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\author{Maria K (mkravatz)}
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  /Title (thyroid-and-parathyroid-disease.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Thyroid \& Parathyroid Disease Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Thyroid \& Parathyroid Disease Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18199/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 9th December, 2018.\\
   Updated 9th December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Thyroid Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Affects metab., growth, development; temp. regulation, HR, RR (every cell, tissue, organ)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Endocrine system = "duct system"} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} How does it work?} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Negative feedback loop}}... \{\{nl\}\} - Hypothalamus releases TRH \{\{fa-arrow-right\}\} Pituitary releases TSH \{\{fa-arrow-right\}\} Thyroid releases T`3` \& T`4` \{\{fa-arrow-right\}\} T`3` \& T`4` maintain normal levels in blood \{\{fa-arrow-right\}\} Normal function maintained \{\{fa-arrow-right\}\} Normal levels "turn off" hypothalamus} \tn 
% Row Count 11 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hypothyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Underactive thyroid; not enough T`3` and T`4`} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Primary}}: dec. thyroid tissue, dec. TH \{\{nl\}\} {\bf{Secondary}}: inadequate TSH production} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pathophysiology}}: Low metabolism \{\{fa-arrow-right\}\} Hypothalamus \& anterior pituitary release TSH \{\{fa-arrow-right\}\} TSH tries to get thyroid to release hormones \{\{fa-arrow-right\}\} TSH binds to thyroid cells \{\{fa-arrow-right\}\} Inability = thyroid gland enlarges \{\{fa-arrow-right\}\} Goiter} \tn 
% Row Count 9 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Symptoms: (early = fatigue, vague) \{\{nl\}\} - {\emph{Neuro}}: {\bf{memory loss, gait, AMS}} \{\{nl\}\} - {\emph{CV}}: {\bf{low HR, low BP, eye/face edema}} \{\{nl\}\} - {\emph{Lungs}}: {\bf{muscle weakness, dec. effort}} \{\{nl\}\} - {\emph{GI}}: {\bf{dec. bowel, low metab., constipation}} \{\{nl\}\} - {\emph{Renal}}: {\bf{dec. urine output}} \{\{nl\}\} - {\emph{M/S}}: {\bf{weakness, myalgia}} \{\{nl\}\} - {\emph{Skin}}: {\bf{dec. turgor, dry, stiff, puffy, PM}} \{\{nl\}\} - {\emph{Psych}}: {\bf{depression}} \{\{nl\}\} - {\emph{Reproductive}}: {\bf{irregular/heavy periods}}} \tn 
% Row Count 19 (+ 10)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Drug therapy}}: \{\{nl\}\} - Levothyroxine (Synthroid) (most common), Liothyronine (Cytomel, Liotrix) \{\{nl\}\} {\bf{Education}}: \{\{nl\}\} - Take first (30 min before/2 hr after meal) \{\{nl\}\} - Therapy is LIFELONG! \{\{nl\}\} - Don't take within 4 hr of GI meds, antacids \{\{nl\}\} - Side effects: signs of hyperthyroidism} \tn 
% Row Count 26 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pretibial myxedema (PM)}}: {\emph{r/t accumulations of mucopolysaccharides; reversible}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hashimoto's Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Most common cause of hypothyroidism}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cause}}: immune system attacks thyroid \{\{nl\}\} - Also: dec. iodine, tumor, overtreated} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Manifestations}}: dysphagia, enlarged thyroid} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Risk Factors}}: sex, age, heredity, another autoimmune disorder, radiation} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Complications}}: goiter, cardiac problems, mental health, myxedema, birth defects} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Myxedema Coma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{A medical emergency; "severe" hypothyroidism (r/t untreated, stopping meds)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Causes}}: acute illness, surgery (thyroid), chemo, narcotics, d/c replacement therapy} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Presentation}}: \{\{nl\}\} - Coma \{\{nl\}\} - Respiratory failure \& hypotension \{\{nl\}\} - Hypothermia \{\{nl\}\} - Hyponatremia (r/t dec. glomerular fx) \{\{nl\}\} - Hypoglycemia (r/t gluconeogenesis)} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Monitor}}: \{\{nl\}\} - Labs \& electrolyte imbalance(s) \{\{nl\}\} - Resp. rate \& heart rhythms} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Interventions}}: \{\{nl\}\} - Maintain patent airway \{\{nl\}\} - Cardiac monitoring \{\{nl\}\} - IV: TH replacement, glucocorticoids \{\{nl\}\} - Correct electrolytes \{\{nl\}\} - Conserve body heat \{\{nl\}\} - Narcan? \{\{nl\}\} - NO vasoconstrictive drugs \{\{nl\}\} - Seizure precautions (r/t low Na \& AMS)} \tn 
% Row Count 16 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hyperthyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Increased secretion of thyroid hormones} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Causes: \{\{nl\}\} - {\bf{Grave's disease}} (most common) \{\{nl\}\} - Multiple thyroid nodules \{\{nl\}\} - Toxic multinodular goiter \{\{nl\}\} - Excessive thyroid replacement hormones \{\{nl\}\} - Thyroiditis \{\{nl\}\} - Too much iodine} \tn 
% Row Count 6 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Signs \& Symptoms: \{\{nl\}\} - {\emph{Neuro}}: {\bf{tremors, restless, irritable, confusion, seizures}} \{\{nl\}\} - {\emph{CV}}: {\bf{dysrhythmias, a fib.}} \{\{nl\}\} - {\emph{Lungs}}: {\bf{inc. resp. drive = dyspnea}} \{\{nl\}\} - {\emph{GI}}: {\bf{diarrhea, inc. peristalsis, dec. nutrients, losing electrolytes, weight loss}} \{\{nl\}\} - {\emph{Renal}}: {\bf{r/t HTN}} \{\{nl\}\} - {\emph{M/S}}: {\bf{restless \& nervousness = fatigue}} \{\{nl\}\} - {\emph{Skin}}: {\bf{smooth skin}} \{\{nl\}\} - {\emph{Psych}}: {\bf{restless, moody, insomnia}} \{\{nl\}\} - {\emph{Reproductive}}: {\bf{issues, irregular periods}}} \tn 
% Row Count 16 (+ 10)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Interventions: \{\{nl\}\} - {\bf{Monitor}}: EKG, HR, RR, VS; thyroid storm \{\{nl\}\} - {\bf{Comfort}}: calm, cool, comfortable \{\{nl\}\} - {\bf{Diet}}: avoid iodine, \textgreater{} calories (inc. metab.) \{\{nl\}\} - {\bf{Education}}: watch for toxicity, med compliance, avoid aspirin} \tn 
% Row Count 21 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment: \{\{nl\}\} {\bf{Drug therapy}}: {\emph{antithyroid meds \& radioactive iodine = most common treatment}} \{\{nl\}\} - {\emph{Thionamides}}: PTU, Tapazole \{\{nl\}\} - {\emph{Beta-blockers}} (treat symptoms; HTN, inc. HR, palpitations) \{\{nl\}\} - {\emph{Radioactive iodine}} (kills thyroid slowly, more permanent cure; not if pregnant or BF) \{\{nl\}\} {\bf{Surgery}}: to remove all or part of thyroid \{\{nl\}\} {\bf{Combination therapy}}} \tn 
% Row Count 29 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Propiothiouracil (PTU)}} - stops T`3` \& T`4`; doesn't harm gland; can take in 1st trimester, but can cause liver failure  \newline {\bf{Tapazole (Methimazole)}} - causes anemia, safer}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Grave's Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Autoimmune; most common cause of hyperthyroidism}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cause}}: antibodies attach to TSH receptors\{\{fa-arrow-right\}\} inc. \# and size of cells \{\{fa-arrow-right\}\} thyroid enlarges (goiter) \{\{fa-arrow-right\}\} overproduction of hormones} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Additional Manifestations: \{\{nl\}\} - {\bf{Exophthalmos}}: autoimmune \{\{fa-arrow-right\}\} attacks area behind eyes, causes edema \{\{nl\}\} - {\bf{Pretibial myxedema}} \{\{nl\}\} - {\bf{Grave's dermopathy}}: resembles orange peel; r/t inc. protein under skin, legs, \& feet} \tn 
