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Nutrition and Metabolism
Dysfunction: Thyroid and Adrenal
Bringing it all together!
• The signs and symptoms are mainly a
result of what two things?
– Hyper-metabolism
– Overly sensitive sympathetic nervous system
The body senses that there is too
much thyroid hormone and via the
negative feedback loop, inhibits
secretion of TSH.
• 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
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
• 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 bracelet
2. 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
• What questions/clarifications do you have
or need from the modules?
Parathyroid gland
Maintain calcium and phosphorus
• Parathyroid hormone
maintains an adequate
amount of calcium in
the blood
• Major cause of
benign parathyroid
• Will have increased levels of calcium in the
• 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
• Parathyroidectomy
is the most common
– May be
immediately after
– May need life time
calcium and vitamin
D replacement