Endo Flashcards
Define acromegaly
Constellation of signs and symptoms caused by hypersecretion of GH in adults
note: most are caused by a pituitary adenoma
Outline the signs of acromegaly
coarsening of facial features
soft-tissue and skin changes - rings and shoes becoming tight
carpal tunnel syndrome
joint pain and dysfunction
snoring
alterations in sexual functioning
Can also get hyperprolactinaemia symptoms
List some appropriate investigations for acromegaly
serum insulin-like growth factor 1 (IGF-1) [lacks specificity]
oral glucose tolerance test (OGTT) - CONFIRMATORY [failure of GH suppression after 75g glucose load]
random serum growth hormone (GH)
Consider visual field testing
Consider MRI pituitary
Generate a management plan for acromegaly
1st line = transphenoidal surgery + consider radiotherapy
2nd line = somatostatin analogues (octreotide, lanreotide)
3rd line = dopamine agonists (cabergoline)
3rd line = GH receptor antagonists (pegvisomant - recombinant GH analogue)
What hormones does the adrenal gland produce and where are they produced?
CORTEX:
Mineralocorticoid (aldosterone) - zona glomerulosa
Glucocorticoids (cortisol) - zona fasciculata
Androgens (DHEA) - zona reticularis
MEDULLA:
adrenaline/noradrenaline
List some risk factors for adrenal insufficiency
Primary - Addison’s disease (usually autoimmune)
Secondary - hypothalamic/pituitary failure
Infections - TB
Infiltrative - mets, amyloidosis, lymphoma
Iatrogenic - sudden cessation of long term steroid therapy
Outline the presenting symptoms of adrenal insufficiency
Chronic Presentation - the symptoms tend to be VAGUE and NON-SPECIFIC
Dizziness
Anorexia
Weight loss
Diarrhoea and Vomiting
Abdominal pain
Lethargy
Weakness
Depression
INCREASED PIGMENTATION
Acute Presentation (Addisonian Crisis)
Acute adrenal insufficiency
Major haemodynamic collapse: shock, N+V, hypothermia and abdo pain
Precipitated by stress (e.g. infection, surgery)
List some appropriate investigations for adrenal insufficiency
morning serum cortisol (< 100 nmol/L is diagnostic)
plasma adrenocorticotrophic hormone (ACTH)
serum electrolytes
urea and creatinine
FBC
TFTs
What is the difference between the short synacthen and long synacthen test?
Short Synacthen Test
-Give IM 250 µg tetrocosactrin (synthetic ACTH)
-Serum cortisol < 550 nmol/L at 30 mins indicates adrenal failure
Long Synacthen Test
-1 mg synthetic ACTH administered
-Measure serum cortisol at 0, 30, 60, 90 and 120 minutes
-Then measure again at 4, 6, 8, 12 and 24 hours
-Patients with primary adrenal insufficiency show no increased after 6 hours
Generate a management plan for an Addisonian crisis
A-E approach
1. Rapid IV fluid rehydration
2. 50 mL of 5% dextrose to correct hypoglycaemia
3. IV or Im 100 mg hydrocortisone bolus
4. Followed by 100 mg 6 hourly hydrocortisone until BP is stable
5. Treat precipitating cause (e.g. antibiotics for infection)
Monitor
How is ongoing adrenal insufficiency managed?
