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Endocrine Flashcards

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1
Q

Blood supply of thyroid

A

Superior thyroid- branch of external carotid

Inferior- thyrocervical

Thyroidea ima- from brachiocephalic

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2
Q

Venous supply of thyroid

A

Superior and middle- IJV
Inferior in brachiocephalic

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3
Q

Synthesis of thyroid hormones

A
  • Thyroid actively concentrates iodide( to 25 times the plasma conc.)
  • Iodide is oxidised to atomic iodine by peroxidase(in the follicular cells)
  • Atomic iodine then iodinates tyrosine residues (contained in thyroglobulin).
  • Iodinated tyrosine residues undergo coupling to either T3 or T4.
  • Process is stimulated by TSH, which stimulates secretion of thyroid hormones.
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4
Q

AB in hasimotos

A

Thyroperoxidase

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5
Q

Most sensitive tests for hyper and hypo thyroidism

A

Hyper- T3

Hypo- TSH and T4

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6
Q

Features of toxic nodule

A

Small swelling @midline/near midline; hot intolerance recently

Low TSH
High T3

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7
Q

What is suggestive of a thyroid cancer on imagine

A

Cold nodule- reduced/no uptake in radio iodine

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8
Q

Causes of hypothyroidism

A

Primary-Hashimoto
Iodine def
Radioiodine

Secondary- pituitary- surgery, tumour, radiation

Tertiary- hypothalamus

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9
Q

Pendred syndrome

A

Bilateral sensorineural hearing loss + Goitre + Hypothyroidism

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10
Q

Cause of brown tumour

A

Brown tumors are tumors of bone that arise in settings of excess osteoclast activity, such as hyperparathyroidism

They appear brown because haemosiderin is deposited at the site.

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11
Q

Mx of severe hypercalcaemia

A

Aggressive fluids
IV pamidromate
Furosemide

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12
Q

When is urgent mx of hypercalc required

A

> 3.5
Reduced consciousness
Abdo pain
Pre Renal failure

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13
Q

Causes of hypocalcaemia

A

Vit D def
Renal failure
Hypoparathyroidism
Pseudohypo (target insensitive to PTH)
Mg def

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14
Q

Sx of hypocalacaemia

A

Parasthesia
Spasm, tetany, convulsion
Psychosis
Chcosteck
Trousseau
Prolonged QT

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15
Q

Mx of severe hypocalcaemia

A

Calcium gluconate, 10ml of 10% solution over 10 minutes

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16
Q

What is Mg required for physiologically

A

Mg is required for both PTH secretion and its action on target tissues.

  • Hypomagnesaemia cause both hypocalcaemia and make patients unresponsive to treatment with calcium and
    vitamin D supplementation.
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17
Q

Most common cause of hyponatraemia in surgery

A

Over administration of dextrose

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18
Q

Causes of pseudohyponatraemia

A

Include hyperlipidaemia (increase in serum volume)
Multiple myeloma
Taking blood from a drip arm

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19
Q

Features of papillary thyroid cancer

A

Young person
Multinodular
Not capsulated
Orphan Annie nuclei
Psammoma body
TSH dependent

Spread by lymphatics !
Cold radioisotope

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20
Q

Features of follicular thyroid cancer

A

Capsulated
Solitary nodule
Spread via blood- to lung, brain, bone
Prominent oxyphil cells and scanty thyroid colloid

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21
Q

Features of medullary thyroid cancer

A

Multifocal- MEN
Diarrhoea and flushing
Potentially recurrent after surgery

High calcitonin- para C cells

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22
Q

Features of anaplastic thyroid cancer

A

Rapidly enlarging
Aggressive
Local invasion
Cold scan

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23
Q

Mx of thyroid cancer

A

Pap
<2cm lobectomy
Thyroxine life long
Yearly thyroglobulin FU

> 2cm
Total thyroidectomy
RI ablation
Suppressive thyroxine lifelong
Yearly TG FU

