Endo Flashcards
Painless thyroiditis consists of
Hyperthy followed by hypothy and then recovery. May have high anti-Peroxidase ab even in postpartum thyroiditis. Similar to hashimoto with DECR RAIU (radioactive iodine intake)
Assoc with HCV interferon tx, lithium tx
Self limited dz and can consider b blocker for symp and to prevent afib
Chvostek sign
Facial twitch when facial n tapped due to HYPOca
Vs HYPERca may present weak, constipated
Exogenous hyperthyroid has what pattern for Tg (thyroglobulin) and radioactive uptake?
BOTH low
If both high- graves
Low TG RAIU but high TG means thyroiditis
High TG alone can be thyroid cancer
Match the following- Sglt2 (sodium gluc transporter) - candidiasis Ddp4-pancreatitis Biguanide-gi side effects Alpha glucosidase inh- gi side effects
Metformin is biguanide
Acarbose is alpha glucosidase
How does amiodarone affect thyroid levels?
Decr conversion of t4 to t3 meaning incr t4. Decr t3.
Normal or borderline high tsh if clinically euthyroid. Amio usually causes hypothyroidism
Just rpt tfts in 3 months
Ct head with thick calvari and cotton wool appearance of skull is
Pagets disease- asymp
Check ca is normal but ALP is high.
Next get bone scan.
Tx is bisphosphonate
Common symptom of advanced pagets disease?
Hearing loss
U tx with calcitonin and bisphosphonate but wont reverse damage
Elevated calcium. Next labs?
pth. If high pth, check urine calcium excretion. High urine calcium means 1 or 3 hyperpara. Low urine excretion means familial hyperca hypocalcuria.
Low pth then measure pthrp (most likely cause), 25 vit d and 1,25 vit dz
Rapidly enlarging prior small goiter that now causes facial plethora with arm raised and esophageal obstruction with tfts looking like hashimotos is due to
Thyroid lymphoma. Risk factor is hashimotos
Tx of diabetic neuropathy besides pregabalin, tca?
snri loke duloxetine!!!!
Often spontaneously resolve in 1 yr and can dc meds
Msk pain, insomnia, fatigue should get what lab workup?
Fibromyalgia - get cbc (anemia), cpk (ro myositis) vs esr va tsh (hypothy)
Lithium induced hypothyroidism (symptomatic). Next step is
Add synthroid
B4 start lithium need to check tfta and also monitor tfts q6m
Medullary thyroid cancer that is resected but still elevated calcitonin means you need to perform what test next?
Ct neck and chest to eval for residual cancer
Medullary thy cancer is malign of parafollicular cells and DO not uptake iodine and thus rai doesnt work
Advantage of long acting insulin over mixed insulin (short plus long)
Less risk hypoglycemia
Thyroid nodule >1 cm with normal tfts should get what next?
Fna
If tsh low then get radionuclide thyroid scan
Fna shows medullary thyroid cancer. Need to rule out MEN with what tests?
RET oncogene mutation, calcitonin lvl, CEA, calcium/pth
Need to eval for men2a- med thyroid cancer, pheo, hyperparathyroidism bc cant procede with thyroidectomy wo first ro pheo due to OR risks
Men2b has neuromas, marfanoid
What is risk of type 1 dm in kid of mother w type1? Of father?
3%, 6%
Fever, heat intolerance, enlaeged thyroid very tender with tfts showing hyperthyroidism is due to
What do u find on RAI???!!!
What is tx???
Subacute thyroiditis
Decr uptake!!!!!!!!!!!
Tx is supportive bc dz is self limited!!! Nsaids and bblocker!!
Vs in graves u have incr uptake
Pt w hx of gastric ulcer, now w high serum calcium level and high pth and low phos. What is next step in management?
Refer for parathyroidectomy
men1 syndrome- 3p’s parathyroidism, pancreatic tumor (gastrinoma), pituitary tumor (prolactinoma)
Dont need to check calcitonin and metaneprines which are part of men2
Type 1 dm2 who now is often hypoglycemic, hyperk, hypotens, arf my have
Addisons and should get cosyntropin test
May also see eosinophilia
Loss of cremaster reflex in someone w recent mva, hx of dm2 neuropathy w the ed, normal motor and sensory is due to
Injury to spinal cord at L1-2
Dm2 neuropathy
Dm2!!
L1-2 injury would also cause hip flexion and adduction prob
Can you continue oral med and start insulin?
Yes! Check for met acidosis by calculating and if there is stop metformin! If kidney injury stop gly buride bc metabolized that way
Can continue pioglitazone, acarbose, repaglinide which metabolized by liver
Pt w hx of adrenalectomy or abd procedure and w hyperpigmentation and cushings and bitemporal hemianopsia has
Nelsons syndrome - check mri and high acth
Vs prolactinoma does not have incr pigmentation
Pt w hx if thyroida sp thyroidectomy on synthroid w high normal tsh. Should u change synthroid dose?
Yes incr for goal tsh low botmal
Tx of graves w RAI should be given w
Steroids to prevent complications w existing opthalmopahy
Sp RAI for graves, and pt asymp. What test to use to monitor?
T3 t4!!! Bc tsh may be suppresses for wks after
Pt w primary hypoparathyroidism should be tx with what? Means low ca and vit d.
What if check urine calcium is high and serum calcium levels are low?
Tx w calcium and high dose vit d
Urine calcium high should tx w THIAZide bc hypercalcemia causing
Dka - if on ivf and insulin and glc
Half insulin and add dextrose to fluid to prevent hypoglycemia!!!!!
not continue same regimen
Asymp hypothy w normal t4 and dunno t3, next lab?
Antithyroid ab, lipid panel
If those abn then tx
