Module 9 Part 1

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Nervousness & Anxiety
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1

Thyroid Gland: Thyroid Folicles

- What hormones?

Synthesize and secrete thyroid hormone

-Thyroglobulin (Globular protein): Transport proteins attached to T3/T4

-(T3)Triiodothyronine: Contains 3 iodine molecules

-(T4)Thyroxine: Contains 4 iodine molecules

2

Thyroid Gland: Parafolicular (C-cells) produce what?

Calcitonin: decrease blood calcium levels by inhibiting bone-resorbing osteoclasts

3

Graves Disease: What type of thyroidism?

Hyperthyroidism

Increase level of thyroid hormone = Thyroxicosis

4

Graves Disease: How is this different from Hashimoto's Disease?

Type II Hypersensitivity Rxn of thyroid by TSI (Thyroido Stimulating Immunoblogins)- Acts like TSH but is NOT - Antibodies stimulating thyroid gland

5

Graves Disease: Negative Feedback Loop

Primary Endocrine Disorder- Problem with Thyroid

TRH low

TSH low

T3/T4 high

6

Graves Disease: S/s

-Anxiety, Always thinking, double vision

-GI tract fast, Lose wt, Temp=Hot

- Bulging Eyes, Thickening of shins, Goiter, Myxedema

7

Graves Disease: Testing

-TSH = low

-T3/T4= high

-Radioactive thyroid uptake scan

8

Graves Disease: Tx

-Meds to lower thyroid hormone; Propylthiouracil (PTU)

- Radioactive iodine treatment

-Thyroid removal

9

Thyroid Crisis (Storm): What?

*Rare but dangerous worsening of the thyrotoxic state*

Death can occur w/in 48 hrs w/o Tx

10

Thyroid Crisis (Storm): Cause

Spontaneous

*Usually in undiagnosed ro untreated graves disease*

Extra Stress: infection, emotional stress, surgery(thyroid), OB complication, Dialysis

11

Thyroid Crisis (Storm): S/s

-Hyperthermia, N/V, Diarrhea- dehydratoin

-Tachycardia- Atrial tachydysrhythmias

-Agitation/ Delerium

12

Thyroid Crisis (Storm): Tx

-PTU: Blocks major enzyme in thyroid

-Beta blocker: control cardiovascular symptoms

-Corticosteroids

-Saturation solution of KI: iodine acutely inhibits hormonal secretion w/in hrs, but responsible mechanisms are uncertain

13

Toxic Nodular Goiter (TNG): What? what if only one nodule?

*Benign or malignant*9%) thyroid nodule*

If only 1 nodule = Toxic Adenoma

14

Toxic Nodular Goiter (TNG): S/s

-S/s hyperthyroidism

-No exophthalmos (bulging eye)

-No Pretibial Myxedema

15

Toxic Nodular Goiter (TNG): Testing

-TSH low , T3/T4 high

-Palpable

-US Thyroid

-Iodine scan = hot nodule

Biopsy

16

Toxic Nodular Goiter (TNG): Hot Nodule

Benign Usually

Rolling Lymph + Painful

De Quervain: Subacute Thyroiditis (Burned out thyroid)

17

Toxic Nodular Goiter (TNG): Cold Nodule

Malignant Usually

Not painful + stuck in one place

18

Graves Disease: Takes up Iodine

All gland takes up iodine

19

Hashimotos(Hypo-): Takes up iodine

Less of the gland takes up iodine

20

TNG: Takes up iodine

some areas of gland is active

21

Epinephrine & Norepinephrine: What are they? Where do they come from?

Fight or Flight Response

They are Catecholamines which are neurotransmiters

Secreted from Adrenal Glands

22

Epinephrine & Norepinephrine: S/s

-increase HR, contractility & BP

-Vasoconstriction, major vessels dilate, sweat/chills

-Pupils dilate

-Decrease bowel movement & digestive enzymes

-Quick deep breathing

-Muscles tense up

23

Pheochromocytoma: What is it? AKA?

**Rare tumor of adrenal medulla (Chromaffin Cell Tumor)**

24

Pheochromocytoma: S/s Classis Triad

**ON EXAM**

  1. Diaphoresis (Sweating)
  2. Episodic HA
  3. Tachycardia
25

Pheochromocytoma: S/s

Episodic HTN: exercise, too much tyrosine (aged cheese, red wine, yogurt), caffeine

- external pressure on tumor

- induction of anaesthesia

26

Pheochromocytoma: Testing & Tx

Testing: CT & Urine Analysis

Tx: Surgery