Endo revision2

Question 1

thyroidism lab tests

Answer 1

hypo
TSH up, T3/4 down

Hyper-
tsh down, T3 Up

Question 2

Subclinical Hypothyroidism

Answer 2

Elevated TSH but normal t3/t4-
Dont do anything, but repeat TFTs after 6w
AB–TPO and others

mx- either do nothing or low dose thyroxine
risk of progressing

if tsh> 10- can try and give meds

Question 3

Hyperthyroidism

Answer 3

Graves, dequervains, benign adenoma, amiodarone

test- TSHR AB, TFT, scintillography/uptake scan
care-dont check TFT in hospital- as its affected

mx- initial Bblock-propanolol
carbimazole/propyluracil-care of neutropenia
+ replace

75% of hyperthyroidism gets back to normal- especially if subclinical

Question 4

Subacute thyroiditis

Answer 4

very common but self-limiting
a lot of cause of thyroitoxicosis AND hypo
usually hyper-> hypo->normal

never eye disease ofc

ix- Hx,
TFTs-
ESR and TPO can be raised
Isotope uptake- REDUCED

mx- bblock
and thyroixin in hypo- but be able to withdraw
sx management

Question 5

What if both TSH and T4 are down

Answer 5

think secondary causes-
check cortisol and other endocrine axis issues

Question 6

approach to thyroid Lumps

Answer 6

Isolated, or multiple (with 1 dominant or not)
or smooth enlarged
pain or not

ask -thyroid disease, pain, FLAWS, radiation
Test- TFT
USS and Fine needle aspiration-if cancer or not

cancer is rare, but can be part of a multimodular goitre

Question 7

Hypercalcemia

Answer 7

Bone pain, Abdo pain, stones, Depression, confusion
polyuria etc

cause- hyperparathyroidism, isolated(drugs), cancer, renal failure, sarcoid

always check PTH (low, but high/normal in hyperPTH), Vit D

mx- stop drugs that can cause it
Hydration +++
Bisphosphonates for cancer!

Question 8

Hypocalcemia

Answer 8

rare-usually post thyroid surgery-primary hypopara
other causes- Vit D def (malab), Mg Def, pancreatitis
Renal failure (hypopara)

See trousseau (BP Cuff 3mins), Chovsteks

ECG-look for QTc elongation, tetany

if no signs of those-home with calcichew (or if PTH down- 1a calcidol supplement)
MUST USE 1a caldidol
if you dont have PTH–you cant convert Vit D to active vit D

If Tetany/QTc prolong-emergency IV Calcium Glucoronate
sustained treatment- calcichew+1a calcidol

Question 9

Hypercalcemia emergency

Answer 9

if really raised- emergency
give Fluidsfluidsfluids (3-6L)
furosemide too pee better
IV pamidronate
heamodyalisis
if cancer–bisphosphonates

if dont-

Question 10

Hypercalcemia causes

Answer 10

primaryPTH- adenoma
cancer
Myeloma
sarcoid
thiazide diuretics
vit d toxicity

Question 11

Hyponatremia Mx

Answer 11

acute severe hyponatremia (confusion,coma,)
give 3% saline immediately over 20mins
and can repeat
dont want to give too fast-central pontine myelonosis

probs also ITU

Question 12

Hyponatremia Mx

Answer 12

acute severe hyponatremia (confusion,coma,)
give 3% saline immediately over 20mins
and can repeat
dont want to give too fast-central pontine myelonosis

probs also ITU

Question 13

Hyponatremia Mx

Answer 13

acute severe hyponatremia (confusion,coma,)
give 3% saline immediately over 20mins
and can repeat
dont want to give too fast-central pontine myelonosis

probs also ITU

Question 14

Hyponatremia Mx

Answer 14

acute severe hyponatremia (confusion,coma,)
give 3% saline immediately over 20mins
and can repeat
dont want to give too fast-central pontine myelonosis

probs also ITU

Question 15

Hyponatremia Mx

Answer 15

acute severe hyponatremia (confusion,coma,)
give 3% saline immediately over 20mins
and can repeat
dont want to give too fast-central pontine myelonosis

probs also ITU