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Endocrine Flashcards

1
Q

Name 6 complications diabetes

A

Acute

  • hypoglycaemic
  • DKA
  • HHS (hyperglycaemic hyperosmolar state)

Chronic

→ Microvascular

  • retinopathy, cataract
  • nephropathy
  • neuropathy: peripheral and autonomic (gastroparesis, altered bowel habit, postural hypotension )
  • foot disease

→ Macrovascular

  • cardiovascular: coronary artery disease, mi
  • Cerebrovascular: stroke
  • peripheral vascular disease: claudication, ischaemia, decreased pulses
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2
Q

Name 7 symptoms diabetes

A
  • Polyphagia (hunger)
  • glycosuria
  • polyuria
  • polydipsia (thirst)
  • unexplained weight loss
  • visual blurring
  • genital thrush
  • lethargy
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3
Q

Name 10 causes insulin resistance

A

Non-modifiable

  • Asians, especially Indians
  • cystic fibrosis
  • acromegaly

Modifiable

  • obesity
  • Tb drugs
  • pregnancy
  • Cushing’s
  • renal failure
  • PCOS
  • metabolic syndrome: central obesity, hyperglycaemia, ht, dyslipidaemia
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4
Q

Treatment hypoglycemia?

A
  • Stat 20ml vile of 50% dextrose
  • another 20ml vile added to 10% dextrose drip
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5
Q

Management DKA? (6)

A
  1. Blood gas
  • check potassium
  • controversial: correct acidosis with bicarb if ph < 7
  1. Fluid
  • iv 0,9% sodium chloride (prefer) or ringers 1l over 1h then 250 - 500ml per hour
  • goal: replace 50% of fluid deficit in first 12 hours, rest in next 12 hours (about 5-10 L average loss)
  • once glucose <14, use 5% dextrose to prevent hypoglycaemia
  1. Insulin
  • first check serum potassium
  • 0,15 units /kg/hour of iv short/rapid acting insulin if K not low
  • or 10 units regular insulin IM or iv hourly
  • then continuous infusion 0,1 u/kg/h until glucose < 14, then half infusion rate.
  • monitor glucose hourly and adjust accordingly
  • switch to subcutaneous insulin when: fully concious and eating, AGAP normal and acidosis resolved, glucose < 15, bohb<1
  1. Electrolytes
  • potassium: first check levels. If < 3,5, give before insulin 40 mmol. 20 mmol KCI per L iv fluid if 3.5-5.5. Don’t give if 5.5 or more
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6
Q

Name the 3 types of insulin and doses

A

• Short acting subcutaneous injections (Sc) 3x daily 30 min before meals
• intermediate acting sc once or twice daily usually at night at bedtime, approx 8
hours before breakfast
• biphasic sc once or twice daily

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7
Q

Name and describe the 2 insulin regimens for dm 1

A
  • Basal bolus regimen: combined intermediate acting (basal) and short acting (bolus).
    Pre-meal short acting and bedtime intermediate acting not later than 22h00. Preferred in dm 1
  • Pre-mixed twice daily insulin: twice daily mixture of intermediate or short acting insulin and used with at least daily glucose monitoring - practical solution for those that can’t monitor blood glucose frequently
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8
Q

Dose Of basal bolus insulin regimen?

A

Initial total daily insulin dose: 0,6 units/kg/ body weight
Total dose divided into
• 40-50% basal insulin
• rest as bolus insulin, split equally before each meal
Adjust according to individual needs

For dm 1

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9
Q

Add on insulin therapy (intermediate to long acting) starting dose and increments for dm 2?

A

Starting: 10 units in evening before bedtime but not after 22h00
Increments: increase gradually to 20 units, 2-4 units increase each week.

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10
Q

Substitution insulin therapy (biphasic) starting dose and increments for dm 2?

A

Starting: twice daily. total daily dose 0,3 units /kg/day divided as 213 30 minutes before breakfast and 1/3 30 minutes before supper
Increment: 4 units weekly. First increment added to dose before breakfast, second added to dose before supper.

