1. Nutrition and Metabolism Dysfunction: Thyroid and Adrenal Disorders Bringing it all together!

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

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

4. 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

5. 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.

6. 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

7. Thyroid Storm What is the most dangerous aspect of thyroid storm? Massive sympathetic outflow and the cardiac implications of it

8. 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

9. 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

10. Questions What questions/clarifications do you have or need from the modules?

11. Parathyroid gland

12. Purpose: Maintain calcium and phosphorus balance Parathyroid hormone maintains an adequate amount of calcium in the blood Major cause of hyperparathyroidism: benign parathyroid tumor

13. 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

14. Treatment Parathyroidectomy is the most common treatment –May be hypocalcemic immediately after surgery –May need life time calcium and vitamin D replacement