Chapter 10 Pathos

What hormones are secreted by the thyroid gland and what are their functions?

• T3 (Triiodothyronine) and T4 (Thyroxine): Regulate metabolism, growth, and development.

• Calcitonin: Lowers blood calcium by inhibiting osteoclasts and stimulating osteoblasts.

• Regulation: Hypothalamus → TRH → Pituitary → TSH → Thyroid → T3/T4. Requires iodine.

What is a goiter and what causes it?

Goiter = visible thyroid enlargement.

• Causes: Iodine deficiency (most common worldwide), autoimmune thyroiditis (Hashimoto’s or Graves’), tumor, inflammation.

• Occurs in: Hypo-, hyper-, or euthyroid states.

• Complications: Compression of trachea or esophagus.

Hypothyroidism

Pathophysiology: Decreased T3/T4 → ↓ metabolic rate.
Risk Factors: Older age, autoimmune thyroiditis (Hashimoto’s), iatrogenic causes.
Manifestations: Fatigue, weight gain, cold intolerance, bradycardia, hypotension, dry skin, constipation, goiter, depression, myxedema (severe).
Treatment: Lifelong thyroid hormone replacement, temperature management, treat constipation.

Hyperthyroidism

Pathophysiology: Excess T3/T4 → ↑ metabolic rate (often Graves’ Disease).
Causes: Autoimmune stimulation (Graves), excess iodine, thyroid tumor, excessive thyroid medication.
Manifestations: Weight loss, tachycardia, hypertension, heat intolerance, anxiety, tremor, exophthalmos, diarrhea, goiter.
Complication: Thyrotoxicosis (thyroid storm).
Treatment: Radioactive iodine, antithyroid meds, surgery, beta blockers

Hyperthyroidism VS hypothyroidism

Feature	Hypothyroidism	Hyperthyroidism
Metabolic rate	↓	↑
Weight	Gain	Loss
Temperature tolerance	Cold	Heat
HR/BP	↓	↑
Skin	Dry, pale	Warm, moist
GI	Constipation	Diarrhea
Mood	Depression	Anxiety

Which hormone requires iodine for synthesis?
A. Cortisol
B. Insulin
C. Thyroxine (T4)
D. Aldosterone

C

Which symptom is typical of hyperthyroidism?
A. Bradycardia
B. Weight gain
C. Heat intolerance
D. Constipation

C

Scenario: A patient presents with unexplained weight loss, anxiety, and bulging eyes. Labs show low TSH and high T3/T4.
Q: What disorder is most likely?

Graves’ disease (hyperthyroidism).
Nursing Priority: Monitor for thyroid storm and protect eyes from dryness/injury.

Cortex

Produces cortisol (glucocorticoid), aldosterone (mineralocorticoid), androgens.

Medulla

Produces epinephrine and norepinephrine.

Addison’s Disease (Adrenal Insufficiency)

Pathophysiology: ↓ cortisol & aldosterone → ↓ Na⁺, ↑ K⁺, ↓ glucose.
Causes: Autoimmune destruction, infection, pituitary dysfunction (↓ ACTH).
Manifestations: Hypotension, fatigue, hyperpigmentation, weight loss, hypoglycemia, salt craving, hyperkalemia.
Treatment: Lifelong steroid replacement, increased salt intake, wear medical alert bracelet.

Cushing’s Disease (Excess Cortisol)

Pathophysiology: ↑ cortisol (due to ↑ ACTH or adrenal tumor).
Manifestations: Moon face, buffalo hump, central obesity, thin skin, purple striae, muscle wasting, hypertension, hyperglycemia, mood changes.
Treatment: Taper steroids, surgery/radiation for tumor, manage glucose & infection risk.

Which hormone conserves sodium and water?

A. Aldosterone
B. Cortisol
C. Epinephrine
D. ACTH

A

Which finding is associated with Cushing’s syndrome?
A. Moon face and truncal obesity
B. Weight loss and hyperpigmentation
C. Hypoglycemia
D. Bradycardia

A

A patient taking high-dose prednisone suddenly stops medication and presents with hypotension, fatigue, and low sodium.
Q: What happened?

A: Acute adrenal insufficiency (Addisonian crisis) due to sudden withdrawal of glucocorticoids.
Priority Action: IV steroids and fluids.

