thyroid Storm
    • accute
    • increased mortality rate
    • usually a co-morbidity
  40. General Metabolic changes with hyperthyroidism
    • weight loss
    • increased appetite
    • excessive sweating
    • heat intollerance
  41. Sympathetic nercous changes in hyperthyroidism
    • nercousness
    • irritablity
    • fatigability (crash)
  42. Cardiovascular effects of hyperthyroidism
    • Tachycardia
    • palpitations
    • shortness of breath
  43. Neuromuscular effect of hyperthyroidism
    • muscle cramps
    • fine tremor
    • eyelid retraction
    • infrequent blinking
  44. GI changes with hyperthyroidism
    diarrhea
  45. Graves' Disease
    • onset at 20-40 years
    • women 5x as likely
    • autoimmune overstimulation of TSH antibodies
  46. Laboratory Tests for Hyperthyroidism
    • TSH and T4
    • T3 and free T4
  47. Low levels in hyperthyroidism
    TSH
  48. High levels in hyperthyroidism
    • T3
    • T4
    • Free T4
  49. Hyperthyroidism treatment directed at reducing thyroid hormone
    • eradication through radioactive iodine (most common)
    • surgical removal of gland
  50. Propylthiouracil
    blocks conversion of T4 to T3
  51. Methimazole
    block oxidation of iodine in the thyroid gland to stop producettion of T4 and T3
  52. Beta Blockers
    suppress sympathetic nervous system
  53. Hyperthyroidism follow ups
    • 2-4 weeks then 6-8 weeks until normalized
    • follow hypothyroidism monitoring
  54. Surgical removal of thyroid gland may result in
    • hypothyroidism
    • may still have bulging eyes

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