Replacement:
-Glucocorticoids with hydrocortisone (3/day)
-Mineralocorticoids with fludrocortisone
[Hydrocortisone dosage needs to be increased during times of acute illness or stress]
Define carcinoid syndrome
Constellation of symptoms (esp liver mets) caused by systemic release of humoral factors from carcinoid tumours (slow-growing type of neuroendocrine tumours)
List the presenting symptoms of carcinoid syndrome
Paroxysmal FLUSHING
Diarrhoea
Crampy abdominal pain
Wheeze – due to bronchospasm
Sweating
Palpitations
Telangiectasia
List some appropriate investigations for carcinoid syndrome
serum chromogranin A/B (will be elevated)
urinary 5-hydroxyindoleacetic acid
metabolic panel
liver function tests
full blood count
CT/PET scan to localise tumour
Generate a management plan for carcinoid syndrome
Surgical resection + perioperative octreotide infusion
For unresectable - somatostatin analogue or interferon alpha
Consider chemotherapy, radiotherapy and immunotherapy
Consider palliative debulking
What are the risk factors for Cushing’s syndrome
ACTH dependent:
-pituitary adenoma (Cushing’s disease)
-ectopic ACTH from lung cancer/carcinoid tumours
ACTH independent
-adrenal adenoma
-adrenal carcinoma
Taking STEROIDS
Outline the presenting symptoms of Cushing’s syndrome
Myalgia
Thin skin/easy bruising
Poor wound healing
Weight gain - central obesity
Moon face
Interscapular fat bad
Hirsuitism
Acne
Menstrual irregularities
List the appropriate investigations for Cushing’s syndrome
- Urine pregnancy test (if appropriate)
- Bloods (U+Es, LFTs, BMs, CRP)
- 1 mg overnight dexamethasone suppression test
- Late-night salivary cortisol
- 24hr urinary free cortisol
Can also do low dose dexamethasone test (over 48hrs)
Consider ix for cause:
-pituitary MRI
-high dose dexamethasone suppression test
-petrosal sinus sampling
-ACTH levels
Generate a management plan for Cushing’s syndrome
If iatrogenic - discontinue steroids
Medical:
-inhibit cortisol synthesis with metyrapone or ketoconazole
Surgical:
-pituitary adenoma - trans-sphenoidal resection
-adrenal adenoma - surgical removal
If refractory Cushing’s disease - bilateral adrenalectomy
List some complications of Cushing’s syndrome
Diabetes
Osteoporosis
HTN
Pre-disposition to infections
Define diabetes insipidus
Diabetes insipidus is a metabolic disorder characterised by an absolute or relative inability to concentrate urine due inadequate secretion or of insensitivity to vasopressin (ADH)
List some causes of diabetes insipidus
Central:
-Idiopathic
-Tumours e.g. pituitary
-Infiltrative (e.g. sarcoidosis)
-Infection (e.g. meningitis)
-Vascular (e.g. aneurysms, Sheehan syndrome)
-Trauma (e.g. head injury, neurosurgery)
Nephrogenic:
-Idiopathic
-Drugs (e.g. lithium)
-Post-obstructive uropathy
-Pyelonephritis
-Pregnancy
-Osmotic diuresis (e.g. diabetes mellitus)
Outline the presenting symptoms of diabetes insipidus
Polyuria
Nocturia
Polydipsia
Enuresis (in children)
List some appropriate investigations for diabetes insipidus
- Bloods (U+Es - Na, Ca, K, glucose)
- urine osmolality (decreased)
- serum osmolality (increased)
- urine dipstick (negative for glucose)
- water deprivation test
Explain the results of a water deprivation test
Water restricted for 8 hrs and then desmopression given and osmolality measured.
Normally water restriction = increased urine osmolality (>600 mosmol/kg)
DI = urine osmolality is LOW (<400 mosmol/kg)
Cranial DI - urine osmolality rises >50% after desmopressin
Nephrogenic DI - osmolality rises <45% after desmopressin
Generate a management plan for diabetes insipidus
A-E
1. Give IV fluids if hypernatraemic (5% dextrose may be necessary)
2. Desmopressin
3. Maintenance of fluid balance
If nephrogenic then can give thiazide diuretics or NSAIDs (these inhibit prostaglandin synthesis and prostaglandin inhibits ADH)
What HLA associations are linked to T1DM?
HLA-DQ, HLA-DR3/4
List some causes of T2DM
MODY (maturity onset diabetes of the young) – autosomal dominant
Pancreatic disease e.g. chronic pancreatitis, pancreatic ca.
