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Y4 Endocrinology and Diabetes > 4. Thyroid, Calcium and Sodium disorders > Flashcards

4. Thyroid, Calcium and Sodium disorders Flashcards

1
Q

Active thyroid hormone

A

T3
`

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2
Q

How does T3 affect gut motility

A

Increases it

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3
Q

How does hyperthyroidism affect heat tolerance

A

Reduces it

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4
Q

complications of hyperthyroidism

A

Osteoporosis, AF, HF, blood clots, muscle weakness, mood changes, weight loss

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5
Q

What are other causes of hyperthyroid apart form Grave’s

A

Nodular thyroid disease, thyroiditis (DQ), pregnancy, ajiodarone, lithium

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6
Q

What Ab is raises in Graves

A

TRAB

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7
Q

What Ix should be done if TRAbs are +ve or -ve

A

Arrange scinitigraphy if +ve alr

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8
Q

Sx of Grave’s apart from TED

A

Tremor, palpitations, weight loss, bowel changes, irritability, heat intolerance, menstrual irregularity

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9
Q

Sx of thyroid eye disease

A

Dry eyes, grittiness, discomfort, may also affect vision- double vision and pain in the eyes, bulging appearance of the eyes

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10
Q

How does PTU work
CMZ

A

Inhibits TPO
CMX prevents thyroid peroxidase enzyme from iodinating and coupling the tyrosine residues on thyroglobulin

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11
Q

What does neck lump mean in hyperthyroidism with no TRAbs

A

TNG, toxic solitary adenoma, TrAb -ve disease

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12
Q

Grave’s examination

A

Neck lump, lid lag, pain on extrem gases, exopthalamos, tremor, palmar eryhtema, sweaty hands?

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13
Q

Main risk factor affecting Grave’s

A

Cigarette smoking

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14
Q

what would you do if TFT is normal but neck lump present

A

Thyroid ultrasound to check for malignancy

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15
Q

How to treat Graves

A

Carbimazole
PTU
BB for Sx control- PROPANOLOL

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16
Q

What are definitive therapies for Graves and side effects

A

Radioiodine and surgery
High chance of requiring lifelong thyroxine replacement

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17
Q

Side effects of carbimazole

A

Liver injury, rash, thrombocytopaenia- SORE THROAT/fever needs urgent blood tests

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18
Q

Should PTU or carbimazole be given to pregnant women

A

PTU

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19
Q

Side effects of Radioiodine apart from hypo

A

May cause short term increase and TED

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20
Q

Side effects of thyroid surgery

A

Hypocalcaaemia, nerve damage- may affect speech

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21
Q

Role of calcitonin andwhere does it work on

A

Impt to ensure that calcium Is reabsorbed from the intestines and kidneys + effects of calcium redistribution inbone- inhibits osteoclast resorption, lowering Ca and PO4

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22
Q

Where does 1-OH ase work and what stimulates it

A

in kidney- to make active vit d3
PTH and low po4

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23
Q

Effects of PTH

A

Increases ca resorption in distal tubules, decreases PO4 resorption in proximal tubule,
stimulates 1-OHase

