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PGY 412: Endocrine Disorders
In what three way is the thyroid gland important for metabolic homeostasis? |
energy metabolism
oxygen consumption
cardiac contractility |
Where is the thyroid gland locateD? |
inferior to larynx and spanning the ventral aspect of the trachea |
Follicular thyroid cells make what? |
T4, T3, rT3 |
Parafollicular cells make what? |
Calcitonin |
What do C cells make? |
calcitonin |
What does the parathyroid gland make? |
PTH |
How is the thyroid gland regulated? |
negative feedback loop
hypothalamus
pituitary gland
thyroid gland |
What are hormones produced by thyroid gland? |
thyroxine T4
triiodothyronine T3
calcitonin |
How is T3 formed? |
deiodination of T4 in peripheral tissues |
Which thyroid hormone has a longer half-life and more pharmacologically active? |
T4 |
Iodide deficiency causes what main symptom? |
goiter formation |
What is the minimum dietary intake of iodine in US? |
150 mcg |
What is the mechanism of action of thyroid hormone? |
it is lipid soluble, enters the cell nucleus and activates gene expression |
how is thyroid function regulated? |
negative feedback mechanism : high levels of T3, T4 and low levels of Iodine |
The disruption of normal hypothalamic-pituitary-axis leads to what two main conditions? |
hypothyroidism
hyperthyroidism |
Moist sweating is a symptom of hyperT or hypoT? |
hyper |
Feeling hot or warm is a symptom of hyperT or hypoT? |
hyper |
drooping lids is a symptom of hyperT or hypoT? |
hypo |
infertility is a symptom of hyperT or hypoT? |
hypo |
decreased fertility is a symptom of hyperT or hypoT? |
hypr |
anaemia is a symptom of hyperT or hypoT? |
both |
bulging of eyes is a symptom of hyperT or hypoT? |
hyper |
tachycardia is a symptom of hyperT or hypoT? |
hyper |
decreased appetite is a symptom of hyperT or hypoT? |
hypo |
increased bowel movements is a symptom of hyperT or hypoT? |
gyper |
stiffness, fatigue, decrease reflexes is a symptom of hyperT or hypoT? |
hypo |
polyuria is a symptom of hyperT or hypoT? |
hyper |
increased erythropoiesis, anaemia is a symptom of hyperT or hypoT? |
hyper |
hypermennorhea is a symptom of hyperT or hypoT? |
hypo |
hypogonadism is a symptom of hyperT or hypoT? |
hypo |
lethargy, slowed mental process is a symptom of hyperT or hypoT? |
hypo |
nervousness is a symptom of hyperT or hypoT? |
hyper |
decreased vital capacity is a symptom of hyperT or hypoT? |
hyper |
hypoventilation is a symptom of hyperT or hypoT? |
hypo |
Where are parathyroid glands located? |
posterior aspect of thyroid fland |
What hormone is produced by the parathyroid glands? |
parathyroid hormone |
What effects does parathyroid hormone have on the body? |
-regulator of serum calcium
-antagonist of calcitonin |
Cause of hyperparathyroidism? |
Primary- cell adenoma
Secondary - compensatory response to chronic hypocalcemia which can be caused by malabsorption or decreased renal activation of Vit D |
What are the typical treatment for hypo and hyperthyroidism? |
Hypo- replacement therapy
Hyper - antithyroid drugs, surgical excision of abnormal tissue, radioactive Iodine ablation |
what is another term for hyperthyroidisim? |
thyrotoxicosis |
What is the cause of Grave's disease? |
autoimmune disease that leads to overactivity of thyroid via stimulatory autantibody |
What are the symptoms of GRaves diosease? |
exophthalmic goiter, so eyes protrude |
What is the treatment for grave's disease? |
removal or destruction of some thyroid tissue by surgery or radiation
low TSH and TRH |
What causes nodular thyroid disease? |
autonomously functioning follicular cells
symptoms of hyperthyroidism |
What are the thyroid diseases that lead to hypothyroidism? |
Hashimoto's disease
Cretinism
Myxedema |
What causes Hashimoto's disease? |
autoimmune disease, also iodine defiicient diet |
What are the symptoms of Hashimoto's disease? |
hypothyroidism symptoms |
What are the causes for cretinism? |
low thyroid function since birth |
What are the symptoms of cretinism? |
-they are short and stocky
-hypothyroidism since birth |
What is the treatment for cretinism? |
thyroid treatment/supplementation, without this in first two months child becomes mentally retarded |
What causes myxedema? |
hypothyroidism in adults, can be due to wide variety of reasons |
What are the symptoms for myxedema? |
most important is droopy eyelids and edema around eyes |
What are the typical test used for monitoring patients being treated with thyroid hormones? |
TSH levels
TSH suppression test
T4 levels (free and bound) |
What are the causes of hyperthyroidism? |
grave's disease
Nodular thyroid disease
abnormal secretion of TSH via TSH secreting tumors
Thyroiditis
Thyroid storm |
What is the course of treatment for TSH secreting tumors? |
microsurgery to remove tumor
radiation
medication treatment |
What are the causes for nontoxic goiters? |
iodine deficiency
chemical defect which causes impaired secretion of thyroxine |
Nontoxic goiters have a high incidence among what group of people? |
more females, age 2-60 yrs |
What is the common course of treatment for nontoxic goiters? |
biopsy
suppression of TSH with thyroxine
iodide supplementation |
what are the two types of thyroid neoplasms? |
benign and malignant like the carcinomas |
What is the most common and least common thyroid neoplasms? |
radiation of head and neck regions |
What are the clinical symptoms of hyperparathyroidism? |
hypercalcemia
pathological fractures
compression fractures of vertebral bodies
kidney stones
fatigue
headache
depression
anorexia
nausea
vomiting |
What are the causes of hypoparathyroidism? |
damage to thyroid gland like from surgery
hypomagnesemia due to chronic alcoholism, malnutrition and malabsorption |
Pathophysiology of hypoparathyroidism? |
decrease serum calcium
increase serum phosphate |
What are clinical symptoms of hypoparathyroidism? |
tetany
muscle spasms
hyperreflexia
convulsions
laryngeal spsms |
Which thyroid neoplasm is deadliest |
A aplastic carcinoma |
Primary hyperparathyroidism |
Cell adenoma secretes PTH |
Secondary hyper parathyroidism |
Compensatory response to chronic hypocalcemia due to decrease bit d renal activation or malnutrition |