ENDO Flashcards
Graves disease (diffuse toxic goiter):
pathophys/presentation?
dx?
tx?
autoimmune dz due to TSI (anti-TSH) → hyperthyroid sx, exophthalmos, thyroid bruits, pretibial myxedema
Dx ↓TSH, ↑free T4
Tx PTU (pregnant), methimazole (not pregnant), oral radioiodine (can become hypothyroid), subtotal thyroidectomy (permanent)
Plummer disease (toxic multinodular goiter):
dx?
tx?
multiple hyperfunctioning areas in thyroid → hyperthyroid sx
Dx ↓TSH, ↑free T4 + patchy uptake on T3 scan
Tx oral radioiodine (2 cm)
Toxic adenoma:
dx?
tx?
Dx ↓TSH, ↑free T4 + hot nodule on T3 scan
Tx oral radioiodine (2 cm)

Thyroid storm:
presentation?
tx?
precipitating factor (stress, infx) → hyperthyroidism exacerbation → marked fever, tachycardia, agitation, GI sx
β-blockers + antithyroid drugs
Hashimoto thyroiditis:
pathophys/presentation?
dx?
tx?
autoimmune dz w/ lymphocytic infiltration → hypothyroid sx
Dx ↑TSH, ↓/nl free T4
Tx Synthroid
De Quervain thyroiditis:
presentation?
dx?
tx?
painful granulomatous inflammation following viral URI → hypo- thyroid sx
Dx ↑TSH, ↓/nl free T4
Tx NSAIDs + observation (will self-resolve)
Acute thyroiditis:
presentation?
dx?
tx?
painful, swollen, tender thyroid mass due to Staph/Strep infx → hypothyroid sx
Dx ↑TSH, ↓/nl free T4
Tx I+D
Riedel thyroiditis:
presentation?
firm, painless thyroid → hypothyroid sx
Myxedema coma:
presentation?
tx?
precipitating factor (stress, infx) → hypothyroidism exacerbation → marked hypothermia, ∆MS, respiratory depression
Tx IV thyroxine + hydrocortisone + supportive care
Management of Thyroid nodules?
- TSH, if normal…
- FNA
- If malignant, remove; if benign, observe; if indeterminant, thyroid scan –> cold = malig
Papillary thyroid cancer: spread? pathology? prognosis? tx?
lymphatic
Psamomma bodies w/ Orphan Annie nuclei
best px
total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
*f/u thyroglobulin levels
Follicular thyroid cancer:
spread?
MC population?
tx?
hematogenous spread
endemic to iodine deficient areas
Tx hemilobectomy + frozen bx → total thyroidectomy if bx shows carcinoma
*f/u thyroglobulin levels
Medullary thyroid cancer: spread? pathology? tx? f/u on...
lymphatic and hematogenous spread
amyloid deposits
total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN
f/u calcitonin levels + 24-hr urinary VMA (MEN2 syndrome also has pheos)
Anaplastic thyroid cancer:
px?
tx?
worst px
tx palliative care
Hurthle cell cancer:
tx?
Tx total thyroidectomy w/ central LN excision → modified radical neck dissection if +LN; f/u thyroglobulin levels
Hypocalcemia sx =
neuromuscular irritability (tingling, tetany), prolonged QT, arrhythmias
Hypercalcemia sx =
stones (kidney)
bones (bone pain, osteitis fibrosa cystica)
groans (peptic ulcers, pancreatitis)
psychic overtones (depression, anxiety, ∆MS)
Hypoparathyroidism: labs? tx? Chvostek sign = Trousseau sign =
↓PTH, ↓Ca, ↑P
vit D and Ca
Chvostek sign: tapping on Cheek causes muscle contractions
Trousseau sign: inflating BP cuff causes carpal muscle spasms
Pseudohypoparathyroidism =
labs?
tx?
PE finding?
end-organ resistance to PTH
↑PTH, ↓Ca, ↑P
vit D + Ca
Knuckle-knuckle-dimple-dimple sign: hand morphology seen w/ pseudohypoparathyroidism
Primary hyperparathyroidism:
labs?
↑PTH, ↑Ca, ↓P + Cl:P ratio >33:1
Secondary hyperparathyroidism:
pathophys?
labs?
renal failure → ↓1α-hydroxylase → ↓vit D → ↓Ca → compensatory ↑PTH
↑↑PTH, ↓Ca, ↑P
Prolactinoma:
presentation?
dx?
tx?
galactorrhea, amenorrhea, infertility, ↓libido
Dx ↑PRL + β-HCG/TSH (r/o 2° causes)
Tx bromocriptine or cabergoline (<1 cm), transsphenoid hypophysectomy (≥1 cm)
Acromegaly: presentation? MCC death? dx? tx?
↑GH → overgrowth of brow, jaw, hands, and feet
MCC death is CV disease
Dx oral glucose test
Tx transsphenoid hypophysectomy + octreotide (suppress GH)
Pituitary Cushing:
presentation?
dx?
tx?
↑ACTH → truncal obesity, abd striae, buffalo hump, hyperglycemia, osteoporosis, HTN, immunosuppression
Dx ↑ACTH + dexa suppression test (pituitary Cushing is suppressable)
Tx transsphenoid hypophysectomy
Hypopituitarism is a/w ↓ levels of which hormones?
↓FSH/LH, ↓ACTH, ↓TSH, ↓PRL, ↓GH
Craniopharyngioma:
presentation?
dx?
tx?
embryological remnant of Rathke pouch → bitemporal hemianopsia (◐◑), headache, papilledema, ∆MS
MRI (supracellar calcified cysts)
Tx transsphenoid hypophysectomy
Central vs nephrogenic diabetes insipidus?
tx?
Central DI: ↓ADH secretion from posterior pituitary; tx = DDAVP
Nephrogenic DI: normal ADH but kidneys don’t respond; tx = HCTZ
SIADH:
presentation?
dx?
tx?
↑ADH secretion from posterior pituitary → volume expansion, hyponatremia (coma/sz/death if acute, asx if chronic)
Dx Na <270
Tx water restriction