% Row Count 12 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Thyroid Storm (Thyrotoxic Crisis)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{What is it?}} - Extreme exacerbation of hyperthyroidism} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Causes}}: illness, Grave's disease, meds that inc. TH, untreated/undiagnosed tumor} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Signs \& Symptoms: \{\{nl\}\} - {\bf{Inc. HR \& BP}} = severe cardiac problems \{\{nl\}\} - {\bf{Inc. temp}} = diaphoresis \{\{nl\}\} - {\bf{Resp. failure}} \{\{nl\}\} - {\bf{Anxiety or agitation}}} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment: \{\{nl\}\} - {\bf{Interventions to counteract symptoms}} \{\{nl\}\} - {\bf{Block TH synthesis}} \{\{nl\}\} - {\bf{Control temp.}} \{\{fa-arrow-right\}\} NO ASA \{\{nl\}\} - {\bf{Meds to suppress immune system?}}} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{x{1.09848 cm} x{1.73926 cm} x{1.73926 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Tests for Thyroid Problems}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & \{\{bb\}\} {\bf{HYPO}} & \{\{bb\}\} {\bf{HYPER}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\{\{bt\}\} T`3` & \{\{fa-arrow-down\}\} & \{\{fa-arrow-up\}\} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
T`4` & \{\{fa-arrow-down\}\} & \{\{fa-arrow-up\}\} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
TSH = 0.4-4 & \{\{fa-arrow-up\}\} & \{\{fa-arrow-down\}\} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
TSH Assay & \{\{fa-arrow-up\}\} & \{\{fa-arrow-down\}\} \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{{\bf{Thyroid Labs}} - T`3`, T`4`, TSH \newline {\bf{TSH Assay}} - r/t central hypothyroidism \newline {\bf{Thyroid Peroxidase (TPO)}} - enzyme in follicle cells important to hormone production; converts T`4` to T`3; (+) may indicate autoimmune, not definite for thyroid disease \newline {\bf{Radioisotope Uptake Scan}} - evaluates size, areas of over- or under-activity \newline {\bf{Thyroid Scan}}  \newline {\bf{Thyroid US}} - uses sound waves to image, characteristics (nodules, blood flow) \newline {\bf{Fine Needle Aspiration (FNA)}} - malignant vs. benign}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Thyroid Surgery}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Total or subtotal thyroidectomy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{When?}} \{\{nl\}\} - Large goiter, poor response to drugs \{\{nl\}\} - Can't/won't take meds \{\{nl\}\} - Malignancy} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pre-Op: \{\{nl\}\} - {\bf{Meds}}: dec. hormone secretion, \{\{nl\}\} beta-blocker, steroids to dec. immune system (w/ autoimmune dx) \{\{nl\}\} - {\bf{Control}}: HTN, dysrhythmias, tachycardia} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Post-Op: (BOWTIE) \{\{nl\}\} - {\bf{B}} leeding \{\{nl\}\} - {\bf{O}} pen airway \{\{nl\}\} - {\bf{W}} hisper \{\{nl\}\} - {\bf{T}} rach kit \& suctioning ready \{\{nl\}\} - {\bf{I}} ncision (assess/clean dressing \& splint) \{\{nl\}\} - {\bf{E}} mergency \{\{nl\}\} - Also: monitor VS, semi-Fowler's, labs, humidify air, diet, cough \& deep breathe} \tn 
% Row Count 14 (+ 6)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Complications}}: hemorrhage, resp. distress, parathyroid injury} \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hypoparathyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Abnormally low levels of PTH} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Causes: \{\{nl\}\} - {\bf{Iatrogenic}} \{\{nl\}\} - {\bf{Idiopathic}} \{\{nl\}\} - {\bf{Hypomagnesemia}} (inhibits PTH secretion) \{\{nl\}\} - Other: {\bf{autoimmune}}} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Signs \& Symptoms: \{\{nl\}\} - {\bf{P}} = paresthesias, positive Chvostek's \& Trousseau's signs \{\{nl\}\} - {\bf{T}} = tetany (bronchospams, seizures, EKG) \{\{nl\}\} - {\bf{H}} = hypocalcemia \& hyperphosphatemia} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diagnostics: \{\{nl\}\} - {\bf{EKG}} = seizure activity, slow brain waves \{\{nl\}\} - {\bf{Blood tests}} = labs \{\{nl\}\} - {\bf{CT scans}} = specific compared to US, may show brain calcifications \{\{nl\}\} - MRIs may be even more specific} \tn 
