By N. Olivier. University of the District of Columbia. 2018.
Effects of 2 in- second day 40 mg) order 20mg cialis jelly mastercard erectile dysfunction treatment new zealand, so this medication error occurred because haled corticosteroids on growth purchase 20 mg cialis jelly fast delivery erectile dysfunction treatment auckland. The Medical Letter him or her write the order indicating the dosage for day 1, day 2, on Drugs and Therapeutics, 44, 6–8. American Journal of Nurs- daily, it helps to look at how much was administered the previous ing, 100(7), 49–50. What is the difference between glucocorticoid and min- trol of growth and metabolism. Reﬂect on: Signs and symptoms of hypothyroidism and its impact on functional abilities. Once formed, the hormones are stored within the chemically inactive thyro- The thyroid gland produces three hormones: thyroxine, tri- globulin molecule. Thyroxine contains four atoms Thyroid hormones are released into the circulation when of iodine and is also called T4. Triiodothyronine contains three the thyroid gland is stimulated by thyroid-stimulating hor- atoms of iodine and is called T3. Compared with thyroxine, tri- mone (thyrotropin or TSH) from the anterior pituitary gland. Despite these minor differences, the membranes, proteolytic enzymes break down the molecule so two hormones produce the same physiologic effects and have the active hormones can be released. Calcitonin functions in calcium thyroglobulin, the hormones become largely bound to plasma metabolism and is discussed in Chapter 26. Only the small amounts left unbound are biologi- Production of thyroxine and triiodothyronine depends on cally active. The bound thyroid hormones are released to tis- the presence of iodine and tyrosine in the thyroid gland. Once in the cells, the hormones combine Plasma iodide is derived from dietary sources and from the with intracellular proteins so they are again stored. They are metabolic breakdown of thyroid hormone, which allows some released slowly within the cell and used over a period of days iodine to be reused. Once used by the cells, the thyroid hormones release the circulating blood, concentrates it, and secretes enzymes the iodine atoms. Most of the iodine is reabsorbed and used to that change the chemically inactive iodide to free iodine produce new thyroid hormones; the remainder is excreted in atoms. In a series Thyroid hormones control the rate of cellular metabolism of chemical reactions, iodine atoms become attached to tyro- and thereby inﬂuence the functioning of virtually every cell 353 354 SECTION 4 DRUGS AFFECTING THE ENDOCRINE SYSTEM in the body. The heart, skeletal muscle, liver, and kidneys are ment with amiodarone, lithium, or iodine. Secondary hypo- especially responsive to the stimulating effects of thyroid thyroidism occurs when there is decreased TSH from the hormones. Thyroid hormones are required for normal growth and de- Congenital hypothyroidism (cretinism) occurs when a child velopment and are considered especially critical for brain is born without a thyroid gland or with a poorly functioning and skeletal development and maturation. Some speciﬁc physiologic effects include: rarely present at birth but develop gradually during infancy and • Increased rate of cellular metabolism and oxygen con- early childhood and include poor growth and development, sumption with a resultant increase in heat production lethargy and inactivity, feeding problems, slow pulse, subnor- • Increased heart rate, force of contraction, and cardiac mal temperature, and constipation. If the disorder is untreated output (increased cardiac workload) until the child is several months old, permanent mental retar- • Increased carbohydrate metabolism dation is likely to result. Subclinical hypothyroidism, which is the most com- • Inhibition of pituitary secretion of TSH mon thyroid disorder, involves a mildly elevated serum TSH and normal serum thyroxine levels. Clinical hypothyroidism produces variable signs and THYROID DISORDERS symptoms, depending on the amount of circulating thyroid hormone. They Thyroid disorders requiring drug therapy are goiter, hypothy- usually increase in incidence and severity over time as the roidism, and hyperthyroidism. Hypothyroidism and hyperthy- thyroid gland gradually atrophies and functioning glandular roidism produce opposing effects on body tissues, depending tissue is replaced by nonfunctioning ﬁbrous connective tissue on the levels of circulating thyroid hormone. Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders such as hypo- Simple Goiter natremia, hypoglycemia, and lactic acidosis. Predisposing factors include exposure to cold, infection, trauma, respiratory Simple goiter is an enlargement of the thyroid gland resulting disease, and administration of central nervous system (CNS) from iodine deﬁciency. Inadequate iodine decreases thyroid depressant drugs (eg, anesthetics, analgesics, sedatives). To compensate, the anterior pituitary person with severe hypothyroidism cannot metabolize and gland secretes more TSH, which causes the thyroid to enlarge excrete the drugs. If the enlarged gland secretes enough hormone, thyroid function is normal and the main Treatment consequences of the goiter are disﬁgurement, psychological distress, dyspnea, and dysphagia. If the gland cannot secrete Regardless of the cause of hypothyroidism and the age at enough hormone despite enlargement, hypothyroidism re- which it occurs, the speciﬁc treatment is replacement of thy- sults. Simple or endemic goiter is a common condition in roid hormone from an exogenous source. In patients with subclinical largely because of the widespread use of iodized table salt.
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