Acts on osteoclast to increase permeability to calcium, driving calcium to ECF

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24
Q

Effects of activated Vit D

A

Increases ca resorption in distal tubule
Increases ca and po4 absorption in gut

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25
what mineral is needed for synthesis, release and action of PTH
Mg
26
Where is calcitonin produced
parathyroid
27
wht drugs can cause calcitonin production
B adrenergic agonists
28
what stimulates calcitonin
high calcium
29
what is the response to hypocal
Increase PTH, increased renal cal absorption and PO4 excretion but increased calcium and po4 mobalisation on bone, and increase production of active vit d, increased calcium and po4 from gut
30
What is repsonse to hypophosphataemia
Increased 1-a hydroxylation, increasing GI absorption of calcium and PO4, increased cal will reduce PThH, increasing PO4 resorption and reducing renal calcium resorption
31
ECG in acute severe hypocalcaemia
lengthened ST segment and prolonge QTC
32
how is phosphate, Mg, Vit D and PTH like in hypocalcaemia
raised reduced reduced increased
33
Clincal presentation of hypocal
Peri-oral and digital paraesthesia, tetany and carpopedal spasm, laryngospasm, arrhytmia, seizure
34
Primary and other causes of acute severe hypocal
Thyroidectomy -- Selective parathyroidectomy Vit D deficiency Mg deficiency (may be PPI associated) Drug induced hypocalacaemia Pancreatitis, rhabdomyolysis, large vol blood transfusions
35
Ix for hypocal
Adjusted calcium, phosphate, PTH, U+E, Vit D, Mg, ALP
36
Px of hypercalcaemia
Confused, abd pain , urinary freq, fatique May have increased urine output and thirst Renal impairment, back and loin pain, radiating to groin SHORTENED QT Nephrolithiasis or neprhocalcinosis Pancreatitis, peptic ulcers Hypertension, cardiomyopathhy, muscle weakness Anorexia, nausea and constipation May have dysrrhythmia if severe or coma bone disease- osteoporosis, osteomalacia, and arthritis, osteotis fibrosa
37
Bloods in hypercal pt
Increased adjusted cal, normal phos, PTH may be raised ( pri problem with PT gland)
38
What Ix to do if suspected hypercal with osmotic sx
Glucose
39
What test to do if urinary sx
PSA
40
Most common cause of hypercal and how could we investigate this. Ix for other systems
Primary hyperparathyroidism or malignancy Could do abd x ray to check for lesions ultrasound of parathyroid DEXA scan to check for bines
41
Mx of hypercal
Can remove PT
42
What diuretics can cause hypercalcaemia
THIAZIDES
43
What are other cauxes of hypercal
Phaeochromocytoma, lithium, thyrotoxicosis, rhabdo
44
Investigations for hypercal
Adjusted cal, phosph, PTH, U+E, Vit D, ALP
45
What does high ca high PTH suggest What does high ca low PTH suggest
High PTH- primary or tertiary hyperparathyroid (ESKD) Low PTH (Malaignancy, other rarer causes)
46
how should PTH be usully if calcium is raised and how should urine calcium be
raised is pri hyper or low if sec hyper, should not be normal Urine ca should be increased
47
Normal PTH, slightly high calcium, low urinary calcium- what is this
Famillilal hypocalciuric hypercalcaemia- problem with calcium sensing receptor so less calcium is excreted through urine
48
Management of acute symptomatic hypercal
Rehydrate with 0.9% saline, consider dialysis if severe renal failure Intravenous bisphophonagtes after rehydration - pamidronate or ibandronic acid
49
possible complications of bisphosphonates
may cause hypocalcaemia if vit d deficiency or reduced PTH
50
Second line treatment of hypercal
Glucocorticoids ( predni) as they inhibit 1.25ohd prdtn- in malignancy Calcitonin if poor response to bisphosphonates Calcimimetics if due to pri hyperparathyroid, parathyroid carcinoma or renal failure parathyroidectomy if poor response to other measures and severe
51
Sx of vit d deficiency
May have wedge fracture in T/L spine and pubic rami fracture
52
Bloods in vit d deficiency
Low adjusted calcium, phosphate normal, high PTH, mg normal, vit d low,
53
54
Risk of vit d deficieny
Dark skin, housebound, non fish eater, fat malabsorption, coeliac, small bowel disease, chronic pancreatitis Hypo parathyroidism can reduce Vit D action Hypomg can inhibit PTH release Renal impairment reduces ability to make vit d
55
What ix to do for suspected vit d deficiency
Ca, Po4, Mg, ALP, U+E, 25(OH) VitD
56
Suggestive sx of Vit D deficiency
Bone pain, bone tenderness, muscle weakness
57
What does raised ALP suggest if Vit D deficiency is present
Raised ALP - is osteomalacia If normal ALP, Ca and Po4, check 25ohd result, and treat based on whether it is insufficienct or deficient. If PTH is raised, treat insufficient like deficient (Level 2)
58
Level 1-3 treatment for Vit D deficiency / insufficiency
Lifestyle advice 800 units per day 25000 units 3 times weekly for first 4 weeks then 25000 units per week for 8 weeks
59
What are the common sx of hyponatraemia
Neurological sx as a result of cerebral oedema
60
How to differentiate between moderately severe and severe hypona
Moderately severe - nausea without vomiting, confusion and headache Severe- vomiting, cardiorespiratory distress, abnormal and deep somnolence, seizures and coma
61
What is chronic hyponatraemia
When it develops after 48hrs
62
How does acute hyponatremia affect plasma osmolality
If sodium drops qquicjly, will reduce plasma osmolarity and increase osmotic drive, drawing water into the brain- oedema Causes neurological sx
63
What happens in chronic hyponatraemia
Compensation where electrolyte moves out of brain and takes some water with it Brain starts to decompress Since hyponatraemia develops slowly, may be asymptomatic Won’t treat rapidly with hypertonic saline
64
How to treat hyponatraemia
Hypertonic saline
65
What pts may be prone to polydipsia
Pts with mental health problem
66
What does weight or gain suggest in hyponatraemia
Thyroid or glucocorticoid dysfunction ( may have addisonian crisis)
67
Causes of hyponatraemia
Glucocorticoid def Hypothyroidism Cirrhosis/HF Drug induced SIADH
68
What are bloods in SIADH like
Low Na and plasma osmolality, elevated urinary Na and urine osmolality
69
How to test for hypoadrenalism
Early morning cortisol or short synacthen test
70
Fluid status in SIADH
Euvolaemic
71
How to assess for fluid status
BP HR, CRT, JVP, Urine output
72
Causes of SIADH
Cardiac surgery complication, pleural effusion from chest infection ( may show consolidation on CXR) , brain pathology
73
SIADH- urinary sodium
Should be inappropriately high above 30, urine osmolality over 100
74
How to treat SIADH
Most importantly fluid restriction May use furosemide for diuresis Demeclocycline may be used rarely, but is nephrotoxic
75
What does visual field defect suggest
Pit problem
76
How to treat pit problem with low hormones
Give hydrocortisone, then add thyroxine ( can't give straightaway as may precipitate addisonian crisis)
77
Urinary sodium, ureas and creatinine in hyponatremia in AKI and how to treat
Very low, as kidney trying to retain sodium by reducing urine loss- depletional hyponatraemia Urea and creatinine high Treat with IV saline
78
When should water deprivation test be done
IF there is suspected AVP deficit
79
What drugs can cause increased Na excretion
ACEi, thiazide and PPI
80
What endocrine disorder can cause hyponatraemia
Hypothyroidism, Addison's

Y4 Endocrinology and Diabetes (3 decks)

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