Endocrinopathies e.g. Cushing’s syndrome, acromegaly, PCOS
Drugs e.g. corticosteroids
Give some risk factors for T2DM
Genetic predisposition
Older age
Physical inactivity
Obesity - ↑FFAs, hyperglycaemia
Hypertension
Dysplipidaemia
Cardiovascular disease
List some appropriate investigations for suspected diabetes
- Urine dip
- Blood glucose
- HbA1c (>48 mmol/mol or 6.5%)
- Urine albumin:creatinine ratio
- eGFR
- U+Es
- Lipids
[If suspecting DKA then do ABG and ketones]
What are the blood glucose cut offs for diagnosing diabetes?
Fasting blood glucose >7
2hr post OGTT >11.1
Random >11.1
For diagnosis need:
-Symptomatic + 1 positive result
-Asymptomatic + 2 positive results
Generate a management plan for T1DM
Patient education
MDT
Diabetes specialist nurse
DAFNE (dose adjusted for normal eating)
Glycaemic control insulin (either basal bolus regimen or insulin pump)
Generate a management plan for DKA
IV fluid replacement with 0.9% saline
Start IV dextrose when glucose reaches 15mmol/l
Insulin infusion
Potassium (in fluids)
Monitor blood glucose, ketones, urine output and VBG
What advice is given for T2DM
Patient education
Lifestyle measures - diet, weight loss, exercise
BP control (ACEi +/- diuretic)
Statins
Smoking cessation
Outline the medication pathway for T2DM
- Metformin
(if C/I then usually start on sulfonylurea) - Metformin + sulfonylurea
(or sulfonylurea + DDP4i) - Metformin + sulfonylurea + SGLT2/DPP4i/Pioglitazone
- Substitute least effective of the three with GLP-1 (NOTE: do NOT give DPP4 and GLP 1 in combo)
- Add in insulin
Generate a management plan for HHS/HONK
IV isotonic saline fluid replacement (unless 0.45% saline if Na+ >155mmol/l)
Start IV dextrose when glucose reaches 15mmol/l
Insulin infusion 3 U/hour
Potassium (in fluids)
Monitor blood glucose, ketones, urine output and venous blood gases
Outline the main complications of diabetes
Diabetic kidney disease
Impaired vision (diabetic retinopathy)
Peripheral vascular disease
Peripheral neuropathy
IHD
Stroke/TIA
Gangrene
Infection
Impotence/ED
Define Grave’s disease
Hyperthyroidism due to presence of TSH receptor stimulating antibodies
(most common cause of hyperthyroidism in UK)
List the presenting symptoms of Grave’s disease
Heat intolerance
Sweating
Weight loss
Palpitations
Tremor
Exopthalmos
Pretibial myxoedema
Diffuse goitre
Anxiety
Oligomenorrhoea/Amenorrhoea
List some appropriate investigations for Grave’s disease
- Thyroid examination
- TFTs (low TSH + high T3/T4)
- Autoantibodies (Anti-TSHr, Anti-TPO, anti-thyroglobulin)
- Imaging (thyroid uptake scan - diffuse)
- CRP
Can do biopsy - will show tall follicles with scalloped borders
Generate a management plan for Grave’s disease
- Carbimazole or PTU (in pregs) - block organification of iodine - Risk of AGRANULOCYTOSIS
- Beta blocker for HR
- Radioactive iodine if treatment failure
- Consider thyroid surgery (risk of damage to recurrent laryngeal nerve)
Generate a management plan for a thyroid storm
- A-E approach
- IV fluids + analgesia
- Propranolol
- Steroids
- High dose carbimazole/PTU
What are the different types of hyperparathyroidism?
