Endo Flashcards
Hormone used to titrate antithyroid meds for Grave’s
Free T4
Grave’s disease antibody
Anti TSH receptor
Acts on TSHr in pituitary gland –> over-activation of thyroid to produce T3 and T4
Most common benign thyroid nodule
Follicular adenoma
Most common neoplasm of thyroid (benign and malignant combined)
Follicular adenoma
Most common malignant cancer of the thyroid
Papillary carcinoma
DeQuervain thyroiditis
AKA subacute granulomatous thyroiditis
Benign
Follows infection
Presents as painful nodule
Doppler ultrasound finding of benign nodular hyperplasia
Ring of fire
Follicular adenoma of thyroid characteristics
Red light on colour dopplery U/S
Confined in capusle
Different growth pattern from surrounding parenchyma
Most sensitive means of differentiating primary from secondary causes of hyperaldosteronism
Aldosterone-to-renin-ratio (ARR) = ratio of plasma aldo to plasma renin activity
-Measures the rate of production of angiotensin I from endogenous angiotensinogen via renin
-As aldo secretion rises, ARR should fall b/c of Na retention
(RAS decreases when BP high)
Renin function
Angiotensinogen to Angiotensin I
ACE function
Angiotensin I to Angiotensin II
Aldosterone is produced from
Adrenal cortex
Signalled by Ang II
Primary aldosteronism
Conn’s Syndrome
Increased production of aldosterone from adrenal gland –> decreased renin
Renin levels may fall well before plasma aldo is increased
Triad of:
HTN
Hypokalemia
Metabolic alkalosis
Secondary hyperaldosteronism
Decreased renal blood flow (ie. due to obstruction, edematous d/o such as CHF/nephrotic syndrome/cirrhosis, renal vasoconstriction)
RAS stimulated –> aldo hypersecreted
Aldo and renin HIGH
Hashimoto’s antibody
Anti-TPO
Timeframe to recheck TSH
Wait >6wks to recheck TSH after dose change
Regular monitoring is 2-3mo then annually once stable
Hyperthyroid tx
Methimazole (high rate of relapse)
I-131
Starting insulin dose
0.3-0.5 U/kg
Rapid acting insulins (bolus dosing)
Insulin aspart (NovoRapid) Insulin lispro (Humalog)
Short-acting insulins (bolus dosing)
Humulin-R
Novolin-ge Toronto
Intermediate acting insulin (basal dosing)
Humulin-N
Novolin-ge NPH
Long-acting insulin (basal dosing)
Insulin detemir (Levemir) Insulin glargine (Lantus)
Carcinoid syndrome
Flushing (histamine, bradykinin), secretory diarrhea (serotonin), abdo pain, tricuspid regurg, skin color changes, wheezing
Result from carcinoid tumour (slow growing neuroendocrine tumours)
Usually asymptomatic
Once carcinoid symptoms occur then metastasis to LIVER likely has already occurred
Biochemical test to confirm carcinoid syndrome
5-hydroxyindoleacetic acid (5-HIAA) measured in 24h urine sample
Serotonin released by carcinoid tumours –> metabolized by monoamine oxidases in liver, lungs and brain –> 5-HIAA
+ imaging
+ hepatic panel if liver met
Carcinoid tumour mgmt
Cytoreductive surgery (debulking) on primary or met Somatostatin analogues (ie. octreotide) have hormone blocking properties --> help with symptoms \+/- chemoembolization of mets (esp in liver)
Most common location of carcinoid tumour
Ileum
sometimes appendix
Thyroid nodule with high TSH next step
FNA biopsy with cytology
Thyroid nodule with low TSH next step
Radioiodine 123 scan or Technetium-99 scan to test for nodule functionality
+ fT4 and T3
Cold thyroid nodule
FNA biopsy, U/S
R/O malignancy
Homogeneously diffusely hot thyroid nodule
Graves
Hetereogeneously diffusely hot thyroid nodule
Toxic multinodular goiter
Focal diffuse hot thyroid nodule
Functioning adenoma
No pick up on I123 thyroid scan
Thyroglobulin levels
If high –> ?thyroiditis
If low –> ?thyrotoxicosis
Most common thyroid cancer
Papillary carcinoma
Syndrome a/w medullary thyroid cancer
MEN-2A/B
Tx for thyroid CA
Thyroidectomy +/- I131 radiation
Parathyroid hormone action
hypercalcemia + hypophosphatemia
Vitamin D association with Ca and P
Increases GI absorption of both
MEN-1
Often a/w zollinger-ellison syndrome
Auto dominant d/o
Tumours in parathyroid gland (causes hyperca), pancrea, pituitary gland
If TSH < ___ in pregnancy with negative anti-TPO, no need to treat
4
Treatment for Graves in pregnancy
Propylthiouracil during preconception and 1st trimester
Switch to methimazole after first triemster to reduce maternal hepatotoxicity
Follow b/w q4-6wks
Propylthiouracil excreted in breastmilk T/F
True
Sick euthyroid syndrome
Abnormal thyroid function a/w acute severe non-thyroidal illness
Low T3 + normal T4 and TSH
If severe, serum T4 may also drop and TSH may be high or low
Creutzfelt-Jakob disease
Neurodegenerative prion based brain disorder that has long incubation period with rapid progressive mental deterioration and myoclonus
Incurable and fatal
Spong-like appearance of brain
Brain bx is gold standard for dx
Adrenal cytoplasmic antibodies positive in what disease?
Addison’s disease
Addison’s disease
Primary adrenal insufficiency
Hypocortosolism
Conn’s syndrome
Primary hyperaldosteronism
Paget disease lab findings
Increased ALP, normal Ca, phosphate and PTH
Urinary pyridine and deoxypyridine levels increased
Hypercalcemia treatment
IVF (+/- furosemide to prevent HF)
Adjunctive tx: Alendronate, calcitonin
Hypercalcemia tx secondary to hormonal treatment
Prednisone
TSH screening in pregnancy
q4wks during first half of pregnancy
At least once each trimester in latter half of pregnancy
Insulinoma
Raised insulin –> fasting hypoglycemia
Plasma C-peptide
