THYROID GLAND

T3 (triiodothyronine) - metabolism (breakdown of energy)

→ GIT
T4 (thyroxine) - heat production
→ skin (moist)
T3 & T4
→ enhances → SNS → (Active and Alert)

HYPERTHYROIDISM AND HYPOTHYROIDISM

9
Findings Hyperthyroidism Hypothyroidism

Cause Graves Disease → Autoimmune Hashimoto’s Disease

K
↓ ↓
Hyperactive TG → ↑ TH Autoimmune

BL
↓
Destruction of TG
↓
↓TH

L
Appearance Inflammation/edema ↓metabolism
↓ N
fat pads behind the eyes
↓
↑mucopolysaccharide → pupunta
M
“Exophthalmos” → protruded sa ilalim ng balat → dadami ang
eyeball tubig (attract H20) “myxedema”
↓
puffy face &
A

eyes
R
-T
AM
IC

Interventions Hyperthyroidism Hypothyroidism

DOC Anti-TH → thioAmides “dagdagan ng levo-levo”

ex. Propylthiouracil, Methimazole TH replacement → Levothyroxine
WOF: Agranulocytes → ↓WBC/ morning (it can cause insomnia) &
↑infection empty stomach (acidic)
“headache, fever, & sore throat” “before breakfast”

Calorie (weight) High Low

 Fiber Low High

Fluids (GI, Kidney, Skin) High High

Activity Bed rest Exercise (moderate)

30 mins/day
3-5x/week

Environment Cool & Non-stimulating Warm environment

environment

9
Sedatives (+) (-)

Stimulants (-) (+)

K
BL
Findings Hyperthyroidism Hypothyroidism

T3 & T4 High Low

L
TSH Low High

Metabolism
N
High Low
M
Body weight Low High

Appetite High Low

A

GIT High - Diarrhea Low - Constipation

R

Heat production High Temp, Heat Intolerance Low temp, Cold intolerance
-T

Skin Moist Dry

SNS Hyperactive Hypoactive

AM

Vital signs High Low

Severe form Thyroid Storm Myxedema Coma

SUMMARY: High all, except TSH & body Low all, except TSH & body weight
IC

weight Hypoactive
Hyperactive “Slow, Cold, Dry”
“Fast, Hot, Wet”

FINDINGS HYPERTHYROIDISM HYPOTHYROIDISM

Hashimoto’s ✔
 Exophthalmos ✔

High T3 & T4 ✔

High TSH ✔

High Metabolism ✔

High Body Weight ✔

Low appetite ✔

9
Diarrhea ✔

K
Heat Intolerance ✔

BL
Dry ✔

Lethargy ✔

Tachycardia ✔

L
Myxedema Coma
N ✔
M
PARATHYROID GLAND
PTH → Ca (Bones) → Blood
↑Ca (blood)
A

↓Ca (bones)
CALCITONIN → Ca (Blood) → Bones (Calcitonin is produced by thyroid gland)
R

↓Ca (blood)
↑Ca (bones)
-T

Calcium
➔ Phosphorus → Inverse
➔ Muscle → Inverse
AM

➔ Cardio → Direct
➔ ↑Ca → effect in kidneys

HYPERPARATHYROIDISM & HYPOPARATHYROIDISM

IC

FINDINGS HYPERPARATHYROIDISM HYPOTHYROIDISM

Cause Tumor (Ectopic production) Thyroidectomy (total)

PTH High PTH Low PTH

↑Ca (blood); ↓Ca (bones) ↓Ca (blood); ↑Ca (bones)

Calcium Hypercalcemia Hypocalcemia

Phosphorus (inverse) Low High

Muscle activity (inverse) Hypoactive Hyperactive (TwiTCing SpaSm)

Tetany
Trousseau's
Chvostek's
Spasm → larynx & bronchus
Seizure

GIT (inverse) Constipation Diarrhea

9
Bones Weak bones, pain, & Pathologic N/A
Fracture

K
Heart (direct) BP, RR ↑HR, BP ↓HR, BP

BL
Kidneys Supersaturation → renal calculi N/A
osmotic diuresis → polyuria →
dehydration

