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- low T3 & T4 increases TRH and TSH (high TSH- hyperplasia & hypertrophy) that stimulates the thyroid gland (leading to goiter resulting in an iodine deficit that decreases T3 & T4 resulting in hypothyroidism).
- s/s-low T3 & T4, low metabolic rate, endemic goiter, pale and cool skin with facial edema, cold intolerance, bradycardia, enlarged heart, lethargic, slow intellectual function, increased wt. & decreased appetite, thick tongue.
- autoimmune disease that causes chronic inflammation of thyroid.
- s/s- goiter, fullness feeling in throat, fatigue, wt. gain, cold intolerance, bradycardia.
- tx-synthetic hormone
acute hypothyroidism with hypotension, hypothermia, and loss of consciousness.
- untreated congenital hypothyroidism, caused by iodine deficiency during pregnancy, absent or nonfunctioning gland.
- s/s- difficulty feeding, delayed tooth eruption, malocclusion, large protruding tongue, stunted skeletal muscle growth & extreme lethargy.
goiter and endemic goiter
can be seen in Hashimoto's in Hypothyroidism, and in Grave's in Hyperthyroidism
foods that contain elements what block synthesis of T3 & T4, but increase TSH, can promote goiter formation is large amounts are ingested. (cabbage, turnips, lithium, flouride).
hyperthyroid condition, produces large nodular gland from hyperactivity & excessive TSH stimulation.
- excessive thyroid hormone released producing increased sympathetic activity.
- s/s are related to bodies response to the demands of hypermetabolism. Causes are often autoimmune.
- s/s- high T3 & T4, high metabolic rate, goiter with Grave's disease, skin flushed & warm, heat intorlerance, exophthalamos with Grave's disease, tachycardia, increased BP, restless, nervous, hand tremors, low body wt with increased appetite, muscle weakness, diarrhea.
- manifested by signs of hypermetabolism, toxic goiter, exophthalomos (protruding, staring eyes, increased tissue mass in the orbit pushing eyeball forward).
- s/s- nervousness, heat intolerance, tachycardia, diarrhea, wt. loss, goiter, bulging eyes called Grave's ophthalmopathy.
- tx- with radioactive iodine ro surgery (risk for hypothyroidism)
thyroitoxic crisis, an acute situation with uncontrolled hyperthyroidism, usually caused by infection or surgery. Results in hyperthermia, tachycardia, heart failure, and delirium.
Thyroid function tests
T3, T4, TSH; T3 & T4 are low in hypothyroidism & TSH is elevated. Thyroid scans, US, fine needle aspiration.
- PTH functions to increase bone resorption resulting in increased calcium in the bone, decalcification of the bone and increased phosphate excretion. (hypercalcemia & hypophosphatemia)
- s/s- bone fractures, wt. loss, arthritis, waxy pallor skin, bone deformities, kidney stones, anorexia, N & V, increased gastrin.
- dx- check PTH, calcium, phosphate, X-rays show bone abnormalities.
- leads to hypocalcemia, results in weak cardiac muscle contractions but also increases excitability of nerves leading to spontaneous skeletal muscle contraction (tetany first seen in hands & feet). Hypocalcemia leads to high PTH.
- tx- with calcium & Vit. D.
- caused by adenoma, hyperplasia, or secondary to renal failure. Leads to hypercalcemia resulting in forceful cardiac contractions. Increased PTH causes calcium to leave the bone, leading to osteoporosis and bone fractures, also hypercalcemia increases kidney stones.
- pt with bone cancer, or immobility may have hypercalcemia and low PTH. pt with severe renal disease have decreased activation of Vit. D in kidneys. Vit. D is essential for calcium absorption and metabolism. Renal failure also leads to hyperphosphatemia causing hypocalcemia.
- benign tumor of the adrenal medulla that secretes E, NE, and other substances. Is a "curable" cause of hypertension.