Primary - increased secretion of PTH independent to plasma Ca
Secondary - increased PTH secretion secondary to hypocalcaemia
Tertiary - autonomous PTH secretion following chronic secondary hyperparathyroidism
Outline some causes of primary hyperparathyroidism
Parathyroid adenoma
Parathyroid hyperplasia
Parathyroid carcinoma
MEN syndrome
Outline some causes of secondary hyperparathyroidism
Chronic renal failure
Vitamin D deficiency
Malabsorption syndromes
List the presenting symptoms of primary hyperparathyroidism
Signs of hypercalcaemia:
-Polyuria
-Renal calculi
-Constipation
-Depression/anxiety
-Fatigue
-Memory loss
-Paraesthesia
List the presenting symptoms of secondary hyperparathyroidism
Signs of hypocalcaemia or underlying cause
-Tingling in fingers/toes
-Myoclonus
-Muscle cramps
-Chvostek’s sign
-Trousseau’s sign
List some appropriate investigations for hyperparathyroidism
- serum calcium
- Serum PTH
- vitamin D level
- U+Es + LFTs (albumin)
- serum phosphate
- ALP
- 24 urinary calcium
- Consider ABG
- X ray (pepper pot skull in primary, rachitic rosary in secondary)
- Renal ultrasound (if suspected calculi)
Generate a management plan for hyperparathyroidism
Managing the hypercalcaemia:
-IV fluids
-Consider bisphosphonate if Ca still high
1st line - parathyroidectomy + monitoring + vit D supplementation
For secondary hyperparathyroidism - treat underlying cause (e.g. phosphate restriction for CKD)
List some complications of primary and secondary hyperparathyroidism
Primary:
-Osteoporosis
-Bone fractures
Secondary:
-Osteitis fibrosa cystica
-Uraemia
List some causes of hypothyroidism
Acquired:
-Hashimoto’s thyroiditis (AI)
-Iatrogenic (post-surgery, radioiodine, hyperthyroid meds)
-Iodine excess (Wolff-Chaikoff effect)
Congenital:
-Thyroid agenesis
Outline the presenting symptoms of hypothyroidism
Cold intolerance
Weight gain
Lethargy
Dry skin
Memory issues
Hair loss
Ataxia
Paraesthesia
Menstrual irregularities
Myxoedema coma - hypoventilation, hypothermia, hyponatraemia, confusion, coma, heart failure
List some appropriate investigations
- Thyroid exam
- TFTs (high TSH, low T3/4)
- Antibodies (anti-TPO, anti-TG, AMA)
- U+Es
- lipids
- Uptake scan
Generate a management plan for hypothyroidism
- low dose levothyroxine (25-200 mcg/day)
NOTE: rule out underlying adrenal insufficiency before starting thyroid medication
Generate a management plan for myxoedema coma
Oxygen
Rewarming
Rehydration
IV T4/T3
IV hydrocortisone
Treat underlying cause (e.g. infection)
What are the features of MEN1?
Parathyroid tumours
Pituitary adenomas
Pancreatic islet cell tumours
What are the features of MEN2a and MEN2b?
MEN2a:
Parathyroid tumours
Phaeochromocytomas
Medullary thyroid cancer
MEN2b:
Mucosal neuromas (e.g. GI tract)
Medullary thyroid cancer
Phaeochromocytomas
List some appropriate investigations for MEN1/2
serum calcitonin (MEN2)
serum CEA (MEN2)
plasma metanephrines (MEN2)
serum parathyroid hormone and calcium (MEN1/2)
fasting serum gastrin (MEN1)
serum chromogranin A (MEN1)
serum prolactin (MEN1)
insulin-like growth factor-1 (MEN1)
24-hour urine metanephrines and catecholamines (MEN2)
24-hour urine calcium (MEN1/2)
thyroid biopsy (MEN2)
Generate a management plan for MEN1/2
Treat the symptoms:
-Hyperparathyroidsm - hypercalcaemia pharmacotherapy + surgery
-Gastrinoma - PPI + surgery
-Non-functioning pituitary adenomas - monitor + surgery
-Prolactinomas - dopamine agonists
-Thyroid cancer - surgery + hormone replacement
-Phaeo - surgery + consider short term alpha 1 antagonists and steroid replacement.
How is obesity defined?