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11
Q

Which 2 tests screen for diabetic peripheral neuropathy

A
  • Ipswich touch test
  • monofilament testing
  • tuning fork 128 Hz
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12
Q

Name 10 clinical features hyperthyroidism

A

Like hyper metabolism.

  • General: fatigue, heat intolerance,
  • CNS: fine tremor! Proximal muscle weakness! Hypo K periodic paralysis , irritable
  • skin: Palmar erythema! Fine hair! Vitiligo! Pruritis, clubbing + pretibial myxoedema in graves
  • eye: lid lag! Lid retraction, exophthalmos, diplopia, periorbital oedema,
  • neck: goiter.in graves, goitre with bruit!
  • chest: tachycardia! Palpitations! Afib! Increase sbp, breast enlargement
  • git: weight loss + increased appetite! Diarrhoea! Thirst
  • gynae: oligomenorrhea/amenorrhoea, loss fertility
  • musculoskeletal: proximal muscle weakness! loss bone mass
  • haematology: graves - leukopenia, lymphocytosis, splenomegaly, lymphadenopathy
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13
Q

Which is the only disease that causes exophthalmos

A

Graves’ disease: tsh receptors on orbital muscles. Biopsy shows lymphocyte infiltration

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14
Q

Name 3 manifestations of Graves’ disease

A
  • Eye disease!: exophthalmos! Ophthalmoplegia (if see eye involvement, think graves)
  • pretibial myxoedema
  • thyroid acropachy: extreme manifestation - clubbing, painful finger and toe swelling, periosteal reaction in limb bones
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15
Q

Name 8 causes hyperthyroidism/ thyrotoxicosis

A
  • Graves’ disease (76 % )
  • toxic multi nodular goitre (14%)
  • toxic nodule (adenoma) (5%)
  • thyroiditis eg de Quervain’s (viral) (3%); postpartum
  • iodide induced: drugs eg amioderone!, radiographic contrast media, iodine supplement
  • extra thyroidal source thyroid hormone: factitious thyrotoxicosis, struma ovarii (ovarian teratoma containing thyroid tissue)
  • TSH induced: tsh- secreting pituitary aclenoma, choriocarcinoma + hydatiform mole ( HCG stimulates thyroid)
  • follicular carcinoma with or without metastases
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16
Q

Name 4 causes hypothyroidism

A
  • Hashimoto’s! (Other autoimmune = spontaneous atrophic hypothyroidism, graves with TSH r blocking antibodies)
  • congenital (dyshormonogenesis, thyroid aplasia)
  • iatrogenic !: thionamides, radioactive iodine, surgery, amiodarone, lithium
  • hypothyroid phase of thyroiditis (transient thyroiditis)
  • iodine deficiency
  • infitrative: amyloidosis, sarcoidosis, Riedel’s thyroiditis
  • secondary hypothyroid: TSH deficiency
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17
Q

Test for dm 1?

A

Anti-gad (islet cell ab against glutamic acid)

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18
Q

Name 6 oral agents used in diabetes

A

DIE GAMES

  • DPP 4 inhibitors (dipeptidyl peptidase): vildagliptin (block inactivation of incretin. Don’t use with GLP 1)
  • incretins: glp-1 (glucagon like peptic 1 inject) eg exenetide ( stimulate B cells + slow gastric empty,significant weight loss. don’t use with DPP4)
  • sulphonylurias: glimepiride (stimulate insulin release from B cells )
  • alpha glucosidase inhibitors: acarbose (slows digestion)
  • biguanides: metformin (increase peripheral glucose uptake)
  • meglitinides: repaglinide (post prandial glucose regulator)
  • SGLT2 inhibitors eg canagliflozin
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19
Q

Name types of insulins and examples

A
  • Short acting regular human insulin (actrapid)
  • rapid acting analogue insulin (aspart / novorapid ; lispro )
  • intermediate acting basal human insulin ( NPH /protaphane)
  • long acting basal analogue insulin (glargine / optisulin)
  • pre-mixed human biphasic insulin = 30% regular + 70% intermediate human / NPH (actraphane humulin 30/70)
  • pre-mixed analogue insulins

(For bolus, analogue preferred if can afford. For basal, human preferred)

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20
Q

Insulin regimen for diabetes 2?