L
SUMMARY: Hypercalcemia Hypocalcemia
Problem in bones and kidneys TwiTChing SpaSm

INTERVENTIONS
N
HYPERPARATHYROIDISM HYPOPARATHYROIDISM
M
DOC Calcitonin PTH
Ca (blood) → Ca (bones) Calcium Gluconate
A

Calcium diet Low High

R

Phosphorus diet High Low

-T

Fluid intake (GI, Kidney, High High

Skin)

Fiber (GI) High Low

AM

Activity Exercise (moderate) Bed rest

Exercise: Ca (Blood) → Bones
Immobility: → Ca (Bones) → Blood
IC

FINDINGS HYPERPARATHYROIDISM HYPOPARATHYROIDISM

Tumor ✔

Low PTH ✔

Hypocalcemia ✔
Hypophosphatemia ✔

Trousseau’s ✔

Muscle weakness ✔

Tetany ✔

Constipation ✔

Pathologic Fracture ✔

9
Hypotension ✔

K
Polyuria ✔

BL
Renal Calculi ✔

Seizure ✔

L
ADRENAL GLANDS
Anterior Pituitary → ACTH & MSH
ACTH → Adrenal Cortex → steroid hormonesN
M
MSH → skin (melanocytes) → melanin → skin color → protection → UV rays
Parts:
1. Medulla → SNS → Epinephrine & Norepinephrine (Catecholamines)
A

2. Cortex → GMA/SSS
➔ Glucocorticoids/Sugar
R

➔ Mineralocorticoids/Salt
➔ Androgen/Sex
-T

GLUCOCORTICOIDS/SU MINERALOCORTICOIDS/SALT ANDROGEN/SEX

GAR ↓ ↓ CHARACTERISTICS (male)
CORTISOL ALDOSTERONE (sorepoex)
SOdium & water
AM

REtention
POtassium
EXcretion/Removal

Natural release: ↑Na & H20 “hair”, ↑muscle, deep voice, etc.
IC

morning (high) ↓K

Sugar: increase

Stress: ↑cortisol
 “resistance to stress”

Suppress: Immune
System

Breakdown: protein
(thinning)

Blocks calcium
absorption
↓Ca

9
CUSHING’S SYNDROME & ADDISON’S DISEASE/ADRENAL INSUFFICIENCY

K
FINDINGS CUSHING'S SYNDROME ADDISON'S DISEASE/ Adrenal

BL
Cushing’s syndrome: moon face → Insufficiency
nasa taas ang moon → UP Addison’s → Absent steroids
STEROIDS

L
Cause N
Excessive use of steroids &
adrenal adenoma (benign)
Bilateral adrenalectomy/
autoimmune
M
➔ lifetime

Appearance ➔ moon face ↓steroids

A

➔ buffalo hump ↓
➔ central/truncal obesity ↑ACTH & ↑MSH ⇒↑Melanin
“hyperpigmentation/bronze skin”
R
-T
AM

Glucocorticoids
(cortisol) ❌ ↑sugar
stress resistance
↑suppression of immunity → ❌❌
↓sugar
↓stress resistance
suppression of immunity
IC

↑infection
↑protein breakdown
skin & extremities → thin
❌ protein break down
skin and extremities
→ thick
“easy bruising & striae” ↓blocks calcium (hypercalcemia)
↑blocks calcium (hypocalcemia)

Mineralocorticoids ↑Na & ↑H20 (hypernatremia) ↓Na & ↓H20 (hyponatremia)

(aldosterone) ↓K(hypocalemia) ↑K (hypercalcemia)
SO RE PO EX
Androgen Hirsutism Hair loss (Alopecia)
Sex → “hair”

SUMMARY ↑steroids → ↑SSS (Sugar, Salt & ↓/Absent steroids → ↓SSS &
water, sex) & ↓Ca, K, I (calcium, ↑Ca, K, Me (melanin)
potassium, immunity)