BMI >30kg/m^2
Define osteomalacia
Metabolic bone disease characterised by incomplete mineralisation of the underlying mature organic bone matrix following growth plate closure in adults
note: in kids it is referred to as Rickets
List some risk factors for osteomalacia
Dietary Ca and Vit D deficiency
CKD
Limited sunlight exposure
Anticonvulsant therapy
Outline the presenting symptoms of osteomalacia
diffuse bone pain and tenderness
fractures
proximal muscle weakness
List some appropriate investigations for osteomalacia
-Serum Ca
-Serum vit D
-Serum phosphate
-U+Es
-PTH
-ALP
-24 hr urinary calcium
-bone x rays/DEXA
Generate a management plan for osteomalacia
Calcium and vitamin D supplementation
Monitoring
Define osteoporosis
Skeletal disease characterised by low bone density and micro-architectural defects in bone tissue causing increased bone fragility.
Defined as a T score ≤-2.5
List some risk factors for osteoporosis
Smoking
Excess alcohol use
Premature menopause
Low BMI
Drugs (steroids, thyroxine)
Cushing’s
Outline the presenting symptoms of osteoporosis
Usually asymptomatic
May present with fractures
Back pain/loss of height over time (due to vertebral fractures)
List some appropriate investigations for osteoporosis
DEXA
Bloods - U+Es, Ca, ALP, Albumin, Vit D, PTH, TFTs
Consider X rays
What is the difference between a T score and a Z score?
T-scores reflect how bone density compares with that of a typical, young, healthy person, whereas Z-scores uses an age-matched control
Generate a management plan for osteoporosis
Lifestyle measures - increased exercise, weight loss
1st line - Bisphosphonates
Calcium and Vit D supplementation
2nd line - terparatide
3rd line - denusomab
What side effect is associated with bisphosphonate treatment?
Jaw necrosis
Define Paget’s disease of bone
A chronic bone disorder that is characterised by focal areas of increased bone remodelling, resulting in overgrowth of poorly organised bone.
What are the 3 distinct phases of Paget’s disease?
- Initial short-lived burst of osteoclastic activity –> bone resorption
- Mixed phase of osteoclastic and osteoblastic activity –> abnormally structured bone
- Chronic sclerotic phase (bone formation outweighs bone resorption
Outline the presenting symptoms/signs of Paget’s disease of bone
Mostly asymptomatic
Gradual bone pain (most likely pelvis, long bones + skull)
Frontal bossing (increased size of headwear)
Prognathism
Facial pain + HEARING loss (if skull involvement)
List some appropriate investigations for Paget’s disease of bone
- Examination
- Plain X ray
- Bone scans
- Serum Ca
- BONE specific ALP (used for treatment response)
- serum ALP
- Vit D (this should be normal)
What would X rays show in Paget’s disease of bone?
lytic changes
fractures
sclerotic picture (later stages)
Generate a management plan for Paget’s disease of bone
If asymptomatic:
-Observe, regular f/u
-Consider bisphosphonate or calcitonin
Symptomatic:
1st line = bisphosphonate or calcitonin
Physiotherapy
Walking aids
Hearing aids
Define phaeochromocytoma
Catecholamine-producing tumours that usually arise from chromaffin cells of the adrenal medulla
note: it is NOT an adenoma like in Cushing’s/Conn’s
Which genetic syndromes can cause phaeochromocytomas?
MEN2a and MEN2b
von Hippel-Lindau syndrome
Neurofibromatosis type 1
Outline the presenting symptoms of phaeochromocytomas
PAROXYSMAL episodes
Headache (due to malignant hypertension)
Palpitations
Chest pain
Dyspnoea
Sweating
GI sx - N+V, epigastric pain, constipation
Neuro sx - Weakness, tremor, anxiety
List some appropriate investigations for phaechromocytomas
- 24 hr urinary catecholamine/metanephrine collection
- Plasma free metanephrines and catecholamines
- Genetic testing
- Consider MRI or CT adrenal protocol for tumour localisation
Generate a management plan for phaeochromocytoma
If hypertensive crisis (>180/120) - 1st line phentolamine
If no hypertensive crisis:
1st line = alpha blockers (phenoxybenzamine)
THEN beta blockers (for reflexive tachycardia)
IV fluids
Surgical excision of tumour
What are the key presenting features of a non-functioning pituitary adenoma?