A

Metformin + basal intermediate insulin ( nph protaphane) at night.

  • start 10 u protaphane at night and titrate up based on morning fasting glucose
  • if > 20 - 30 u needed, change to biphasic mixed insulin (actraphane/ humulin 30/70): 2/3 in morning, 1/3 at night at 0,3u/kg (start this immediately if hba1c > 10%)
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21
Q

Insulin regimen for diabetes 1?

A

Basal bolus regimen at 0,7 - 0,9 u/kg

  • 40% basal at night of intermediate (nph protaphane) or long ( glargine) acting
  • 60% bolus divided by 3 meals of rapid (aspart) or short (actrapid) acting
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22
Q

Approach to treating hyperlipidaemia?

A
  1. Simvastatin 10mg (25% reduction)
  2. SimVa 20mg
  3. Change to Atorvastatin 40 mg if LDL > 3,5 (45% reduction)
  4. Atorva 80 mg
  5. Ezetemibe ( further 25% reductions )

6% statin rule: double dose only reduces by 6%

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23
Q

Targets in diabetes? (6)

A

ABCDES

  • a1c target < 7%, FBG 4 - 7, PPG <10
  • blood pressure < 140/90, < 130/80 if renal disease ( enalapril, amlodipine unless kidney / liver damage, hctz)
  • cholesterol: LDL < 1,8
  • drugs for CVD risk reduction
  • exercise + diet
  • smoking cessation, screen for complications
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24
Q

Clinical clue to DM 2?

A

Obese, older
Metabolic phenotype
Acanthoses nigricans !

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25
Q

Define exophthalmos

A

Hertel exophthalmometer reading ( measure distance lat orbital rims to apex of cornea) > 21 mm

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26
Q

Antibodies in hashimoto? (3)

A
  • Thyroglobulin antibodies
  • anti thyroid peroxidase antibodies (tpo ab)
  • tsh receptor antibodies
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27
Q

Antibodies in graves?

A

Tsh receptor antibodies
Also thyroid peroxidase and thyroglobulin antibodies

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28
Q

Name 4 autoimmune conditions associated with DM 1

A
  • Hyper+ hypo thyroid
  • celiac sprue
  • pernicious anaemia
  • adrenal insufficiency
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29
Q

Normal waist circumference?

A

Men < 94 cm
Women < 80cm

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30
Q

Define impaired glucose tolerance

A

OGTT 2 h glucose 7,8 - 11,1
But fasting < 7

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31
Q

Define impaired fasting glucose

A

Fasting 6,1 - 7

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32
Q

Define gestational diabetes

A

From 24 weeks of pregnancy

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33
Q

Treatment neuropathic pain in diabetic foot?

A
  • Tricyclics eg amitryptilline
  • pregabalin
  • duloxetine (SSNRI)
  • anti-epileptics eg carbamazepine, gabapentin
  • capsaicin
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34
Q

Treatment diabetic infected foot ulcer as outpatient?

A
  • Flucloxacillin 500mg 6 hourly po
  • amoxicillin - clavulanate 1g 12 hourly po

7-14 days

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35
Q

Treatment diabetic infected foot ulcer as inpatient with limb threatening infection? (2)

A
  • Amoxicillin-clavulanate 1,2g 8 hourly iv
  • piperacillin-tazobactam 4,5 g 8 hourly iv for pseudomonas

1-4 weeks

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36
Q

Treatment hyperthyroidism?

