Nutrition and Metabolism Dysfunction: Thyroid and Adrenal

Disorders

Bringing it all together!

Hyperthyroidism

• The signs and symptoms are mainly a result of what two things?– Hyper-metabolism– Overly sensitive sympathetic nervous system

TSH LEVELSThe body senses that there is too much thyroid hormone and via the negative feedback loop, inhibits secretion of TSH.

Thyroid/Adrenals

• What would be the implications for removal of the pituitary gland?

• The hypothalamus and anterior pituitary are integral to the hormone cascade and negative feedback process!

• Would need replacement of both steroids and thyroid hormone

Thyroid Hormone Replacement

Why was Mr. Bill Loney on the same home going medications that Kathy Twohy takes?

Bill was put into a hypothryoid state via removal of his thyroid gland. Kathy was put into a hypothyroid state by autoimmune destruction of her thyroid gland and therefore both needed replacement.

Hypothyroidism

• Give a description of a patient who has obvious hypothyroidism (clothes, hair, face, gender, speech patterns)

• Jacket, thin hair, thick tongue and facial edema, slow/slurred speech, female, lethargic and forgetful

Thyroid Storm

• What is the most dangerous aspect of thyroid storm?

• Massive sympathetic outflow and the cardiac implications of it

Addisonian Crisis

• What are three things a patient with Adrenocortical insufficiency should never leave home without?

1. Med alert bracelet2. IM Cortisone (syringe/medication)3. Card with a list of current meds/dosages and what to do in case of an emergency

Other questions…

What do we call the cluster of signs and symptoms that we expect to see for a patient on high doses of Prednisone or other corticosteroids?

Cushing’s Syndrome

Questions

• What questions/clarifications do you have or need from the modules?

Parathyroid gland

Purpose: Maintain calcium and phosphorus

balance• Parathyroid hormone

maintains an adequate amount of calcium in the blood

• Major cause of hyperparathyroidism: benign parathyroid tumor

Hyper-parathyroidism

• Will have increased levels of calcium in the serum

• Loss of calcium from bones– Bone fractures

• Altered cardiac electrical conduction• Changes in personality, fatigue• Increased blood clotting• Risk for kidney stones• Decreased reflexes• GI concerns: ↓peristalsis

– Increased gastrin hormone secretion

Treatment

• Parathyroidectomy is the most common treatment– May be

hypocalcemic immediately after surgery

– May need life time calcium and vitamin D replacement