Follicular- total
Adenoma- hemi

Med
Total thyroidectomy
Thyroxine
Yearly FU calcitonin

Anaplastic
Debulking and radio palliation- isthmusectomy
Total + radio if capsule and no evident mets

Lymphoma
Radio +/- chemo

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24
Q

Features of lymphoma of thyroud

A

Hx of Hashimoto
Rapidly enlarging
B cell

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25
Type of follicular cancer with poor prognosis
Hurthle cell cancer
26
Acute thyroiditis features
Euthyroid Fever High ECC
27
Sub acute thyroiditis - De querveins
Granulomatous Hyperthyroidism then hypo High WCC High T4 low TSH SMooth tender thyromegaly Low uptake on scan
28
Hashimoto features
TPO + TG+ Anti mito TSH receptor Firm hard receptor Cold, weight gain, tired
29
Reidel syndrome
Hypothyroid Hard AB -ve Fibrosing
30
Cold nodule with hyperthyroid symptoms
Thyroid Carcinoma associated with Grave’s disease is usually Papillay
31
Mx of Graves disease
Medical 1st Carbimazole - TPO inhibitor 2nd Propylthiouracil -use in pregnancy Radio - small, no eye Surgery - large, eye sign Must be euthyroid and vocal cord exam before surgery
32
Mx of multinodular goitre
Total thyroidectomy
33
Mx of thyrotoxicosis with eye signs
Carbimazole Then if relapse- total thyroidectomy
34
High TSH and normal/high T4
Poor complience of thyroxine
35
Low TSH and normal T4
Steroid therapy
36
Skin features of hypothyroidism
Dry- anhydrosis Non pitting edema Eczema Xanthomata
37
Skin features of hyperthyroidism
Pretibial myxoedema Acropachy- clubbing Sweating
38
Radioiodine
Close contact with children not permitted for 4 weeks 15% with eye signs get worse Symptoms improve after 6-8w 80% become hypothyroid CI in pregnancy
39
Prolactinoma sx
Nipple discharge Gynaecomastia Visual signs
40
Causes of gyanecomastia
Kallman Kleinfelter Test failure Spironolactone- most common Finasteride Anabolic steroids Oestrogens
41
When is IV bisphosphante require
Ca >3
42
FHH sx
Loss of PTH receptor sensitivity found in parathyroid and kidney Parathyroid- doesn't detect- increase/normal PTH- Mild hypercalcaemia Kidneys- meant to inhibit reabsorption but doesn't- hypocalciuria High Mg
43
Indications of parathyroidectomy
ABCS <50 age, Asymptomatic - Ca 1 above normal BMD <2.5 SD Calciumstones Nephrolithiasis Life threatening hypercalcaemia Symptomatic
44
Pseduohypoparathyroidism
G protein abnormailty- insensitive to PTH Low IQ, short stature, 4/5th metacarpal short Low Ca, high phosphate, high PTH Measure urinary cAMP and phosphate following PTH infusion If increases- hypoparathyroidism If no- Pseudo
45
Psuedopseduohypoparathyroidism
Skeletal defects similar to PHPTH Normal biochem
46
Thyroid cancer linked to prolonged irradiation exposure
Papillary
47
Adrenal mass that has a lipid rich core
Adenoma
48
Cells of phaeo
Chromaffin cells
49
10% rule of phaeo
10% of cases are bilateral. 10% occur in children. 11% are malignant (higher when tumour is located outside the adrenal). 10% will not be hypertensive.
50
Post thyroidectomy- patient becomes profoundly dyspneic and hypoxic
Tracheomalacia
51
If ultrasound shows indeterminate mass in breast and FNA shows normal tissue what should you do
Excisions biopsy CT rarely helpful in breast
52
Patient presents with MSK pain and x rays show widespread osteopenia -waht ix
USS of neck
53
Cell changes in tertiary hyperparathyroid
Hyperplasia of all 4 glands
54
Haemorrhage in adrenal glands