Headaches
Bitemporal hemianopia
Can have panhypopituitarism
What are the Rotterdam criteria for PCOS?
- Oligomenorrhoea/Amenorrhoea (>2 years)
- Hyperandrogenism (biochemical/clinical)
- Evidence of cysts on ovaries on USS:
-≥ 12 follicles in one ovary measuring 2-9mm in diameter
-Ovarian volume > 10cm3
need 2 of the 3 criteria
List some risk factors for PCOS
Strong FHx
premature adrenarche
obesity
low birth weight
Outline the presenting symptoms of PCOS
- Irregular or absent menstruation
- Infertility
- Hirsutism
- Acne
- Overweight/ obese
- Scalp hair loss
-Depression and other psych factors
-ACANTHOSIS NIGRICANS
List some appropriate investigations for PCOS
- Hormone profile (progesterone, oestrogen, testosteron, LH, FSH, DHEAS)
- Prolactin
- TFTs
- OGTT
- Fasting lipids panel
- Pelvic ultrasound/TVUSS
Generate a management plan for PCOS
Conservative:
-Weigh loss, lifestyle advice
Medical:
If NOT planning pregnancy - COCP, LNG-IUS or Co-cyprindol (useful for hirsuitism)
If planning pregnancy - Clomiphene (+/- metformin)
Surgical:
Not planning pregnancy - laser/electrolysis
Planning pregnancy - laparoscopic ovarian drilling, IVF
Outline some complications of PCOS
Infertility
T2DM
Pregnancy complications
CVD
NAFLD
Endometrial cancer
HTN
OSA
NOTE: NO INCREASED RISK OF BREAST OR OVARIAN CANCER
List some causes of primary aldosteronism
Adrenal adenoma (Conn’s syndrome)
Adrenal cortex hyperplasia
Adrenal carcinoma producing aldosterone
Outline the pathophysiology of hyperaldosteronism
Excess aldosterone leads to increased Na+ and water retention
This leads to hypertension
It also causes increased renal K+ loss leading to hypokalaemia
Renin is suppressed due to NaCl retention
Outline the presenting symptoms of primary hyperaldosteronism
Usually asymptomatic
HTN
Can get symptoms of hypokalaemia:
-Muscle weakness
-Polyuria/polydipsia
-Parasthesia
-Lethargy
-Tetany
-Mood disturbances
List some appropriate investigations for primary hyperaldosteronism
- Ambulatory blood pressure monitoring
- Serum K (LOW)
- Serum Na (usually normal because of associated water resorption)
- Urinary K (HIGH)
- Aldosterone:renin ratio (HIGH due to renin supression)
Consider the following confirmatory tests:
-Salt loading
-CT adrenal/MRI
-Posture stimulation testing
Generate a management plan for primary hyperaldosteronism
Unilateral:
-adrenalectomy + postop aldosterone antagonists
Bilateral hyperplasia:
-Spironolactone OR Eplerenone OR amiloride
What are the different types of prolactinoma?
Microadenomas: < 1 cm
Macroadenomas: > 1 cm
Giant Pituitary Adenomas: > 4 cm
Malignant Prolactinoma (RARE)
Outline the presenting symptoms of a prolactinoma
Women
○ Amenorrhoea/oligomenorrhoea
○ Galactorrhoea
○ Infertility
○ Hirsuitism
○ Reduced libido
Men
○ Symptoms are subtle and develop slowly
○ Reduced libido
○ Reduced beard growth
○ Erectile dysfunction
Note: both can have sx caused by tumour size (headaches, bitemporal hemianopia, cranial nerve palsies)
List some appropriate investigations for a prolactinoma
- Neuro exam
- Pregnancy test (if appropriate)
- Serum prolactin (>5000mU/L suggests true prolactinoma)
- TFTs (hypothyroid stimulates prolactin release)
- Pituitary MRI
Generate a management plan for a prolactinoma
1st line = dopamine agonist (cabergoline)
2nd line = COCP
If macroadenoma or medical treatment ineffective - transphenoidal resection
What is SIADH characterised by?