Pancreas hormones and functions

• Alpha cells: Glucagon → raises glucose.

• Beta cells: Insulin → lowers glucose.

• Delta cells: Somatostatin → inhibits insulin/glucagon.

Normal Values:

• Fasting glucose: 70–130 mg/dL

• HbA1C: <6.5%

• Random glucose: <200 mg/dL

Type 1 Diabetes Mellitus

Etiology: Autoimmune destruction of beta cells → absolute insulin deficiency.
Risk Factors: Genetics, viral triggers.
Manifestations: Polyuria, polydipsia, polyphagia, weight loss, fatigue, blurred vision.
Complications: DKA, hypoglycemia.
Treatment: Insulin therapy, diet, exercise, glucose monitoring.

Type 2 Diabetes Mellitus

Etiology: Insulin resistance → relative deficiency.
Risk Factors: Obesity, inactivity, genetics, age, ethnicity.
Manifestations: Often asymptomatic, fatigue, infections, blurred vision, neuropathy, poor wound healing.
Complications: HHNK, cardiovascular disease, nephropathy.
Treatment: Diet, exercise, oral hypoglycemics, possible insulin.

Prevention Strategies for type 2 diabetes mellitus

• Primary: Weight management, physical activity, diet.

• Secondary: Screening and early diagnosis.

• Tertiary: Prevent complications with glucose control and education.

What is the main difference between Type 1 and Type 2 Diabetes?
A. Type 1 = no insulin production; Type 2 = insulin resistance
B. Both caused by obesity
C. Type 1 occurs only in adults
D. Type 2 requires insulin therapy only

A

1. Which lab value confirms diabetes?
   A. HbA1C ≥ 6.5%
   B. Fasting glucose 100 mg/dL
   C. Random glucose 150 mg/dL
   D. HbA1C < 5.5%

A

A diabetic patient presents with confusion, diaphoresis, and shakiness after exercising without eating.
Q: What is happening?

A: Hypoglycemia.
Action: Administer glucose or glucagon immediately, recheck blood sugar.

Thyroid, adrenal cortex and pancreas hormones

Gland	Hormone	Function
Thyroid	T3/T4	Metabolism
Thyroid	Calcitonin	↓ Calcium
Adrenal Cortex	Cortisol	↑ Glucose, stress
Adrenal Cortex	Aldosterone	↑ Na⁺, ↓ K⁺
Pancreas	Insulin	↓ Glucose
Pancreas	Glucagon	↑ Glucose

Which hormone is responsible for regulating the body’s basal metabolic rate (BMR)?
A. Calcitonin
B. Thyroxine (T4)
C. Aldosterone
D. Cortisol

B

What is the most common cause of goiter worldwide?
A. Autoimmune thyroiditis
B. Iodine deficiency
C. Pituitary tumor
D. Radiation exposure

B

Which symptom is most consistent with hypothyroidism?
A. Weight loss, tachycardia, heat intolerance
B. Weight gain, fatigue, cold intolerance
C. Diarrhea, sweating, anxiety
D. Increased appetite, insomnia

B

What is the hallmark feature of Graves’ disease?
A. Moon face
B. Bradycardia
C. Exophthalmos
D. Myxedema

C

The nurse expects which lab results in a patient with primary hyperthyroidism?
A. High TSH, low T3/T4

B. Low TSH, high T3/T4
C. High TSH, high T3/T4
D. Low TSH, low T3/T4

B

A 40-year-old woman reports anxiety, sweating, and an unintentional 10-lb weight loss in 3 weeks. She has a visible neck swelling and bulging eyes.
Question: What condition do you suspect, and what complication must be prevented?

• Condition: Graves’ Disease (Hyperthyroidism).

• Complication: Thyrotoxicosis (thyroid storm).

• Nursing priority: Monitor temperature, heart rate, and administer antithyroid medication.

A patient with hypothyroidism is started on levothyroxine. After 1 week, they report palpitations and nervousness.
Question: What does this indicate?

• Possible over-replacement of thyroid hormone → signs of hyperthyroidism.

• Action: Notify provider for dose adjustment.

