Endocrine Flashcards
(25 cards)
AE of PTU/Methimazole
Agranulocytosis, Methimazole: 1st trimester tertogen, cholestatis
PTU: HEPATIC fail, ANCA vasculitis
AE of radioactive iodine ablation
permanent hypothyroidism
worsening of exopthalmos/optho effects
radiation side effects
Conn’s Syndrome
primary hyperaldosteronism
adrenal adenoma or bilateral CAH
hypertension, hypokalemia, metabolic alkalosis -
aldosterone increases Na absp, K secretion and Bicarb secretion
Causes of hypercalcemia with low PTH
Malignancy vit D toxicity HCTZ/Theophylline - drug induced thyroidtoxicosis, vitamin A toxicity immobilization miscellaneous - adrenal insufficiency , pheo, acromegaly
hypercalcemia with elevated PTH causes
primary or tertiary hyperparathyroidism
familial
lithium induced
MEN 1
primary hyperparathyroidism
pituitary
pancreatic tumors
MEN 2A
RET- onco gene FAMILY HISTORY primary hyperparathyroid (hyper Ca) medullary thyroid (anxious, headache, palpitations) Pheo (HTN, papilledema, headaches)
MEN 2B
MTC
Pheo
Marfan habitus
mucosal and intestinal neuroma
Graves Disease pathophysiology
TSH stimulating IgG antibodies
- bind to receptors of TSH on the thyroid, cause synthesis of excess thyroid
- DIFFUSE uptake on radioiodine scan
Multinodular toxic goiter aka Plummer Disease
hyperfunctioning of discrete areas
increased T4/t3, low TSH
patchy uptake on scan
Subacute thyroiditis
causes transient hyperthyroidism
diffusely enlarged thyroid gland, bruit, non tender, symmetric enlargement
graves disease
tender thyroid, diffusely enlarged, viral illness
subacute thyroiditis
bumpy, irregular thyroid, asymmetric
Hashimoto or multinodular toxic goiter
Diagnostic w/u for hyperthyrid
- TSH - high/normal - unlikely hyperthyroid
- T4 - should be elevated in hyperthyroid
- Radioactive iodine uptake - shows that T3 is bound to TBG. this shows true hyperthyroid
- high TBG, consider pregnancy
PTU mechanism of action
inihibits conversion of t4–> t3
Hyperthyroid treatment
- Bblocker for symptom
- Methimazole
- taper Bb
- continue methimazole 1-2 years, measure TSH igG at 12 months
hyperthyroid treatment for pregnant patients
PTU preferred
Indications for 131 I
elderly patient w graves
solitary toxic nodule
patients with graves in which PTU/methimazole fails aka relapse or agranulocytosis
Thyroid Storm
post infection, stress, DKA, trauma etc
- medical emergency
- tX; IV fluids, cooling blankets, glucose, PTU q 2 hours and bblockers
- give dexamethasone as well to prevent peropheral thyroid conversion
3 causes of hypothyroid
- Hashimoto aka chronic thyroiditis
- Iatrogenic from hyperT treatment
- Secondary hypothyroid - low TSH, low T4/3
Lab findings in hypothyroid
High TSH, low T4 - primary
low TSG, low t4 - secondary
increased antimicrosomal antibodies - Hashimotos
low radioactive iodine uptake, painful tender thyroid, hyperthyroid symptoms, post stress/illness
Subacute viral thyroiditis
131 I uptake is low because follicular cells are damaged – differentiates from graves!
lab findings in subacute thyroiditis
low TSH, increased T4/3, high ESR
