Endocrine Flashcards
What 4 things do you think of when it comes to hyperthyroidism
Graves
Medication cause = Amiodarone
Multi nodular goiter
Toxic thyroid adenoma
What does the thyroid look like with Graves’ disease
Diffuse non tender enlargement
What does the thyroid look like in multi nodular toxic goiter
Bumpy irregular asymmetric with nodules
4 general sxs for hyperthyroidism
Dysrhythmia
Moist Pretibial myxedema
Increased DTRs
Proptosis
Lab findings and antibodies in hyperthyroidism
Low , NML TSH ; high FT4 or FT3
Thyroid stimulating immunoglobulins
What two things do you think of with high FT4/FT3 labs and low radio iodine uptake
Subacute thyroiditis and Amiodarone exposure
Give 4 talking points for hyperthyroid medications
First and Best = Radio Iodine ablation ; common in Graves’ disease
Methimazole ; can be used if they dont want ablation
PTU = best in pregnancy
Propanolol best for hyper sympathetic sxs
surgery if large goiters and contraindications
What is the #1 risk factor for a thyroid storm?
1 infection
What are three complications to think of in thyroid storm?
Heart failure
Hyprecalcemia
Osteoporosis
Which hyperthyroid medication is teratogenic
Methimazole
How does exogenous iodine effect thyroid hormone?
Inhibits release of thyroid hormone
Used days [7] before thyroidectomy
What do yo have to remember when administering iodine
Block the sympathetic pathway first with PTU or Methimazole (1hr before)
What is the benefit of steroids in thyroid storm
Can treat adrenal insufficiency and autoimmune process in Graves’ disease
What are the main antibodies in hypothyroidism (Hashimotos)
Anti TPO and anti thyroglobulin
What 4 medications can cause hypothyroidism
Methimazole
PTU
Lithium
Amiodarone
What are two uncommon sxs of hypothyroidism
Slow mentation
Menorrhagia
What’s the effect on DTRs in hypothyroidism
Delayed!
What is the extreme/severe version of hypothyroidism
Myxedema coma
What is the dose adjustment per levels of thyroid hormone (TSH) ?
Less the 5-10
10
Less than 20
Less the 5-10 = 25 to 50
10 = 50 to 75
Less than 20 = 75 to 100
What it the #1 cause of supparative thyroiditis
Staph A.
What proceeds subacute thyroiditis normally?
URI
What is the tell tale sign of subacute thyroiditis
The gland itself is painful ; low grade fever ; pain that radiates to the ears
What are the tell tale signs of bacterial thyroiditis
Severely tender thyroid ; sudden onset fever erythema and fluctuation
What studies would you get with subacute thyroiditis or infectious
Subacute
> radio iodine uptake = LOW
Infectious
>thyroid U/S
>FNA with gram stain
Do you give antibiotics to subacute thyroiditis?
NO
ASA/ NSAIDS
Prednisone
Supportive care
Physical exam findings in thyroid nodules (3)
Smooth firm
Well outlined
Painless
For a thyroid nodule that has low TSH what should you do?
Radionuclide thyroid scan
HOT = benign
COLD = MALIGNANT
For a thyroid nodule that has normal to high TSH what should you do?
Thyroid U/S
What are malignant findings for thyroid on U/S
Hypoechoic with irregular margins and micro calcifications
If a thyroid nodule is suspicious for malignancy on U/S what do you do?
FNA
If a thyroid nodule is causing dysphagia and proved benign what can you do for management? If what?
RF ablation if greater than 3cm
What is the monitor time for thyroid nodules
6 months by U/S and then yearly
Most common type of thyroid cancer
Papillary carcinoma
Talking points for medullary thyroid cancer (2)
Arises from parafollicular cells
Produces calcitonin
Talking point for follicular thyroid cancer
Higher rates of metastasis
What do you need to know about anaplastic carcinoma
Common in elderly MOST AGGRESSIVE
What are secondary findings associated with medullary thyroid cancer
Diarrhea
Flushing
What are secondary findings associated with anaplastic thyroid cancer
Dysphagia
Laryngeal nerve involvement
Hoarseness
Metastatic papillary and follicular cancers often have an increase in what hormone?
Serum thyroglobulin
What is the management for thyroid cancer (papillary and follicular)
Total thyroidectomy
What is the #1 cause of primary hyperparathyroidism
Parathyroid adenoma
2nd = lithium use or malignancy
2 common reasons for secondary hyperparathyriodism
CKD causing low calcitriol ; which causes increased PTH
Vitamin D deficiency
At worst think ESRD and Renal transplant
Dont forget what sxs with hyperparathyriodism and why
Stones Moans Groans and Psych Overtones
Think: Hypercalcemia
3 management things to remember in severe Hypercalcemia
IVF
Furosemide
Bisphosphonates and Calcitonin
If someone has hyperparathyriodism secondary to CKD you will likely replace what deficiency?
