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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 LEVELS
The 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 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
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
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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