MedEd thyroid and misc endo

Question 1

What cells produce T3 and T4?

Answer 1

Follicular thyroid cells

Question 2

What does negative feedback to the pituitary?

Answer 2

T3 and T4

Question 3

What are hyperthyroid symptoms?

Answer 3

Tremor 
Anxiety
Palpitations
Diarrhoea
Oligomenorrhea

Question 4

What are hypothyroid symptoms?

Answer 4

lethary
weight gain
cold intolerance
constipation
menorrhagia 
reduced deep tendon reflexes

Question 5

What are causes of hyperthyroid?

Answer 5

Graves
toxic multinod goitre
viral thyroiditis
drugs

Question 6

What drug causes hyperthyroidism?

Answer 6

Amiodarone

Question 7

What are causes of hypothyroid?

Answer 7

hashimotos
de quervains thyroiditis (subacute)
drugs
iodine deficiency

Question 8

what drugs cause hypothyroidism?

Answer 8

amiodarone

lithium

Question 9

How is hyperthyroid amanged?

Answer 9

Propanolol
Carbimazole
Radioiodine

Question 10

How does carbimazole work in hyperthyroidism?

Answer 10

It is a TPO inhibitor and TPO is needed to make thyroxine

Question 11

What is a side effect of carbimazole?

Answer 11

angranulocytosis ie no neutrophils

Question 12

how is hypothyroidism managed?

Answer 12

Levothyroxine

Question 13

what causes exopthalamos?

Answer 13

anti TSH receptor antibodies binding to TSH receptors behind the eyes

Question 14

what are the defining features of graves?

Answer 14

bilateral exopthalamos
lid lag
pre tibial myexodema
thyroid acropachy

Question 15

what are features of thyroid cancer?

Answer 15

non functional
painless
rapidly growing 
solitary 
irregular in shape 
palpable nodule thats hard and fixed
hoarse voice 
dysphagia
haemoptysis 
airway obstrcution
cervical lymohadenopathy

Question 16

what is the most common thyroid cancer?

Answer 16

papillary carcinoma

Question 17

what are defining features of thyroid cancer?

Answer 17

hoarse voice

Question 18

what is seen on hisotology in papillary thyroid cancer?

Answer 18

psammoma body

Question 19

what thyroid cancer is associated with low dietary iodine intake

Answer 19

follicular carcinoma

Question 20

what thyroid cancer is associated with MEN 2A and MEN 2B

Answer 20

medullary

Question 21

what is the GS ix for thyroid cancer?

Answer 21

fine needle aspiration with biopsy

Question 22

what is MEN 1 syndrome? what organs and cells are involved

Answer 22

parathyroid adenomas which are functional
pancreatic islet cells
pituitary problems eg prolactinoma
other cells can also be involved

Question 23

what 3 cells/organs are involved with MEN 1 syndrome?

Answer 23

parathyroid gland
pancreas
pituitary

Question 24

what are hypercalcaemia symtpoms?

Answer 24

stones
abdo groans
bones
psychic moans

Question 25

what is GS ix for MEN 1 syndrome?

Answer 25

CT/MRI body

Question 26

what causes non MEN 1 gastrinomas?

Answer 26

zollinger ellinson syndrome

Question 27

what characterises MEN 2A and 2B?

Answer 27

meduallry thyroid cancer

Question 28

what organs/cells are involved with MEN 2A?

Answer 28

parathyroid | phaeochromocytoma

Question 29

what tumors/features are involved with MEN 2B?

Answer 29

phaeochromocytoma neuromas marfanoid habitus

Question 30

what MEN syndrome is someone with marfans like habitus likely to have? what are some examples of this?

Answer 30

``` MEN 2B tall stature pectus excavatum long limbs eye problems ```

Question 31

what is GS ix for MEN 2A and 2B? what else might you do

Answer 31

``` genetic testing for RET oncogene might also do: calcitonin urine catecholamines CT/MRI ```

Question 32

what gene is tested for in MEN 2A and B?