Hypotonic hyponatraemia
Concentrated urine
Euvolaemic state
Which drugs can cause SIADH?
Vincristine
Opiates
Carbamazepine
Chlorpropamide
List some causes of SIADH
Brain:
-Haemorrhage/thrombosis
-Meningitis
-Abscess
-Trauma
-GBS
Lung:
-Pneumonia
-TB
Tumours:
-SCLC
-Breast cancer
-Lymphoma
-Leukaemia
Metabolic:
-Porphyria
-Alcohol withdrawal
Outline the presenting symptoms of SIADH
Can be ASYMPTOMATIC
Headache
N+V
Muscle cramp/weakness
Confusion
Drowsiness
Convulsions
Coma
List some appropriate investigations for SIADH
- Serum Na (LOW)
- Serum osmolality (LOW)
- Serum urea, creatinine
- Urine osmolality (HIGH)
- Urine Na (HIGH)
- Glucose, serum protein and lipids - to rule out pseudohyponatraemia
- TFTs
Generate a management plan for SIADH
1st line: Treat underlying cause
1st line: Fluid restriction to 1L per day
2nd line: Vasopressin receptor antagonists (e.g. tolvaptan)
3rd line: NaCl + furosemide
4th line: demeclocycline
In SEVERE/ACUTE cases - slow IV hypertonic saline and furosemide with close monitoring
Give some differentials for SIADH
Pseudohyponatraemia
Psychogenic polydipsia
Renal failure
Addison’s disease
Hypothyroidism
What complication can be caused by correcting SIADH?
Central pontine myelinolysis (demylination of pons) - occurs with rapid correction of hyponatraemia
Characterised by:
-Quadriparesis
-Respiratory arrest
-Fits
What are the types of thyroid cancer (from most common to least)
Papillary – well-differentiated developed from follicular cells and spreads to N [Psammoma bodies, Orphan Anne nuclei]
Follicular – well-diff developed from follicular cells and rarely spreads to N [Hurthle cells]
Medullary – develops from C cells
Anaplastic – v. rare – fast growing and poorly diff
List the presenting features of thyroid cancer
Slow-growing neck lump
Discomfort swallowing
Hoarse voice - RED FLAG!!
Cervical lymphadenopathy
List some appropriate investigations for thyroid cancer
- Examination
- TFTs (usually normal)
- Bone profile
- Markers:
-Thyroglobulin - papillary and follicular
-Calcitonin - medullary - Thyroid US
- Fine-Needle Aspiration Cytology (FNA)
- Excision Lymph Node Biopsy
Consider CT/MRI - for staging
Generate a management plan for thyroid cancer
Surgery
Thyroid hormone replacement
Consider chemotherapy and external radiation
Define thyroiditis
Inflammation of thyroid gland
What are the main types of thyroiditis
Hashimoto’s - AI
de Quervain’s - viral
Postpartum
Drug-induced
Ridel’s - fibrosis (woody/craggy lump)
What happens to TFTs in thyroiditis
Increase in thyroid hormone synthesis causes hyperthyroidism
Then the stores run out and pt becomes HYPOthyroid
Outline the presenting symptoms of thyroiditis
neck pain
tender, firm, enlarged thyroid
fever
palpitations
sx of hypothyroid
sx due to thyroid gland enlargement (dyspnoea, dysphagia)
List some appropriate investigations for thyroiditis
- Examination of thyroid
- TFTs (TSH raised)
- ESR/CRP
- Antibodies (Anti-TPO, Anti-thyroglobulin, AMA)
- Thyroid US
- Radionucleotide isotope scanning (usually LOW)
Generate a management plan for thyroiditis
Mainly supportive care
Thyroid supplementation
Analgesia
Consider corticosteroid
If severe thyrotoxicosis - potassium iodide + pred
