MVU NURS 623 EXAM 2 | QUESTIONS & ANSWERS |
COMPLETE SOLUTIONS | RATED | A+
Common endocrine problems - Hirsutism
Alopecia
Gynecomastia
Increased neck mass
Polydipsia
Polyphagia
Polyuria
Unexplaned weight gain/loss
Organize endocrine disorders - Glandular Disorders
Thyroid
parathyroid
pituatary
adrenal
Diabetes
DM1
DM@
hypoglycemia
Metabolic disorders
Obesity
Gout
Pituatary gland - the endocrine system's most influential gland. Under the influence of
the hypothalamus, it regulates growth and controls other endocrine glands.
When thyroid hormone levels in the blood are low, the pituitary releases more TSH.
When thyroid hormone levels are high, the pituitary decreases TSH production.
When theres a problem in the pituatary you will see tsh and T4 both down.
How to differentiate hypothyroid and hyperthyroidism. - What differentiates one from
the other
•Causes
,•Clinical presentation
•Diagnostic tests
•Treatment
Hyperthyroidism - •Excess secretion & synthesis of one or both: Thyroxine (t4)
triiodothroinine (t3)
Long term effects without treatment:
Heart disease
osteoporosis
Mental disease
infertility
Hyperthyroidism clinical findings - "Hot/buldging/fast"
-intolerance to heat
-thin fine hair
-bulging eyes (exopthalmus)
-thryomegaly
-tachycardia
-HTN
-weight loss
-Tremors.
-pretibial myxedema (thickening of skin on shins usually)
-decreased visual acuity
-photophobia.
Hypothyroid clinical manifestations - "cold/slow/tired"
-Intolerance to cold, coarse hair/ hair loss, extreme -fatigue, lethargy, slow speech,
constipation, brittle -hair/ nails.
-High TSH
-Low free T4 levels
-Once confirmed diagnosis of hypothyroidism, -thyroid peroxidase antibody (TPO) to
confirm
-Hashimoto's thyroiditis (gold standard for diagnosis of Hashimoto's)
hyperthyroidism causes - Graves disease (diffuse toxic goiter) is most common.
Subacute or painless thyroiditis. Toxic nodular goiter. Factitious hyperthyroidism.
Hypothyroidism causes - Hashimoto thyroiditis (90% of cases)
Subacute painless lymphocytic thyroiditis
Hypopituitarism, iodine deficiency, enzyme deficiency
Drugs: Amiodarone, lithium, sulfonamides, phenylbutazone
Hypothalamic dysfunction/hypopituitarism
, Diagnostic tests for thyroid problems - TSH
Free T 4
- meds can alter labs: Steroids, adrogens, estrogens, salicylates, heparine, iodine
containing coumpounds.
If Ft4 normal, then do FT3
Also do CBC and LFT
Further testing after initial thyroid testing - TSH receptor antibody
Nuc nmed nscan
24 nhour niodine nuptake
ultrasound
fine nneedle nbiopsy
Hyperthyroid n(graves ndisease) nLabs n
TSH nlevel nwould nbe n__
T3/T4 nwould nbe n___ n- n nTSH nwould nbe nlow n
Serum nfree nT3 nand nT4 nwould nbe nelevated. n
Remember nthe nknocking non nthe ndoor nanalogy: n
the npituitary ngland nrecognizes nthat nthe nt3 nand nt4 nare nelevated, nso nit nwill nnot nsend
nanyone nto nknock non nthe nthyroids ndoor nto nincrease nit n(aka nwill nnot nsend nout nany nmore
nTSH)
Hypothyroidism n(hashimotos's) nlabs n
TSH nlevel nwould nbe n__
T3/T4 nwould nbe n___ n- n nTSH nlevel nis nhigh
T3& nT4 nare nlow. n
This nis nbecause nthe nTSH nis ntrying nto nget nthe nthyroid nto nproduce nmore nT3 nand nT4, nbut
nthe nthyroid ncant. nHence nthe npatient nwill nneed nsynthetic nT4. n(synthroid)
Pituitary nabnormality nlabs
TSH nwould nbe
and nT3/T4 nwould nbe n- n nTSH nwould nbe nelevated
T3/T4 nwould nalso nbe nelevated
This nis nhow nyou nknow nits nthe npituitary nbecause nthe nnegative nfeedback nsystem nis nfailing.