9
K
BL
INTERVENTIONS CUSHING’S ADDISON’S

DOC MMK (Mitotane, Metyrapone, “Add SONE” → STEROIDS

L
Ketoconazole) Ex. predniSONE
↓steroids production take with meal
N in the morning (sabayan mo yung
natural release ng cortisol) →
M
↓adverse effect

Glucose changes monitor blood glucose monitor blood glucose

A

Avoid stress & crowded areas stress

R

Calcium Diet High Low

-T

Na & H20 intake Low High

K diet High Low

Disturbed body image Thera Com Thera Com

AM

FINDINGS CUSHING’S ADDISON’S

IC

Moon face ✔

Buffalo hump ✔

Bronze skin ✔

Truncal obesity ✔

Hypoglycemia ✔
 Poor resistance to ✔
stress

Thin skin ✔

Hypercalcemia ✔

Hyponatremia ✔

FVE ✔

9
Hyperkalemia ✔

Hirsutism ✔

K
BL
ADH/VASOPRESSIN
➔ “anti-ihi”
↓H20/FVD/DHN → Posterior Pituitary
↓

L
Anti-Diuretic Hormone → Kidneys
↓
N
H20 retention, ↓urine output, ↑urine specific gravity → concentrated urine (dark)
M
SIADH & DI
FINDINGS SIADH DI
A

Cause Tumor (ectopic production) Head injury/surgery

R

ADH Sobra/High → ↑water retention ↓water retention

-T

Fluid Imbalance Soak Inside → FVE (1st) Dry Inside → FVD (1st)

Serum Sodium Low sodium (diluted)- swollen High sodium → Hypertonic

inside → Cerebral edema dehydration → shrink cell →
AM

cerebral DHN → Dami inum →

polydipsia

Urine Output Stop Ihi → low urine output → Dami Ihi - high urine output →
oliguria polyuria
IC

USG High Low

Concentration of urine Concentration → dark (classic) Diluted Ihi → clear pero

dehydrated

SUMMARY Sobra AWU (ADH, water, USG) Decrease AWU (ADH, Water,
S.I. USH)
Soaked Inside → FVE (1st) & DI
↓Na Dry Inside → FVD (1st) & ↑Na
 Swollen Inside → Cerebral Dami Inom → Polydipsia/ Thirst
edema (headache) Dami Ihi → Polyuria
Stop Ihi → oliguria Diluted Ihi → Clear

INTERVENTION SIADH DI

Medications Demeclocycline (ADH ADH/Vasopressin

Antagonist/Blocker) Ex. Desmopressin
Diuretics WOF: H20 intoxication → ↓fluid

9
intake

K
Fluid Intake Restrict (800-1000 ml/day) Replace

BL
Monitor Daily weight → best parameter
I&O
Electrolytes → Na

L
SIADH (FVE) DI (FVD)

Hypertension N ✔
M
Weight gain ✔

Flat neck vein ✔

A

Crackles ✔
R

Altered LOC ✔ ✔
-T

Edema ✔

Tachycardia ✔ ✔

Poor Skin Turgor ✔

AM

Dry Skin ✔

Distended Neck Vein ✔

IC

Sunken Eyeballs ✔

Hypotension ✔

FINDINGS SIADH DI

High ADH ✔
FVD ✔

Hypernatremia ✔

Oliguria ✔

High USG ✔

Dilute urine ✔

Polydipsia ✔

9
Cerebral Edema ✔

K
BL
DM1 DM2

Early/Juvenile onset Late/Adult onset

L
Thin Fat/Obese
N
Autoimmune → destruction of pancreas (Beta) Metabolic syndrome “x”
M
↓ ↑BP
↓insulin → w/o carbs metabolism ↑BS
↑LDL
A

↑High cholesterol

Crisis form: Diabetic Ketoacidosis (DKA) → Insulin resistance → may insulin pero hindi
R

250 mg/dl gumagana sa cells

-T

Insulin Resistance → with carbs metabolism

Trivia: Insulin is directly proportional sa skin cells

Crisis: HHNS (Hyperosmolar Hyperglycemic

AM

Ketotic Syndrome) → 600 mg/dl

Management
IC

DM1 DM2
“DIE” “DIE OHA”