Waterhouse - Friderichsen syndrome
55
Thyrotoxicosis, proptosis- receives radiotherapy on eyes, symptoms relapse after stopping carbimaozle Tx?
Total thyroidectomy
56
After thyroidectomy pt develops oculogyric crisis and muscle spasm
hypocalcaemic tetany and will require immediate calcium supplementation.
57
Psychiatric drug that can cause thyroid goitre
Lithium
58
FNA vs core biopsy
Core biopsy is preferred over FNAC by most surgeons. The reason for this is that FNAC often yielded inadequate tissue for assessment. When FNAC demonstrated benign changes, it had to be repeated at least once to confirm this. If it yielded cells that were indeterminate, then a core biopsy was needed. A core biopsy removes many of these stages and is thus more reliable.
59
Thyroglossal cyst removal
Resection of cyst Associated track Central portion of hyoid and wedge of tongue Sistrunks procedure
60
Thyroid mass, euthyroid Ix?
FNAC
61
Other AB found in hashimotos
Anti microsomal
62
Proportion of primary HPTH caused by adenoma
85%
63
% of patient with HPTH that are symptomatic
30%
64
Area affected in adrenals in addisions
Fasciculata
65
Ig of Anti TSH
IgG
66
Treatment of Graves in Pregnancy
PTU in first Can do carbimazole after
67
Treatment success of anti thyroid drugs in children
1/3 replase
68
Dex suppression test results
Cortisol raised- adrenal adenoma or bronchial If ACTH high small cell If Low adrenal If cortisol suppressed pituitary- usually with high dose
69
Which thyroid cancer has best prognosis
Papillary
70
Dx of acromegaly
Initially by IGF 1 Then oral glucose with lack of suppression of GH <1 measurements
71
Diagnosis of diabetes and pre diabetes
Fasting 6.1 7.1 Random 7.8 11.1 Hba1c 42 48
72
Problems with stopping antithyroid drugs
High recurrence rates
73
Where globally is incidence higher for follicular cancer
Iodine deficient
74
Common extra adrenal location of phaeo
Organ of Zuckerkandl Aortic bifurcation
75
Proportion of medullary thyroid that is familial
20%
76
Other conditions Hashimotos is associated with
Coeliac and pernicious anaemia And other AI
77
FHH inheritance and electrolyte disturbances
AD Hypermagnesium
78
Specific imaging for phaeo
MIBG
79
Top endogenous cause of cushings
Pituitary adenoma
80
Proto oncogene with MEN
RET
81
Bilateral adrenalectomy now developed bitemproal semi, pigmentation
Nelsons syndrome Expanding pit tumour- high ACTH
82
What electrolyte abnormality suggests chronic renal failure
Low Ca
83
Thyroid effect on fat
Hypothyroid hypercholestrol
84
Initial test for phaeo
VMA/HVA 24 hour urine
85
Conditions phaeo is associated with
MEN 2A+B VHL NFM1
86
Best method of localised parathyroid adenoma
Bilateral neck exploration
87
Bilateral hilar lymphadeopathy with high Ca
Sarcoid
88
Thyroid effects on Ca
Hyper high Ca
89
Liddle syndrome
Hypokalaemia metabolic acidosis with HTN Low renin activity AD Resistant HTN
90
Gieltman syndrome
Hypokalaemia metabolic alkalosis Hypocalciuria and hypomagnesia BP normal or low Def in Na/Cl in DCL
91
Phaeo, medullary and itchy lesions
MEN 2A Itchy lesions are cutaneous lichen amyloidosis
92
Pre op parathyroid localisation
US Sestamibi radionucleotide scan Technetium
93
Most useful initial ix of goitres
US and FNA
94
Thiazides on Ca
Hypercalcaemia - mild
95
Which thyroid cancer associated with radiation
Papillary
96
Most common enzyme def in CAH
21

eMRCS questions (45 decks)

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