Endocrine

Question 1

55yo female presents to out patient clinic for annual PE. Patient has done labs: lipids are normal, cbc is normal, but TSH is low, T3 and T4 is high. Patient is otherwise healthy. Patient denies vision changes, diarrhea, but states she has a fast heart rate even at rest. Denies smoking, drinking, drug use. Denies recent surgeries. ROS: denies HA, chest pain, constipation, diarrhea, urinary sx.
What would PE should you be looking for in this patient?

Answer 1

-exophthalmos, pretibial myxedema, thyroid bruit –> Grave’s dz

Question 2

55yo female presents to out patient clinic for annual PE. Patient has done labs: lipids are normal, cbc is normal, but TSH is low, T3 and T4 is high. Patient is otherwise healthy. Patient denies vision changes, diarrhea, but states she has a fast heart rate even at rest. Denies smoking, drinking, drug use. Denies recent surgeries. ROS: denies HA, chest pain, constipation, diarrhea, urinary sx.
How should this patient be managed with medications?

Answer 2

-Beta blockers and methimazole/Tapazole and monitor lab work: TSH, T3+T4, CBC, LFT

Question 3

55yo female presents to out patient clinic for annual PE. Patient has done labs: lipids are normal, cbc is normal, but TSH is low, T3 and T4 is high. Patient is otherwise healthy. Patient denies vision changes, diarrhea, but states she has a fast heart rate even at rest. Denies smoking, drinking, drug use. Denies recent surgeries. ROS: denies HA, chest pain, constipation, diarrhea, urinary sx.
What sx may this patient experience if untreated?

Answer 3

-heat intolerance, diarrhea, tachycardia, palpitations, hand tremor, insomnia, muscle weakness wt loss

Question 4

55yo female presents to out patient clinic for annual PE. Patient has done labs: lipids are normal, cbc is normal, but TSH is low, T3 and T4 is high. Patient is otherwise healthy. Patient denies vision changes, diarrhea, but states she has a fast heart rate even at rest. Denies smoking, drinking, drug use. Denies recent surgeries. ROS: denies HA, chest pain, constipation, diarrhea, urinary sx.
What type of medical emergency could happen if untreated?

Answer 4

• myxedema coma

- thyroid storm

Question 5

How to manage thyroid storm patient?

Answer 5

-(1) cool IV (2) cooling blankets (3) glucose (4) beta blockers (5) PTU (6) beta blockers

Question 6

55yo female presents to out patient clinic for annual PE. Patient has done labs: lipids are normal, cbc is normal, but TSH is low, T3 and T4 is high. Patient is otherwise healthy. Patient denies vision changes, diarrhea, but states she has a fast heart rate even at rest. Denies smoking, drinking, drug use. Denies recent surgeries. ROS: denies HA, chest pain, constipation, diarrhea, urinary sx.
Why do you monitor CBC with using thionamides?
Why do you monitor LFT with use of thionamides?

Answer 6

• agranulocytosis may occur (LOW WBC)

- hepatotoxicity may occur (AST, ALT)

Question 7

What is the definition of Graves dz?

Answer 7

autoimmune disorder
lands on the TSH receptors –> causing an overabundance of T3 and T4 hormones BUT low TSH, meaning this is a PRIMARY disorder

Question 8

What thyroid disorder is commonly seen in younger vs older?

Answer 8

younger: graves dz
older: plummer dz

Question 9

What diagnostic imaging can be used to differentiate between graves dz and plummers dz?

Answer 9

thyroid uptake scan

Question 10

How will the of thyroid uptake scan be for graves and plummers?

Answer 10

graves: DIFFUSE UPTAKE b/c EVERY thyroid cell is HYPERfxning
plummers: PATCHY uptake d/t thyroid NOT fxning

Question 11

22yo female presents postpartum 3wks for check up. She complains of palpitation but otherwise asymptomatic. ROS: denies HA, chest pain, SOB, muscle weakness, diarrhea, constipation, blood in urine and stool, depression. PE: loss of wt, no exophthalmos, no thyroidmegaly, no bruit, RRR, lungs clear bilaterally. ECG: sinus tachycardia, NAD. Denies drinking, smoking, drug use.
Differentials?

Answer 11

Graves dz
postpartum thyroiditis
levothyroxine

Question 12

What factors can increase T4?

Answer 12

TBG can increase d/t pregnancy, liver dz, OCP, ASA

TBG is reversibly bound to T4

Question 13

What are the treatment types for hyperthyroidism?

Answer 13

drugs - thionamides
radioiodine 131
surgery

Question 14

What should be monitored after a thyroidecotomy?

Answer 14

hypocalcemia - d/t the parathyroid being removed

Question 15

19yo female G1P0, 22wks pregnant presents to OB/GYN complaining of muscle weakness, diarrhea, heart palpitation, flushing, and started noticing eyes getting bigger. Denies F/C, constipation, vomiting other than morning sickness. PE: skin changes over tibia, exophthalmos, thyroid bruit, skin is warm. ECG: sinus tachycardia. Pt comes in following day after blood work: significant for high T3,T4, low T4. How would you manage this patient?

Answer 15

PTU, avoid thionamides during 1st trimester

Question 16

33yo female presents to outpatient clinic with fatigue, abnormal heavy bleeding during periods, and constipation. Patient is present with husband who also complains that she is “moving slower” and does not have a “sense of humor”. She has been otherwise

Answer 16

a