Endo Part 1 Flashcards by Kolbie Chancellor

What is the pneumonic to remember Metabolic Syndrome?

WEIGHHT

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What are the findings with Metabolic Syndrome?

WEIGHHT
- Waist Expanded
- Impaired Glucose
- HTN
- HDL decreased
- Triglycerides increased

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What is the treatment for Metabolic Syndrome?

Lifestyle modifications
+/- metformin for weight loss
+/- BP medications

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What is most of T4 bound to in the bloodstream? What increases this?

TBG – increases in pregnancy

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Graves disease involves TSH receptor stimulating antibodies. What are findings that are only present with this cause of hyperthyroidism? (4)

Exophthalmos
Pretibial myxedema
Acropachy – hand swelling
Thyroid bruit

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If someone with Graves disease choose to undergo Iodine ablation, what will worsen?

Eye disease – exophthalmos

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In a pregnant woman with Graves disease, what is a potential adverse effect?

Fetal thyroxicosis
– TSH antibodies cross placenta and stimulate fetal thyroid

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What is the treatment for Thyroid eye disease?

Steroids

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What is used for symptom control with hyperthyroidism?

Beta blocker – propranolol

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Which hyperthyroidism medication should be used in pregnancy?

PTU

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What are some adverse effects of PTU and Methimazole

Both = Agranulocytosis
PTU = Liver failure
Methimazole = Cholestasis

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What is the only definitive treatments (2) for hyperthyroidism?

Radioactive iodine ablation
Thyroidectomy

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What is the next most common cause of hyperthyroidism following Graves disease?

Thyroid adenoma – hot nodule

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With UNtreated hyperthyroidism, what is the potential adverse effect?

Osteoporosis and bone resorption
=> Fractures and hypercalcemia

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How may Thyroid storm present?

HIGH fever
Afib
Delirium/coma

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What is the treatment order for a thyroid storm (4)?

Beta blocker
PTU/Methimazole
Iodine
+/- steroids

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What occurs with Euthyroid sick?

Serious illness causes T4 to be converted to reverse T3 which is NON-functional

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What will the levels of TSH, T4 and T3 be with Euthyroid sick?

NORMAL TSH and T4
- LOW T3

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Hashimoto’s thyroiditis may have which 2 antibodies?

Anti-TPO
Anti-Thyroglobulin

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There are many Thyroiditis conditions – postpartum, postviral, subacute; how may they present?

Hyperthyroid –> Hypothyroid

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Which Thyroiditis has a painful goiter (though all can have a nonpainfaul goiter)? What precedes this?

Subacute Thyroiditis
– preceded by viral illness

Which Thyroiditis will have elevated ESR/CRP?

Subacute Thyroiditis

What are some features of congenital hypothyroidism?

Umbilical hernia
Failure to thrive/hypotonia
Prolonged jaundice

What are 2 features seen with Papillary thyroid cancer?

Psammoma bodies
Orphan annie nuclei

What are 2 features seen with Papillary thyroid cancer?

Psammoma bodies Orphan annie nuclei

How does Papillary thyroid cancer spread?

Lymphatic

How does Follicular thyroid cancer spread?

Hematologic

Where is Medullary thyroid cancer and what is produced?

Thyroid C cells --> Calcitonin

MEN 1

3 P's - Pituitary - Parathyroid - Pancreas

MEN 2A

2 P's - Parathyroid - Pheochromocytoma - Medullary Thyroid carcinoma

MEN 2B

1 P - Pheochromocytoma - Medullary Thyroid carcinoma - Marfanoid habitus

What derm finding is seen with a Glucagonoma?

Necrolytic Migratory Erythema

What derm finding is seen with a Glucagonoma?

Necrolytic Migratory Erythema

How does Necrolytic Migratory Erythema look?

Large indurate plaques with CENTRAL CLEARING

If someone takes in too much calcium or alkali like antacids, what are they at risk for?

Milk Alkali Syndrome

What will the levels of Calcium, HCO3 and GFR be with Milk Alkali syndrome?

-- excess intake of calcium/alkali/antacids = HIGH calcium and HCO3 = LOW GFR

What is Paget Disease of Bone?

Bone formation AND resorption

Paget Disease commonly presents at the skull. What are characteristic symptoms?

Bone pain + nerve entrapment + hearing loss

If someone presents with bone pain and hearing loss... expect what?

Paget Disease of bone

What lab value is elevated with Paget Disease of Bone? What are patients at an increased risk for?

HIGH Alk Phos --> Osteosarcoma risk

What will an X-ray show with Paget Disease of Bone?

Mosaic pattern -- cortex sclerosis + thickened trabeculae

Lab values of PTH, Ca, P with Primary Hyperparathyroidism?

HIGH PTH and Ca LOW P

Lab values of PTH, Ca, P with Secondary Hyperparathyroidism?

HIGH PTH and P LOW Ca

What commonly causes Secondary Hyperparathyroidism?

Renal failure

What commonly causes Tertiary Hyperparathyroidism?

Chronic hypocalcemia that causes autonomously functioning parathyroid glands

Lab values of PTH, Ca, P with Tertiary Hyperparathyroidism?

ALL HIGH

What causes Pseudohypoparathyroidism?

PTH resistance -- common with Albright Osteodystrophy (shortened 4th/5th fingers)

Lab values of PTH and Ca with Pseudohypoparathyroidism?

High PTH and Low Ca

What scan may be helpful with hyperparathyroidism?

Sestamibi scan

What may get too high and need treatment with Secondary hyperparathyroidism?

Phosphate -- phosphate binders (ex. sevelamer)