1. DIET → complex carbs “not sweet” 1. DIET

Avoid: Simple carbs “sweet”
Ex. milk (non fat)

Complex carbs → pinakamagandang carbs →

matagal ma-breakdown ang sugar
 2. INSULIN (DOC) 2. INSULIN - last resort

3. EXERCISE (moderate) 3. Exercise

WOF: Hypoglycemia
Exercise after meal, morning

4. Oral Hypoglycemic Agents → DOC

Ex. Metformin
Contraindicated: DM1 & Pregnant

9
DKA & HHNS - triggered by stress → ↑cortisol → ↑sugar

K
Infection → most common stress → “Px needs more insulin”
During periods of infection → ↑sugar → more insulin ang needed para bumababa ang sugar para

BL
hindi ma-trigger ang DKA at HNSS
CLASSIC: Px needs more insulin

DM1: ↑Glucose → ❌
HYPERGLYCEMIA: lalabas kay DKA at HNSS

❌
insulin → cell (hyperglycemia)

L
DM2 → ↑Glucose → insulin → cell (insulin resistance → hyperglycemia)
N
➔ Cell starvation → Polyphagia → Worsen hyperglycemia → lalapot ang dugo (high viscosity)
→ poor circulation → poor wound healing → chronic complication
M
FATAL EFFECT → Kidney → glycosuria → polyuria → FVD/DHN → Polydipsia
↓
Priority
A

5P’s
POLYPHAGIA
R

POLYURIA
POLYDIPSIA
-T

POOR CIRCULATION
POOR WOUND HEALING

*Podiatrist → doctor of foot

AM

DM1 & DKA

↑Glucose →
↓
❌ insulin → cell (hyperglycemia)
↓
Priority w/o carbs metabolism
↓ ↓
IC

FVD/DHN Breakdown/Ketosis
[Link] → ↑ketone (acid) → DKA → ↓pH & ↓HCO3 → M. Acidosis
↓ ↓
Fruity Odor (Acetone) Lungs (magcocompensate)
Ketonuria ↓
↓LOC expel C02
“Kussmaul”

Metabolic Acidosis - lungs ang magcocompensate

Tachypnea - shallow
Hyperventilate - deep

↓ ↓
❌
DM2 & HNSS → 600 mg/dl → ↑serum osmolarity (best parameter)
↑Glucose → insulin → cell

priority w/ carbs metabolism → No breakdown/Ketosis

↓
FVD/DHN

FINDINGS DKA HNSS

9
Blood Glucose 250 mg/dL 600 mg/dL

K
Serum Osmolarity N/A High

BL
Blood pH Low N/A

Bicarbonate Low N/A

Ketonuria (+) (-)

L
Glycosuria

Kussmaul
N (+)

(+)
(+)

(-)
M
Polyuria

(+)
A

Polydipsia
R

Polyphagia

PRIORITY FVD/DHN
-T

MANAGEMENT: 1st Priority: IV NSS/Hypotonic → ↑circulation

2nd Priority: IV Insulin (shoRt/Regular)

HYPOGLYCEMIA → <70 mg/dL

AM

➔ similar to hunger
➔ initial sign → SNS/Adrenergic
↓
“diaphoresis”
IC

tremors “Cold & clammy give some candy” → moist

neurons
↑HR/Palpitation
➔ late sign → “neuro s/sx”
↓
lightheadedness
weakness
↓LOC
Management 1. CONSCIOUS (15 15 3x)
15 mg simple carbs
Recheck BS after 15 mins (max 3)
2. Unconscious/4th checking of BS → I G 5050D
IM Glucagon/50 ml/50% dextrose → Parenteral

FINDINGS HYPERGLYCEMIA HYPOGLYCEMIA

9
Increase Urine Output ✔

Shakiness ✔

K
Lightheadedness ✔

BL
Excessive thirst ✔

Nervousness ✔

L
Polyphagia ✔

Dehydration N✔
M
Moist skin ✔

Glycosuria ✔
A

Fruity Odor ✔
R
-T
AM
IC