Which hormone regulates sodium and water balance by acting on the kidneys?
A. Aldosterone
B. Cortisol
C. Epinephrine
D. Glucagon

A

What are the primary manifestations of Addison’s disease?
A. Hypertension, moon face, hyperglycemia
B. Hypotension, hyperpigmentation, fatigue
C. Tremor, tachycardia, anxiety
D. Polyuria, polydipsia, weight loss

B

Which finding is specific to Cushing’s syndrome?
A. Cold intolerance
B. Hyperpigmentation
C. Truncal obesity with thin extremities
D. Weight loss

C

Cortisol is responsible for all of the following except:
A. Increasing blood glucose
B. Promoting sodium retention directly
C. Suppressing inflammation
D. Managing stress responses

B

A patient with Addison’s disease is at risk for which electrolyte imbalance?
A. Hyponatremia and hyperkalemia
B. Hypernatremia and hypokalemia
C. Hyperglycemia
D. Hypocalcemia

A

A patient with Addison’s disease is admitted after vomiting for two days and has not taken prescribed steroids. They are pale, hypotensive, and weak.
Question: What life-threatening emergency is occurring?

Answer: Addisonian Crisis due to acute cortisol deficiency.
Priority Actions: Administer IV corticosteroids and fluids, monitor electrolytes and blood pressure.

A patient taking long-term prednisone for arthritis develops “moon face,” truncal obesity, and hypertension.
Question: What condition is likely?

Answer: Cushing’s Syndrome (iatrogenic).
Management: Gradual taper of steroids, monitor glucose, blood pressure, and infection risk.

Which pancreatic cells produce insulin?
A. Alpha cells
B. Beta cells
C. Delta cells
D. PP cells

B

Which of the following represents normal fasting blood glucose?
A. 70–130 mg/dL
B. 40–70 mg/dL
C. 150–200 mg/dL
D. 200–250 mg/dL

A

Which lab value best reflects long-term glucose control?
A. Fasting blood glucose
B. Random glucose
C. Hemoglobin A1C
D. Urine ketones

C

Which symptom triad is classic for Type 1 Diabetes Mellitus?
A. Polyuria, polydipsia, polyphagia
B. Weight gain, edema, bradycardia
C. Tremors, sweating, confusion
D. Tachycardia, hypertension, anxiety

A

Which condition is more likely in Type 2 Diabetes than Type 1?
A. Ketoacidosis
B. Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNK)
C. Hypoglycemia
D. Goiter

B

Which is a primary prevention strategy for Type 2 Diabetes?
A. Weight management and exercise
B. Regular foot care
C. Insulin therapy
D. Treating neuropathy

A

A 16-year-old with Type 1 diabetes arrives with Kussmaul respirations and fruity-smelling breath.
Question: What complication is this and what is the priority treatment?

Answer: Diabetic Ketoacidosis (DKA) — metabolic acidosis from ketone accumulation.
Treatment: IV fluids, insulin, and electrolyte replacement (especially potassium).

A Type 2 diabetic patient reports dizziness, sweating, and shaking after skipping lunch but taking oral hypoglycemics.
Question: What is the likely cause and what should be done?

Answer: Hypoglycemia due to medication without food intake.
Immediate Action: Give oral glucose or juice; recheck blood glucose.

A 45-year-old obese patient with a family history of diabetes is found to have fasting glucose of 118 mg/dL and HbA1C of 6.1%.
Question: How would you classify this?

Answer: Prediabetes.
Intervention: Lifestyle modification (diet, exercise, weight loss) to prevent progression.

A diabetic patient has a foot ulcer that is slow to heal.
Question: Which chronic complication contributes to this condition?

Answer: Peripheral neuropathy and poor perfusion due to microvascular damage from chronic hyperglycemia.

Which feedback mechanism primarily regulates hormone secretion in the endocrine system?
A. Negative feedback
B. Positive feedback
C. Reflex arc
D. Autonomic reflex

A

A patient has excessive cortisol due to increased ACTH from a pituitary tumor. This is known as:
A. Cushing’s Disease
B. Addison’s Disease
C. Graves’ Disease
D. Hashimoto’s Thyroiditis

A

What is the role of glucagon?
A. Increases blood glucose by stimulating glycogen breakdown
B. Lowers blood glucose by promoting cellular uptake
C. Converts amino acids to protein
D. Stimulates fat synthesis

A

Which of the following is a secondary prevention measure for diabetes?
A. Annual blood glucose screening
B. Weight loss program for children
C. Insulin therapy education
D. Low-fat diet after diagnosis

A