ENDO Flashcards by Majayda Islam

weight gain 
cold intolerance 
dry coarse skin/hair 
thinning eyebrows
constipation 
menorrhagia 
lethargy

Hypothyroidism

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hypothyroid symptoms with a firm, non tender goitre

Hashimoto’s thyroiditis

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hypothyroid symptoms with a pain goitre and raised ESR

Subacute/De Quervain’s

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lethargy, bradycardic, hypothermia

coma or seizures

myxoedema coma

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management of myxoedema coma

emergency hospital admission

IV thyroxine and hydrocortisone

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management of hypothyroidism

levothyroxine 50-100mg, start at 25mg for elderly/CVD
check TFTs every 3 months
ensure euthryoid before conceiving children/getting pregnant

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treatment for subacute/De Quervain’s

usually self-limiting

mx= aspirin/NSAIDs for pain

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weight loss, heat intolerance 
manic/restless
palpitations 
Increased sweating 
oligomenorrhoea 
anxiety/tremor 
pretibial myxoedema = erythematous, oedematous lesions

Hyperthyroidism

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hyperthyroid symptoms with exophthalmos, ophthalmoplegia and pretibial myxoedema

Grave’s disease

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Hyperthyroid & Scintigraphy reveal patchy iodine uptake

toxic multinodular goitre

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Hyperthyroidism treatment

propranolol = control thyrotoxic symptoms
carbimazole (agranulocytosis risk - check WCC) - propyluracil in pregnancy
radioiodine Tx

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Titrate and block

titrate down to the lowest dose for euthyroid = maintain euthyroid

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block and replace

block T4 synthesis + give levothyroxine

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fever >38°C
tachycardic 
confusion and agitation 
N&V
HTN, HF
jaundice and abnormal LFTs

thyroid storm

triggered by infection, surgery, contrast exposure/CT, trauma

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painless enlarge thyroid nodule
hoarseness and dysphagia
fever, weight loss and night sweats

Thyroid cancer

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Ix for thyroid cancer

TFTs, Thyroid US

I131 scan = cold nodules

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management for thyroid cancer

total thyroidectomy
radioactive I131 to kill residual cells + LT4
yearly thyroglobulin levels to detect any early recurrent disease

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main form of thyroid cancer

papillary

others include follicular and medullary

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abdominal pain 
renal stones 
depression 
bone pain 
unquenchable thirst 
may have peptic ulcers/constipation or pancreatitis

typically elderly females

hyperparathyroidism

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pepperpot skull
PTH high
high calcium, low phosphate

hyperparathyroidism

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management of hyperparathyroidism

definitive = total parathyroidectomy

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tetany/twitching/cramps/spasms of muscle
numb, burning and paresthesia of mouth
Trousseau’s signs +ve = carpal spasm
Chvostek’s signs +ve = twitch on tapping parotid gland
prolong QT

chronic cases may present with cataracts and depression

hypoparathyroidism

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low PTH
low calcium
high phosphate

primary hypoparathyroidism

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low calcium
high phosphate
high PTH

pseudohypoparathyroidism

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pseudohypoparathyroidism diagnosis

urine cAMP and PO4 after PTH infusion

management of hypoparathyroidism

alfacalcidol (vit d) | + calcium supplements

>7.5mmol/L total cholesterol | personal/family history of premature CHD (event before 60yrs)

familial hypercholesterolemia

high dose statins

primary prevention of hyperlipidemia

QRISK @ 40yrs = >=10% >7.5mmol/L LDL atorvastatin 20mg first line

secondary prevention of hyperlipidemia

80mg atorvastatin - aiming for a 40% drop in LDL | +lifestyle changes

``` lethargy weight loss hyperpigmentation - palmar creases loss of pubic hair hypotension, hypoglycaemia low sodium and potassium ```

Addison's disease (corticosteroid insufficiency

Definitive Ix for addison's

Short synacthen test - cortisol <100!!

management for addison's

hydrocortisone (majority in first half of the day) and fludrocortisone

management of addisonian crisis | extreme fatigue, lethargy, dehydration, low sodium and k+

IM/IV hydrocortisone saline infusions 30-60mins with dextrose if hypoglycaemic

``` weight gain 'central, moon faced' hyperglycaemia proximal muscle weakness purple striae/bruises ```

cushing's syndrome

Ix for cushing's

overnight dexamethasone test

management of cushings

if caused due to pituitary tumour = surgical resection | if not tumour = ketoconazole or metyrapone

polydipsia and polyuria picked up routinely on blood tests HbA1c = >=48mmol fasting glucose >7.0mmol or random >=11mmol