Treatment nof nhyperthyroidism n- n nTREATMENT: nHyperthyroidism
First ntreat npatients nsymptoms n(potentially nbeta nblockers)
COMPLETE SOLUTIONS | RATED | A+
Common endocrine problems - Hirsutism
Alopecia
Gynecomastia
Increased neck mass
Polydipsia
Polyphagia
Polyuria
Unexplaned weight gain/loss
Organize endocrine disorders - Glandular Disorders
Thyroid
parathyroid
pituatary
adrenal
Diabetes
DM1
DM@
hypoglycemia
Metabolic disorders
Obesity
Gout
Pituatary gland - the endocrine system's most influential gland. Under the influence of
the hypothalamus, it regulates growth and controls other endocrine glands.
When thyroid hormone levels in the blood are low, the pituitary releases more TSH.
When thyroid hormone levels are high, the pituitary decreases TSH production.
When theres a problem in the pituatary you will see tsh and T4 both down.
How to differentiate hypothyroid and hyperthyroidism. - What differentiates one from
the other
•Causes
,•Clinical presentation
•Diagnostic tests
•Treatment
Hyperthyroidism - •Excess secretion & synthesis of one or both: Thyroxine (t4)
triiodothroinine (t3)
Long term effects without treatment:
Heart disease
osteoporosis
Mental disease
infertility
Hyperthyroidism clinical findings - "Hot/buldging/fast"
-intolerance to heat
-thin fine hair
-bulging eyes (exopthalmus)
-thryomegaly
-tachycardia
-HTN
-weight loss
-Tremors.
-pretibial myxedema (thickening of skin on shins usually)
-decreased visual acuity
-photophobia.
Hypothyroid clinical manifestations - "cold/slow/tired"
-Intolerance to cold, coarse hair/ hair loss, extreme -fatigue, lethargy, slow speech,
constipation, brittle -hair/ nails.
-High TSH
-Low free T4 levels
-Once confirmed diagnosis of hypothyroidism, -thyroid peroxidase antibody (TPO) to
confirm
-Hashimoto's thyroiditis (gold standard for diagnosis of Hashimoto's)
hyperthyroidism causes - Graves disease (diffuse toxic goiter) is most common.
Subacute or painless thyroiditis. Toxic nodular goiter. Factitious hyperthyroidism.
Hypothyroidism causes - Hashimoto thyroiditis (90% of cases)
Subacute painless lymphocytic thyroiditis
Hypopituitarism, iodine deficiency, enzyme deficiency
Drugs: Amiodarone, lithium, sulfonamides, phenylbutazone
Hypothalamic dysfunction/hypopituitarism
, Diagnostic tests for thyroid problems - TSH
Free T 4
- meds can alter labs: Steroids, adrogens, estrogens, salicylates, heparine, iodine
containing coumpounds.
If Ft4 normal, then do FT3
Also do CBC and LFT
Further testing after initial thyroid testing - TSH receptor antibody
Nuc nmed nscan
24 nhour niodine nuptake
ultrasound
fine nneedle nbiopsy
Hyperthyroid n(graves ndisease) nLabs n
TSH nlevel nwould nbe n__
T3/T4 nwould nbe n___ n- n nTSH nwould nbe nlow n
Serum nfree nT3 nand nT4 nwould nbe nelevated. n
Remember nthe nknocking non nthe ndoor nanalogy: n
the npituitary ngland nrecognizes nthat nthe nt3 nand nt4 nare nelevated, nso nit nwill nnot nsend
nanyone nto nknock non nthe nthyroids ndoor nto nincrease nit n(aka nwill nnot nsend nout nany nmore
nTSH)
Hypothyroidism n(hashimotos's) nlabs n
TSH nlevel nwould nbe n__
T3/T4 nwould nbe n___ n- n nTSH nlevel nis nhigh
T3& nT4 nare nlow. n
This nis nbecause nthe nTSH nis ntrying nto nget nthe nthyroid nto nproduce nmore nT3 nand nT4, nbut
nthe nthyroid ncant. nHence nthe npatient nwill nneed nsynthetic nT4. n(synthroid)
Pituitary nabnormality nlabs
TSH nwould nbe
and nT3/T4 nwould nbe n- n nTSH nwould nbe nelevated
T3/T4 nwould nalso nbe nelevated
This nis nhow nyou nknow nits nthe npituitary nbecause nthe nnegative nfeedback nsystem nis nfailing.
Treatment nof nhyperthyroidism n- n nTREATMENT: nHyperthyroidism
First ntreat npatients nsymptoms n(potentially nbeta nblockers)