A

Carbimazole + bb

Rai (radioactive iodine) / surgery

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37
Q

Treatment thyroid storm? (5)

A
  • resuscitate: cooling blankets , fluid, electrolytes, vasopressors
  • carbimazole 40 - 60 mg 6 hourly until crisis controlled (inhibit synthesis thyroid hormone)
  • 30 mins after firSt dose: Lugol’s iodine 10 drops in milk 8 hourly (inhibits thyroid hormone)
  • beta blocker atenolol 50mg daily (decrease periph conversion T4 → T3 )
  • if life threatening: add iv hydrocortisone 100 mg 8 hourly
38
Q

What is myxedema coma?

A

Medical emergency.
Severe hypothyroid complicated by trauma, sepsis, cold exposure, mi, inadvertent admin of hypnotics or narcotics, stress

39
Q

Treatment myxedema coma (4)

A
  • Resuscitate+ admit to ICU
  • corticosteroids (hydrocortisone 100mg 8 h iv) for risk concomitant adrenal insufficiency
  • levothyroxine 0,2 - 0,5 mg iv loading dose, then 0,1 mg iv daily until oral therapy tolerated. Consider T3
  • monitor for arrhythmia!
40
Q

How and when screen for dm nephropathy?

A
  • Urine dipstick at every visit for gross proteinuria, min 4/ year
  • microalbuminuria albumin: creatinine ratio annually
  • start screening for microalbuminuria for type 1 5 years after diagnosis
  • screen for type 2 from diagnosis
41
Q

Name 5 neuropathies in diabetes

A
  • Distal symmetrical polyneuropathy
  • proximal symmetrical polyneuropathy
  • mononeuritis multiplex: 2 separate nerve areas asymmetrical
  • mononeuropathy eg carpal tunnel
  • Autonomic neuropathy
42
Q

Define Charcot’s foot

A

Neuropathic arthropathy
Collapse of arch of midfoot and bony prominences → deformities

43
Q

Fundoscopy findings in diabetic retinopathy? (3)

A
  • Non-proliferative: asymptomatic, microaneurysms, dot and blot flame haemorrhages, hard exudates
  • pre-proliferative: soft exudates, macular edema, cotton wool spots, venous beading
  • proliferative: neovascularisation, increased risk of vitreous haemorrhage + retinal detach
44
Q

Which 2 hormones are secreted by adrenal cortex

A
  • Cortisol
  • aldosterone
45
Q

Which 2 hormones are secreted by adrenal medulla

A
  • Dopamine
  • metanephrines
46
Q

Define adrenal insufficiency

A

Inadequate secretion adrenal cortex hormones

47
Q

Lab findings in primary adrenocortical insufficiency? (7)

A

= Addison’s disease

  • High ACTH
  • low cortisol → hypoglycaemic
  • low mineralocorticoid (aldosterone) → low sodium, high potassium

Also:

  • uraemia
  • high calcium (cortisol normally antagonises Vit D, so also high vit d. )
  • eosinophilia
  • Anaemia
  • plasma renin high
  • DHEA low in females ( → loss libido, hair loss)
48
Q

Define Addison’s disease

A

Primary adrenocortical insufficiency. Cortisol and aldosterone deficiency.

49
Q

Name 5 causes Addison’s disease

A
  • Autoimmune 80%! - poly glandular syndromes
  • infection: tb!, HIV + its opportunistic infections eg CMV, MAC.
  • malignancy: metastases or lymphoma
  • adrenal haemorrhage: Waterhouse - friederichsen syndrome, antiphospholipid syndrome
  • congenital: congenital adrenal hyperplasia
50
Q

Causes secondary adrenocortical insufficiency?

A
  • iatrogenic: long-term steroid then withdrawal. Most common
  • hypothalamic disease
  • pituitary disease
51
Q

Lab findings secondary adrenocortical insufficiency?

