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Pathophys Exam 2
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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
T4
must be converted to T3
90% of thyroid hormone
T3
10%
ready to use form
Protein binding of T3 and T4
99% is protein bound
Hypothalamus
secretes TRH to the Anterior Pituitary gland
Inhibited by T3 and T4
Anterior pituitary
Releases TSH when stimulated by TRH from the hypothalamus
Thyroid gland
Releases T3 and T4 inresponse to TSH from the anterior pituitary gland.
Actions of thyroid hormones are in all tissues except
spleen
retina
lungs
testes
Actions of thyroid hormones include increased metabolism of:
glucose
protein
fat
vitamins
Thyroid hormones are important in children for
growth and development
metabolism of thyroid hormones in cardiovascular tissue
oxygen
vasodilation
metabolism of thyroid hormones in the GI tract
motility
secretions
appetite
activity
weight loss
Metabolism of thyroid hormones in the neuromuscular system
Skeletal muscle tone
Sympathetic activity
tachycardia
palpitations
sweating
Tests of thyroid function screening
T3 level
T4 level
Free T4 level
TSH level
Test of known thyroid problem
Anti-TPO
Radioiodine uptake
Hypothyroidism
underactive thyroid characterized by not producing enough hormone
Congenital Hypothyroidism
Prenatal
1/5000 births
Acquired Hypothyroidism
Primary, Secondary and Tertiary
4-10% of Americans
Primary Hypothyroidism
Thyroid gland misfunction
Secondary and Tertiary Hypothyroidism
Anterior Pituitary or hypothalamus problem
Metabolic changes with Hypothyroidism
weight gain
fatigue
cold intolerance
Skin changes with hypothyroidism
cool, pale rough, cracked
coarse hair
brittle nails
potential hair loss
Changes in eyes with hypothyroidism
Graves' opthalmopathy
Cardiovascular changes in hypothyroidism
Reduced cardiac output
decreased exercise capacity
shortness of breath
GI changes with hypothyroidism
constipation
Hallmark sign of thyroid issues
goiter
thyrotoxicosis
dangerously high levels of T3
Complications of a goiter
swallowing
blood flow
breathing
Risk factors for hypothyroidism
age
family history of thyroid or autoimmune problems
pregnancy
smoking
radiation exposure
iodine exposure
neck trauma
stress
Women vs. men hypothyroidism
Women 5:1
Men 8:1
Diagnosis of Hypothyroidism
History
Physical Exam
Lab tests
Lab test for Hypothyroidism
TSH and T4
T3 and Free T4
Low Levels in Hypothyroidism
T3
T4
Free T4
High levels in hypothyroidism
TSH
Hypothyroidism Treatments
Synthetic T3 and T4
mostly T4
Start low and go slow
Do not change brands
Monitoring TSH
every 6-8 weeks until normalized
every 8-12 weeks after dosage changes
every 6-12 months througout therapy
watch for hyperthyroidism
Hyperthyroidism
Overactive thyroid characterized by producing too much hormone
thyrotoxicosis
Types of Hypothyroidism
Graves' disease
Goiter
Thyroid Storm
Thyroid Storm
accute
increased mortality rate
usually a co-morbidity
General Metabolic changes with hyperthyroidism
weight loss
increased appetite
excessive sweating
heat intollerance
Sympathetic nercous changes in hyperthyroidism
nercousness
irritablity
fatigability (crash)
Cardiovascular effects of hyperthyroidism
Tachycardia
palpitations
shortness of breath
Neuromuscular effect of hyperthyroidism
muscle cramps
fine tremor
eyelid retraction
infrequent blinking
GI changes with hyperthyroidism
diarrhea
Graves' Disease
onset at 20-40 years
women 5x as likely
autoimmune overstimulation of TSH antibodies
Laboratory Tests for Hyperthyroidism
TSH and T4
T3 and free T4
Low levels in hyperthyroidism
TSH
High levels in hyperthyroidism
T3
T4
Free T4
Hyperthyroidism treatment directed at reducing thyroid hormone
eradication through radioactive iodine (most common)
surgical removal of gland
Propylthiouracil
blocks conversion of T4 to T3
Methimazole
block oxidation of iodine in the thyroid gland to stop producettion of T4 and T3
Beta Blockers
suppress sympathetic nervous system
Hyperthyroidism follow ups
2-4 weeks then 6-8 weeks until normalized
follow hypothyroidism monitoring
Surgical removal of thyroid gland may result in
hypothyroidism
may still have bulging eyes
Author
Anonymous
ID
40551
Card Set
Pathophys Exam 2
Description
Thyroid Disorders
Updated
2010-10-07T23:29:38Z
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