Answer 32

RET oncogene

Question 33

what are the types of MEN syndrome, what are they associated with and hwo do you remember this?

Answer 33

MEN 1- parathyroid, pancreas, pituitary (3Ps) MEN 2A- phaeo, parathyroid (2Ps) MEN 2B- phaeo, neuromas, marfanoid habitus (1P) 3Ps, 2Ps, 1P

Question 34

what is the most common feature of carcinoid syndrome?

Answer 34

flushing

Question 35

what is carcinoid syndrome? ie how does it arose

Answer 35

uncontrolled division of neuroendocrine tumors which mets to the liver

Question 36

what is there buildup of in carcinoid syndrome?

Answer 36

serotonin bardykinin histamine

Question 37

what are features of carcinoid syndrome?

Answer 37

``` flushing dairrhoea SOB pulmonary stenosis abdo pain itching ```

Question 38

how fastly do tumors grow in carcinoid syndrome

Answer 38

slow growing

Question 39

what gene mutation is carcinoid syndrome associated with?

Answer 39

MEN 1 mutation

Question 40

what are ix for carcinoid syndrome?

Answer 40

urinary 5-HIAA CT scan ocreotide scan- specific

Question 41

what is a specific ix for carcinoid syndrome?

Answer 41

ocreotide scan

Question 42

describe what LH acts on in males v females and what it produces

Answer 42

males: acts on leydig cells, makes testosterone females: acts on theca cells, makes progesterone

Question 43

describe what FSH acts on in males v females and what it produces

Answer 43

males: acts on sertoli cells and makes sperm (spermatogenesis) females: acts on granulosa cells and makes oestrogen

Question 44

what are features of PCOS?

Answer 44

hirtuism oligomenorrhea polycycstic ovaries infertility/trouble concieving

Question 45

what causes physiological hypogonadism?

Answer 45

pregnancy

Question 46

what causes negative feedback onto the gonadotrophs on the anterior pituitary

Answer 46

LH and FSH

Question 47

what is a defining symptom of kallmanns syndrome hypogonadism

Answer 47

anosmia

Question 48

where are gonadotrophs found

Answer 48

anterior pituiatry

Question 49

what are some causes of primary hypogonadism in females

Answer 49

degenesis of the gonadotrophs eg turners gonadal damage primary ovarian failure pcos

Question 50

what are some causes of secondary hypogonadism

Answer 50

``` kallmann syndrome pituitary or hypothalamic tumor hyperprolactinaemia functional (low bmi, excess exercise, stress) ocp use ```

Question 51

what are some causes of primary hypogonadism in males

Answer 51

gonadal degenesis eg klinefelters, cryptorchidism gonadal damage post orchitis eg mumps

Question 52

what are features of hypogonadism?

Answer 52

``` delayed puberty infertility reduced libido amenorrhea night sweats/hot flushes erectile dysfunction symptoms of cause eg visual changes if tumor ```

Question 53

what ix are done for hypogonadism?

Answer 53

``` preg test LH/FSH prolactin testosterone/oestradiol TFTs karyotyping MRI ```

Question 54

what does gnrh stimulate the production of and where does it act?

Answer 54

growth hormone- acts on all organs | igf-1- made in organs and also acts everywhere

Question 55

what is acromegaly usually caused by?

Answer 55

pituitary adenoma

Question 56

what are features of acroomegaly

Answer 56

``` coarse facial features large tongue large jaw spade like hands and feet excess sweating organomeagly headaches, visual disturbance (bitemp hemianopia), hyperprolactinaemia etc- due to tumor ```

Question 57

what are common complications of acromegaly?

Answer 57

carpal tunnel syndrome colorectal cancer diabetes hypertension

Question 58

what investigation is done to diagnose acromegaly? what is seen?

Answer 58

OGTT | there will be a paradoxical rise in GH if the patient has acromegaly

Question 59

how is acromegaly managed? give GS and other treatments

Answer 59

GS: trans sphenoidal surgery to resect tumor | can also do radiotherapy, somatostatin analogues, dopamine receptor agonists and GH receptor antagonists