🦋 Lecture 7
Thyroid & Adrenals
Hyper/hypothyroidism, thyroid storm, Addison vs Cushing.
Thyroid
⭐
Study Trick: Replace "thyroid" with "METABOLISM" in every question!
| Hyperthyroidism | Hypothyroidism | |
|---|---|---|
| Weight | Weight LOSS | Obese |
| HR/BP | HR up, BP up | HR down, BP down |
| Temperature | Heat intolerance | Cold intolerance |
| Treatment | Radioactive iodine, PTU, Thyroidectomy | Synthroid — morning, empty stomach |
🚨
Thyroid Storm: Temp ≥105°F, BP ~210/180, HR 180–200, psychotically delirious. First: Ice packs | Best: Cooling blanket
⚠️
Hypothyroid: NEVER sedate — can go into COMA. Don't hold Synthroid pre-op without clarifying!
Post-op Risks
| Time Frame | Total Thyroidectomy | Subtotal Thyroidectomy |
|---|---|---|
| First 12 hrs (SAME) | AIRWAY (#1) → HEMORRHAGE (#2) | |
| 12–48 hrs | TETANY (↓ calcium) → can close airway! | THYROID STORM |
| After 48 hrs | INFECTION risk |
📌 TOTAL = TETANY | SUBTOTAL = STORM
Adrenals
| Addison's | Cushing's | |
|---|---|---|
| Cortisol | UNDER-secretion | OVER-secretion |
| Appearance | Hyperpigmented (very tan) | Moon face, buffalo hump, truncal obesity |
| Crisis | Addisonian crisis (shock + hypoglycemia) | High glucose → Accu-Cheks q6h |
| Treatment | ADD-a-SONE (prednisone) | Adrenalectomy → now has Addison's! |
📖 Notes for Dummies
🧠 Think of it this way…
The thyroid is your body's engine speed controller. Too high = everything overheats and races. Too low = everything slows to a crawl. Adrenal glands control your stress hormones. Addison's = tank is empty. Cushing's = tank overflowing.
🔥
Hyperthyroidism = engine running too fast and hot:
Losing weight (burning fuel fast), racing heart, sweating, heat intolerant, eyes bulging (Graves')
Fix: Nuke it (radioactive iodine), Suppress it (PTU), Remove it (surgery)
Losing weight (burning fuel fast), racing heart, sweating, heat intolerant, eyes bulging (Graves')
Fix: Nuke it (radioactive iodine), Suppress it (PTU), Remove it (surgery)
🐌
Hypothyroidism = engine barely running:
Gaining weight, slow heart, cold intolerant, sluggish, dull.
Fix: Replace what's missing — Synthroid in the MORNING on an EMPTY stomach.
Gaining weight, slow heart, cold intolerant, sluggish, dull.
Fix: Replace what's missing — Synthroid in the MORNING on an EMPTY stomach.
🌪️
Thyroid Storm = engine explodes (SUBTOTAL thyroidectomy, 12–48 hrs postop):
Temp 105°F+, BP sky-high, HR 180–200, patient delirious. Medical emergency!
Temp 105°F+, BP sky-high, HR 180–200, patient delirious. Medical emergency!
😰
Addison's vs Cushing's:
Addison's = empty tank → tan skin, crashes under stress → ADD-a-SONE
Cushing's = overflowing tank → looks like a steroid side-effect poster → remove adrenals
Addison's = empty tank → tan skin, crashes under stress → ADD-a-SONE
Cushing's = overflowing tank → looks like a steroid side-effect poster → remove adrenals