Calcitriol
Severe Hypercalcemia can be treated with
Cinacalcet
What deficiency can cause hypoparathyroidism
Magnesium deficiency
What should you think of with hypoparathyroidism or low calcium
Chovsteks
Trousseau’s sign
Increased DTRs
Low PTH Low Ca INCREASED PHOSPHATE
3 etiologies of adrenal insufficiency
Infection [TB, Fungal, HIV]
Destruction [Autoimmune]
Deficiency [Autoimmune]
Difference between primary and secondary adrenal insufficiency
Primary = low cortisol, Low DHEA, Low Aldosterone ; because the adrenal gland is not able to read the ACTH; so an increaed ACTH which results because of high CRH [adrenal gland tumor/infection]
Secondary = low cortisol, Low DHEA, Normal Aldosterone ; because the pituitary gland is sending a low ACTH signal and a high CRH signal results to try to fight the low ACTH [pituitary tumor]
Tertiary is a problem of the hypothalamus
How do we treat adrenal insufficiency
Primary = hydrocortisone / prednisone + fludrocortisone [corrects the low aldosterone]
What is ACTH independent Cushings?
Overproduction or overconsumption of steriods
[independent of your own ACTH]
What is ACTH dependent Cushings?
Cushings Disease !
Due to : pituitary tumor or ectopic ACTH production
What are the main 3 tests we want to do for Cushings
Dexamethasone suppression test
24 hour urinary free cortisol
ACTH level testing
What is a positive dexamethasone suppression test? Also talk about ACTH and disease vs. syndrome
Above 1.4 mL allows you to know that the cortisol can not be suppressed by dexamethasone.
ACTH will be low in Cushings Syndrome
ACTH will be high in Cushings Disease
A positive 24 hr urinary free cortisol will have what ?
High levels of cortisol in the AM = positive test
What is another name for hyperaldosteronism
Conn Disease
3 clinical features of conn disease
Headache
Metabolic alkalosis
Weakness
What it is the concern with acute increased SIADH
Cerebral edema
What are lab findings in SIADH (3)
Low serum sodium
Low serum osmolality
Increased urine osmolality
What are the lab findings of diabetes insipidous
Incr serum sodium
Incr serum osmolality
Dec urine osmolality
4 interventions for SIADH
Water restriction to 500-1500 mL per day
Correct sodium [no more than 10 mEq in 24 hrs // 18 mEq in 48 hrs]
Vasopressin = VAPTANS
Loop diuretic
3 main complications of SIADH
Seizures
Osmotic Demylenation Syndrome [SHRINKING OF THE BRAIN]
Coma/death
Diabetes Insipidous think what?
Low or Resistance to ADH
Large amounts of Dilute Urine
Explain Central vs. Nephrogenic DI
Central = Idio; Trauma; Surgery; Malignancy // ADH is not PRODUCED at the pituitary
Nephrogenic = Genetics[KIDS] Medications[Lithium] , CKD // ADH is not RECOGNIZED at the renal tubule
Lab studies for diagnosis of DI
Low osmolality // Low specific gravity urine
High serum osmolality
High NA+
Water deprivation test positive
What is the water depreciation test in DI
Still pee large amounts of DILUTE urine
-Showing that there is no increased in ADH production to decrease urine production and osmolality
What imaging should i get if I suspect central DI
Brain MRI
What happens when DI patient is given desmopressin? Central vs. Nephro
Central = increase in urine osmolality
Nephro = minimal or no increase in urine osmolality
Management for central DI
Desmopressin = INTRANASAL
Thiazide , Carbamazepine , Chlorpropamide
Management for nephro DI?
Low solute diet
Thiazide diuretic
NSAIDS
If continuing lithium use => Amiloride
How are pituitary Adenomas classified
Secretory and Non Secretory
What are the 4 types of secretary pituitary adenomas
Prolactinoma
Somatotropinoma
Corticotroph adenoma
Thyrotropinoma
3 sxs significant in macro Adenoma of the PT gland > 1cm
Bitemporal heminopsia
Headache
Diplopia
3 talking points for somatotropinoma
Adults = acromegaly
Kids = gigantism
Often HYPERglycemic
Corticotropinoma sxs (3)
Weight gain
Hypertension
Proximal muscle weakness
What are labs for somatotropinoma
Increased IGF-1 ; abnormal glucose tol testing PO
Imaging of choice for pituitary adenoma
MRI with contrast