- s/s- headache, heart palpitations, sweating, anxiety related to high BP. (catecholamines released cause sudden hypertension & severe headache).
hyperfunction of adrenal glands (Cushing's syndrome)
- caused by excessive amount of glucocorticoids, results from adrenal adenoma, pituitary adenoma (Cushing's), and ectopic carinoma causing paraneoplastic syndrome, Iatrogenic conditions.
- s/s- moon face, heavy trunk, buffalo hump, muscle wasting, fragile, red skin, hirutism (increased hair growth), osteoporosis and decreased protein synthesis that delays healing, increased gluconeogenesis and insulin resistance leading to glucose intolerance (DM), retention of sodium & water leading to hypertension, edema, hyperkalemia, suppressed immune response with atrophy of lymphoid tissue leading to infection (TB), stimutation of erythrocyte production, emotional lability & euphoria.
- Labs- high WBC, lyphos, Na.
- tx- hypophysectomy or adrenalectomy, but try to stabilize first.
Adrenal cortical insufficiency- Addison's disease
- deficiency of adrenocortical secretions, glucocorticoids, mineralocorticoids, & androgens. Autoimmune, destroying gland from meningococcal infection (hemorrhage), viral, tubercular, or histoplasmosis infections, tumors.
- s/s- decreased sodium & blood volume, hypotension, high potassium (form aldosteroine deficit) leads to cardiac arrhythmias & failure. Decreased body hair (lack of androgens), hyperpigmentation in extremities, skin creases in buccal mucosa & tongue (from high ACTH, & low cortisol)..
- tx- replacement therapy, check fluids and electrolytes! low aldosterone=hyperkalemia, hyponatremia, & hypovolemia (low BP), & metabolic acidosis. Low cortisol= low gluconeogenesis, depleted liver & muscle glycogen, & hypoglycemia. Low GFR leading to Low urea excretion, anorexia & wt. loss. Low androgens too. Addison's scute with stress.
- tx- hydrocortisone
- Labs- high K+, BUN, low Na, blood glucose, cortisol.
caused by adenomas, 1. enlarged mass causes pressure ( high intracranial pressure)- s/s-headaches, seizures, drowsiness, hemianopsia (pressure on optic chiasm). 2. tumor effects secretion of hormone (somatotropic cells- secrete GH, or ACTH, or prolactin). 3. tumor may destroy an area-lowering ACTH & adrenal cortew activity, 4. tumors can cause hemorrhage or infarction causing high intracranial pressure & pituitary apoplexy (destroying part of gland). Tumors eventually result in panhypopituitarism.
low ACTH, TSH affecting adrenals & thyroid, Low LH & FSH causes testicular failure or amenorrhea, sterility. Low GH causes growth retardation.
caused by adenoma. Prolactin secreting tumors inhibit secretion of gonadol steroids & gonadotropins. HIgh GH results in giantism. High ACTH leads to hypersecretion of adrenals & Cushing's
- short stature, Low GH, somatotropin or SRH.
- s/s- normal intelligence & body proportions, delay in skeletal maturation & puberty.
- tx- prior to epiphyseal seal in child.
tall stature, high GH prior to puberty & epiphyseal fusion
- high GH
- s/s- broad & heavy bones, soft tissue growth resulting in large hands and feet, thick skull, facial feature changes, compressed nerves& vessels through foramina. Carpal tunnel, arthritis, protruding madible (prognathia), macroglossia, GH effects insulin resulting in diabetes. Hypertension, CVD.
Disorders of posterior pituitary
high or low ADH (vasopressin), Low ADH=DI, high ADH+ syndrome of inappropriate antidiuretic hormone secretion leads to high fluid
- low ADH caused by neurohypohysis, head injury, or surgery. Neurogenic when renal tubules don't respond to ADH.
- s/s- polyuriac with high dilute urine & thirst causing dehydration (glucose isn't present in urine).
Inappropriate ADH syndrome (SIADH)
- high ADH causes fluid retentio, stress triggered or ectopic source (ex. bronchogenic carcinoma),
- s/s- severe hyponatremia causing mental confusion.
- tx- diuretics