Endo2 Flashcards

Question

Side effects of acarbose?

Answer 1

can cause gastrointestinal adverse effects reduce dose in patients with kidney impairment

Answer 2

can cause: weight gain peripheral oedema increased risk of heart failure macular oedema (rare) fracture in postmenopausal women (rare) possible increased risk of bladder cancer (pioglitazone) take 6 to 12 weeks to reach maximum effect

Answer 3

Remission in 60%

Answer 4

BMI greater than or equal to **40 and DM** BMI greater than or equal to **35 with DM and suboptimal glycaemic control** despite optimal lifestyle modification and medication management. POST SURG: Need endocrinology review need monitroing of glycaemic control to prevent recurrence Need support and monitoring of nutritional status

Answer 5

LETHARGY and increased SLEEP Cold intolerance Constipation Husky voice Myalgia, arthritis and joint effusion Menstrual abnormalities - mainly menorrhagia and also oligomennorhea Weight gain Physical and mental slowness

Answer 6

Ataxia Puffy face Brittle hair and Hair loss Loss of outer one third of eye brow Dry skin - which is cold and pale Bradycardia CTS and neuropathy Sluggish reflexes Depression and Dementia Cardiac - hyperlipidaemia, pericarditis, ischaemia, cardiomegaly Psychosis Myxoedema coma

Answer 7

1. Hashimotos Thyroiditis (Enlargement of gland and destruction of thyroid tissue by autoimmune antibodies) Commonest cause of hypothyroidism in Aus (_{Atrophic thyroiditis is also common but no goitre}) - To dx - need strong antimicrosomal antibody titre with Fine needle aspirate cytology confirmation (FNAC) FNAC alone may be sufficient for Dx TPO ab \> 1000 2. POSTPARTUM - mainly autoimmune - can be transient or permanent 3. Atrophic thyroiditis - (Autoimmune antibody positive - is associated with other autoimmune diseases) commonest in Aus without a goitre. 4. Infiltrative - Fibrous, scleroderma, haemochromatosis, TB, Amyloid) 5. Iodine deficiency (commonest worldwide) 6. Previous Graves. After treatment. Ultimately resulting in hypothyroidism. 7. Amiodarone, Lithium, Thalidomide, rifampicin, interferon 8. Thyroid surgery and radioactive iodine treatment 9. Congenital 10. Central (hypothalamic failure) 11. Subacute thyroiditis (sometimes)

Answer 8

Turners syndrome Downs Syndrome Type 1 DM Rheumatoid Arthritis

Answer 9

**TSH, T3 and T4** **Antithyroperoxidase antibody (only one needed to confirm autoimmune cause)** (other antibodies antimicrosomal, antithyroglobulin is reserved for ca follow up) **FBE** **Lipid Profile** (*_note that in hypothyroid if you treat with Statins before thyroid replacement you can induce rhabdo)_* **UEC** - Hyponatraemia (increased ADH and free water clearance) Increase **CPK** (muscle damage) **LFT** - Increased **ALT** (liver and muscle damage) **ECG** - sinus bradycardia with flat t waves *Ultrasound only if theres a suspicious structural thyroid abnormality such as a palpable thyroid nodule or goitre.*

Answer 10

SYMPTOMS? OVERT OR SUBCLINICAL DISEASE? HOW HIGH IS THE TSH?

Answer 11

a) Start thyroxine b) Repeat in 4 - 8 weeks

Answer 12

a) Trial therapy to relieve symptoms b) Retest in 4-8 weeks and start treatment if persistent c) Retest in 4-8 weeks and test thyroperoxidase antibodies, then at 3 months, 6, and 12 months IN a young patient (less than 60) with CV risk factors but does not reach treatment threshold, a trial of therapy may be indicated for reduction of CV risk.