T2DM

management of T2DM

1. metformin - if contra = try gliptin or sulphonylurea 2. HbA1c >58mmol/L = add another anti-diabetic agent gliptin/suphonylurea 3. HbA1c >58mmol/L = triple therapy = metformin plus 2 anti-diabetic drugs 4. HbA1c >58mmol/L = offer insulin

``` T2DM fatigue lethargy altered consciousness headaches papilloedema hyperviscosity dehydrated, hypotension and tachycardic ```

Hyperosmolar hyperglycaemic state | hypovolemia, hyperglycaemic,>30 hyperosmotic >320

management of HHS

IV 0.9NaCl first line Insuline 0.01U/kg/hr

``` headache palpitations irritable tremor sweating tingling lips impaired vision ``` severe = loc, convulsions and coma

Hypoglycaemia

manage acute hypoglycaemia episode

adults - 10-20g of fast acting carbohydrate/ 5 glucose tablets recheck glucose in 10-15 mins - if inadequate repeat again after 15mins if unable to swallow/sever condition = IM glucagon

polydipsia polyuria weight loss fasting glucose >=7.0mmol/L random glucose >= 11.1mmol/L

T1DM

management of T1DM

insulin SC injection

``` polydipsia polyuria dehydration - ketones on dipstick abdo pain kussmaul breathing/respiration acetone smelling/fruity breath ```

DKA (diabetic ketoacidosis)

DKA management

fluid replacement using isotonic saline Insulin via IV infusion correct electrolyte disturbance long-acting insulin continued, short-acting stopped.

polyuria polydipsia dehydration

diabetes insipidus

Ix for diabetes insipidus

water deprivation test | high plasma, low urine osmolarity - if osmolarity >700 = exclude DI

management of diabetes insipidus

nephrogenic DI thiazide diuretics low salt/protein diet Cranial DI desmopressin

headaches palpitations sweating usually hypertensive and anxiety

pheochromocytoma

Ix for pheochromocytoma

24hr urinary metanephrines

management of pheochromocytoma

definitive = surgery | - usually stabilised with a/B-blocker first e.g. propranolol/labetalol or phenoxybenzamine

hypertension hypokalaemia - muscle weaknes alkalosis

hyperaldosteronism/conn's syndrome

Ix for hyperaldosteronism/conns

aldosterone/renin ratio is the first-line investigation CT abdomen and adrenal vein sampling

Management for conns

adrenal adenoma: surgery bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

hypovolemia management

initiate fluid resuscitation (250-500mls over 15mins and reassess) can give up to 2L if BP low

hypervolemia management

do not administer fluids | initiate diuretics

euvolemia management

calculate maintenance fluids 25-30ml/kg/day reassess regularly

hypernatremia management

1. correct cause 2. correct body water deficit = either oral/enteral 3. Hypotonic solution = dextrose IV - slow pace to avoid cerebral oedema

hyponatremia management

1. fluid restriction 2. if safe withhold contributory medication 3. Ix for causes/insufficiency

hyperkalemia management

1. ABCDE assessment 2. ECG change = ITU referral 3. calcium gluconate = shift from ECM to ICM 4. Insulin dextrose and nebulised salbutamol 5. remove K+ using calcium resonium or RRT/loop diuretics

hypokalaemia management

1. remove causes (spironolactone) 2. gradual replacement = oral 0.9%Nacl 3. ECG = U waves, small/inverted T waves, prolonged QT/PR & ST depression 4. replenish Mg2+

presents the same as hyperparathyroidism = bone pain, renal stones, abdo pain and depression shortened QT

hypercalcaemia

management of hypercalcaemia

rehydrate with normal saline & bisphosphonates calcitonin steroid in sarcoidosis

presents similar to hypoparathyroidism tetany, muscle twitches trousseau's/Chvostek's sign perioral parathesia pancreatitis presentation with alcoholic background is typical

hypocalcemia

tetany, paresthesia seizures arrhythmias often caused by drugs, diarrhoea or alcohol

hypomagnesaemia

management of hypomagnesaemia

severe = IV Mg2+ replacement (<0.4) >0.4 oral magnesium salts = diarrhoea common side effect

``` excessive growth of hands and feet protruding jaw large tongue excessive sweating/oily skin galactorrhoea ```

acromegaly

Ix for acromegaly

IGF-1 levels If IGF-1 levels are raised then confirm with OGTT OGTT confirms dx

management for acromegaly

trans-sphenoidal surgery = first line somatostatin analogue = octreotide dopamine agonists = bromocriptine

management of galactorrhea (non obstetric lactation)

Rule out serious pathology – breast cancer | Treat underlying cause

gynaecomastia management

Refer if red flags (unilateral, hard/irregular tissue, fixed mass, pain, axillary LAD) Treat underlying cause

ingestion of lactose containing product ``` diarrhoea a bloated stomach stomach cramps and pains stomach rumbling feeling sick flatulence ```

lactose intolerance

management of lactose intolerance

avoid trigger/ try lactose free options