Endo Part 1 Flashcards
What is the pneumonic to remember Metabolic Syndrome?
WEIGHHT
What are the findings with Metabolic Syndrome?
WEIGHHT
- Waist Expanded
- Impaired Glucose
- HTN
- HDL decreased
- Triglycerides increased
What is the treatment for Metabolic Syndrome?
Lifestyle modifications
+/- metformin for weight loss
+/- BP medications
What is most of T4 bound to in the bloodstream? What increases this?
TBG – increases in pregnancy
Graves disease involves TSH receptor stimulating antibodies. What are findings that are only present with this cause of hyperthyroidism? (4)
Exophthalmos
Pretibial myxedema
Acropachy – hand swelling
Thyroid bruit
If someone with Graves disease choose to undergo Iodine ablation, what will worsen?
Eye disease – exophthalmos
In a pregnant woman with Graves disease, what is a potential adverse effect?
Fetal thyroxicosis
– TSH antibodies cross placenta and stimulate fetal thyroid
What is the treatment for Thyroid eye disease?
Steroids
What is used for symptom control with hyperthyroidism?
Beta blocker – propranolol
Which hyperthyroidism medication should be used in pregnancy?
PTU
What are some adverse effects of PTU and Methimazole
Both = Agranulocytosis
PTU = Liver failure
Methimazole = Cholestasis
What is the only definitive treatments (2) for hyperthyroidism?
Radioactive iodine ablation
Thyroidectomy
What is the next most common cause of hyperthyroidism following Graves disease?
Thyroid adenoma – hot nodule
With UNtreated hyperthyroidism, what is the potential adverse effect?
Osteoporosis and bone resorption
=> Fractures and hypercalcemia
How may Thyroid storm present?
HIGH fever
Afib
Delirium/coma
What is the treatment order for a thyroid storm (4)?
Beta blocker
PTU/Methimazole
Iodine
+/- steroids
What occurs with Euthyroid sick?
Serious illness causes T4 to be converted to reverse T3 which is NON-functional
What will the levels of TSH, T4 and T3 be with Euthyroid sick?
NORMAL TSH and T4
- LOW T3
Hashimoto’s thyroiditis may have which 2 antibodies?
Anti-TPO
Anti-Thyroglobulin
There are many Thyroiditis conditions – postpartum, postviral, subacute; how may they present?
Hyperthyroid –> Hypothyroid
Which Thyroiditis has a painful goiter (though all can have a nonpainfaul goiter)? What precedes this?
Subacute Thyroiditis
– preceded by viral illness
Which Thyroiditis will have elevated ESR/CRP?
Subacute Thyroiditis
What are some features of congenital hypothyroidism?
Umbilical hernia
Failure to thrive/hypotonia
Prolonged jaundice
What are 2 features seen with Papillary thyroid cancer?
Psammoma bodies
Orphan annie nuclei
What are 2 features seen with Papillary thyroid cancer?
Psammoma bodies
Orphan annie nuclei
How does Papillary thyroid cancer spread?
Lymphatic
How does Follicular thyroid cancer spread?
Hematologic
Where is Medullary thyroid cancer and what is produced?
Thyroid C cells –> Calcitonin
MEN 1
3 P’s
- Pituitary
- Parathyroid
- Pancreas
MEN 2A
2 P’s
- Parathyroid
- Pheochromocytoma
- Medullary Thyroid carcinoma
MEN 2B
1 P
- Pheochromocytoma
- Medullary Thyroid carcinoma
- Marfanoid habitus
What derm finding is seen with a Glucagonoma?
Necrolytic Migratory Erythema
What derm finding is seen with a Glucagonoma?
Necrolytic Migratory Erythema
How does Necrolytic Migratory Erythema look?
Large indurate plaques with CENTRAL CLEARING
If someone takes in too much calcium or alkali like antacids, what are they at risk for?
Milk Alkali Syndrome
What will the levels of Calcium, HCO3 and GFR be with Milk Alkali syndrome?
– excess intake of calcium/alkali/antacids
= HIGH calcium and HCO3
= LOW GFR
What is Paget Disease of Bone?
Bone formation AND resorption
Paget Disease commonly presents at the skull. What are characteristic symptoms?
Bone pain + nerve entrapment + hearing loss
If someone presents with bone pain and hearing loss… expect what?
Paget Disease of bone
What lab value is elevated with Paget Disease of Bone? What are patients at an increased risk for?
HIGH Alk Phos
–> Osteosarcoma risk
What will an X-ray show with Paget Disease of Bone?
Mosaic pattern
– cortex sclerosis + thickened trabeculae
Lab values of PTH, Ca, P with Primary Hyperparathyroidism?
HIGH PTH and Ca
LOW P
Lab values of PTH, Ca, P with Secondary Hyperparathyroidism?
HIGH PTH and P
LOW Ca
What commonly causes Secondary Hyperparathyroidism?
Renal failure
What commonly causes Tertiary Hyperparathyroidism?
Chronic hypocalcemia that causes autonomously functioning parathyroid glands
Lab values of PTH, Ca, P with Tertiary Hyperparathyroidism?
ALL HIGH
What causes Pseudohypoparathyroidism?
PTH resistance
– common with Albright Osteodystrophy (shortened 4th/5th fingers)
Lab values of PTH and Ca with Pseudohypoparathyroidism?
High PTH and Low Ca
What scan may be helpful with hyperparathyroidism?
Sestamibi scan
What may get too high and need treatment with Secondary hyperparathyroidism?
Phosphate – phosphate binders (ex. sevelamer)