Answer 13

1. **Establish cause -** treat the treatable 2. **exclude** significant cardiac disease - as quick therapy can precipitate ischaemia - (refer to endo) 3. Exclude secondary adrenal failure (From suppression of HPA axis) - here glucocorticoids must be replaced before thyroxine or can precipitate adrenal crisis 4. **Evaluate** - symptoms? Overt? Subclinical? How high is TSH? and determine at what interval you will treat. 5. **STARTING DOSE** IS 1.6micrograms/kilogram per day to the closest 25micrograms. ADJUST DOSE SLOWLY every 4-6 weeks with target of TSH between 0.5 and 2 * (In the **elderly** - start at 25micrograms, in the **young** start with 50micrograms)* * Avoid **overdosage** - low TSH and high T4 can lead to AF, osteoporosis* * Once **Euthyroid -** levels can be checked 3 monthly for a year and then 6-12 monthly.* Explain to patient that therapy will be needed life long.

Answer 14

1. Symptom control 2. Reach normal TSH

Answer 15

1. Younger than 18 years 2. Cardiac disease 3. Other endocrine diseases - Addisons 4. Pregnancy or planning 5. Unresponsive to treatment 6. Presence of a structural abnormality in the gland (eg goitre)

Answer 16

1. PPI 2. Ca 3. Fe 4. Multivitamins 5. Coffee THEREFORE TAKE THYROXINE ON AN EMPTY STOMACH AT LEAST THIRTY MINUTES BEFORE THESE

Answer 17

H. pylori infection (Settles after triple therapy) IBD Coeliac Lactose Intolerance

Answer 18

Liver enzyme inducers: 1. Anti epileptics 2. OCP. 3. Rifampicin

Answer 19

1. Weight gain 2. Starting new meds - PPI, OCP, Fe tablets, vitamins, rifampicin, anti epileptics 3. Pregnancy/Planning pregnancy

Answer 20

**Autoimmune lymphocytic thyroiditis** Hashimoto thyroiditis Atrophic thyroiditis _{Personal or family history of autoimmune conditions
Evidence of specific autoimmune diseases such as vitiligo on examination} **Postablative therapy or surgery** Radioiodine therapy Thyroidectomy _{History of previous radioiodine therapy or thyroid surgery
Evidence of a surgical scar or skin changes suggestive of previous external neck irradiation on examination} **Transient** Subacute thyroiditis Silent thyroiditis Postpartum thyroiditis Early postablative therapy _{Preceding history of viral infection, pregnancy or radioiodine ablation
Evidence of an enlarged tender thyroid on examination (subacute thyroiditis)} **Iodine associated** Iodine deficiency Iodine induced _{Dietary intake history} **Drug induced** Carbimazole Propylthiouracil Iodine Amiodarone Lithium Interferons Thalidomide Sunitinib Rifampicin *Medication history* **Infiltrative** Riedel thyroiditis (fibrous thyroiditis) Scleroderma Amyloid disease Haemochromatosis Infection (eg. tuberculosis) _{Personal history or other systemic features of an infiltrative disorder} **Neonatal/congenital** Thyroid agenesis/ectopia Genetic disorders affecting thyroid hormone synthesis Transplacental passage of TSH receptor blocking antibody _{Family history of thyroid disease/hypothyroidism
Maternal medication use during pregnancy} **Rare** Thyroid agenesis/ectopia Secondary (pituitary or hypothalamic disease) Thyroid hormone resistance syndrome Anomalous laboratory TSH results (eg. caused by heterophil antibodies) _{Other clinical features of pituitary deficiency}

Answer 21

**Appearance** Puffy and pale facies Dry, brittle hair Sparse eyebrows Dry, cool skin Thickened and brittle nails Myxoedema – fluid infiltration of tissues **Energy and nutrient metabolism** Cold intolerance Weight gain Fatigue **Nervous system** Headache Paraesthesias (including carpal tunnel syndrome) Cerebellar ataxia Delayed relaxation of deep tendon reflexes **Cognitive/ psychiatric** Reduced attention span Memory deficits Depression **Cardiovascular** Bradycardia Diastolic hypertension Pericardial effusion Decreased exercise tolerance **Musculoskeletal** Myalgias Arthralgias **Gastrointestinal** Anorexia Constipation **Reproductive system** Irregular or heavy menses Infertility

Endo2 Flashcards

(53 cards)