% Row Count 13 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Interventions: \{\{nl\}\} - {\bf{Symptomatic hypocalcemia}}: give Ca, vitamin D, Mg \& seizure precautions \{\{nl\}\} - Other meds: {\bf{phosphate binders, PTH inj.}} \{\{nl\}\} - {\bf{Monitor}}: Ca, GI, paresthesias \{\{nl\}\} - {\bf{Education}}: medication regimen \{\{nl\}\} - {\bf{Diet}}: inc. Ca} \tn 
% Row Count 19 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Chvostek's sign}}: tap facial nerve, + when twitches (= dec. Ca)  \newline {\bf{Trousseau's sign}}: inflate BP cuff 20-30 mm Hg above normal for 3-5 min; + when involuntary arm movement  \newline {\bf{PTH inj. (Natpara)}} - last resort (inc. risk of osteosarcoma)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Calcium in Parathyroid Disease}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Major controlling factor of PTH secretion} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Ca \& PTH are {\bf{directly}} related \{\{nl\}\} - Increase in PTH = increase in Ca} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Affects kidneys {\emph{(regulates P)}}, bones, GI tract} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hyperparathyroidism}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Abnormally high levels of PTH} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Causes: \{\{nl\}\} - {\bf{Primary}}: hyperplasia, cancer growth \{\{nl\}\} - {\bf{Secondary}}: CKD (PTH overworked = inc. Ca absorbed), vitamin D deficiency} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Signs \& Symptoms: \{\{nl\}\} - {\bf{B}} = bones (inc. fractures) \{\{nl\}\} - {\bf{E}} = epigastric pain, constipation (r/t smooth muscle dec.) \{\{nl\}\} - {\bf{D}} = dehydration (r/t kidney compensation for inc. Ca) \{\{nl\}\} - {\bf{S}} = short QT interval (r/t inc. Ca)} \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Interventions: \{\{nl\}\} - {\bf{Diagnostics}} - inc. Ca \& PTH, dec. P \{\{nl\}\} - {\bf{Monitor}}: labs, EKG (telemetry) \{\{nl\}\} - {\bf{Diet}}: dec. Ca, inc. P - watch in renal pt! (already inc. Ca \& dec. P)} \tn 
% Row Count 13 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Medications: {\bf{GOAL = LOWER Ca LEVELS}} \{\{nl\}\} - {\bf{Loop diuretics}}: hypocalcemia = side effect \{\{nl\}\} - {\bf{Biphophates}}: given for osteoporosis, protect against losing Ca, {\emph{sit upright for 30 min \& w/ full glass of water}} \{\{nl\}\} - {\bf{Calcimimetics}} (ex - Sensipar): deceive thyroid that there's enough PTH} \tn 
% Row Count 20 (+ 7)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Education: \{\{nl\}\} - {\bf{Medication compliance}} \{\{nl\}\} - {\bf{Monitor for s/s of hypocalcemia}} \{\{nl\}\} - {\bf{Diet}} \{\{nl\}\} - {\bf{Prevent complications}}: osteoporosis, traumatic fractures} \tn 
% Row Count 24 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagostic Tests for Parathyroid Problems}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Labs: \{\{nl\}\} - {\bf{Calcium (total) = 8.5-10 mg/dL}} - usually high enough, ionized if specificity desired \{\{nl\}\} - {\bf{Phosphate = 2.7-4.5 mg/dL}} \{\{nl\}\} - {\bf{Magnesium = 1.3-2.1 mEq/L}} \{\{nl\}\} - {\bf{PTH = 10-55 picograms/mm}}} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Hypoparathyroidism: \{\{nl\}\} - Decreased... Ca, Mg, PTH, vitamin D \{\{nl\}\} - Increased... phosphate} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} X-rays} \tn 
% Row Count 8 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{24-hour urine collection for calcium} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Parathyroidectomy}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Total or subtotal} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pre-Op: \{\{nl\}\} - {\bf{Get Ca in check}} \{\{nl\}\} - {\bf{Coags}}} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Post-Op: \{\{nl\}\} - Similar to thyroidectomy {\emph{(dressing, emergency equip., etc.)}} \{\{nl\}\} - Check Ca levels \{\{nl\}\} - Monitor for s/s hypoparathyroidism \{\{nl\}\} - Voice (r/t laryngeal edema) - {\bf{hoarseness}} \{\{nl\}\} - May need lifelong treatment} \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}