A
  • Low ACTH
  • low cortisol, aldosterone
52
Q

Symptoms adrenal insufficiency? (5)

A
  • Chronic fatigue, depression, weakness, psychosis
  • anorexia, weight loss (due to hypoglycaemia)
  • dizzy, fainting
  • myalgias, arthralgia
  • gi!: nausea vomiting, abdominal pain, diarrhea/constipation (think of Addisons in unexplained abdominal symptoms)
53
Q

Signs Addison’s? (8)

A
  • Hyperpigmentation (due to increased ACTH - cross-reacts with melanin receptors) at palmar creases + buccal mucosa
  • postural hypotension
  • androgens: loss libido, alopecia
  • dehydration: loss sodium and water from low aldosterone
  • Excess potassium
  • weight loss, mental changes, muscle weakness, vomiting
  • arrhythmia
  • hypoglycaemia

May have vitiligo

54
Q

Presentation addisonian crisis?

A

Precipitated by infection/trauma/ surgery

  • Shock: tachy, peripheral vasoconstriction, postural hypotension, oliguria, weak, confused, coma
  • hypoglycaemic
  • electrolytes: low na, high K and Ca
55
Q

Management adrenal crisis? (3)

A

Don’t delay treatment for lab results. Treat if suspected.

  • hydrocortisone 100 mg iv stat every 6 hours. Change to oral after 72h of improved
  • fluids: 5% dextrose in normal saline
  • antibiotics if suspect sepsis. Treat precipitant.
56
Q

Treatment adrenal insufficiency? (3)

A
  • 15 - 25 mg hydrocortisone daily in 2-3 divided doses. Avoid giving late in day (insomnia). Increase dose temporarily in stress situations
  • mineralocorticoid replacement if postural hypotension, low sodium, high potassium or high renin: fludrosortisone 0,05 - 0,2 mg daily.
  • adjust based on clinical response, not lab findings
  • consider androgen replacement for symptomatic female: DHEA 50 mg/day

If poor response to treatment, suspect associated autoimmune disease.

57
Q

Cushing syndrome vs disease?

A

Syndrome: chronic glucocorticoid excess, origin adrenal.
Disease: Bilateral adrenal hyperplasia due to ACTH secreting pituitary Adenoma

58
Q

Clinical triad of phaeochromocytoma?

A
  • Episodic headache
  • Diaphoresis (sweating)
  • tachycardia

With or without ht. (If all 4, > 90% probability)

Other symptoms: anxiety, tremor, pallor, visual changes (papilloedema, blurred vision), weight loss, polyuria, polydipsia, hyperglycaemia, arrhythmia, cardiomyopathy

59
Q

Rule of 10 for phaeochromocytoma?

A

10% extra-adrenal

10% Bilateral

10% familial

10% malignant

60
Q

Diagnosis phaeochromocytoma? (3)

A
  • 24 hour urine catecholamines and metanephrines and chromogranin A
  • clonidine suppression test: measures plasma catecholamines before and 3 hours after oral administration of 0,3 mg clonidine. Clonidine will fail to suppress in positive.
  • plasma free adrenaline and noradrenaline: if >2 -4 X ULN, do abdominal Ct or MRI to localise tumour (can also localise with mibg scan)
61
Q

Treatment phaeochromocytoma? (3)

A
  • Pre-op alpha blocker: phenoxybenzamine
  • then only beta blocker (atenolol) to avoid peripheral vasoconstriction and ht exacerbation with only beta blocker
  • to avoid crisis from unopposed alpha adrenergic stimulation during surgery ( HT crisis)
  • then surgery.
62
Q

Signs and symptoms acromegaly? (10)

A

Excessive soft tissue growth!

Symptoms

  • headache
  • excess sweating
  • arthralgia, oa, carpal tunnel syndrome
  • proximal muscle weakness

Signs

  • growth hands and feet: increase ring size, large shoe size, spade -like hands, thick heel pads
  • course facial features: prominent supraorbital ridge (frontal bossing), prognathism, wide spaced teeth, macroglosia
  • hoarse voice
  • obstructive sleep apnoea
  • organomegaly, including cardiomegaly with CCF
  • hyperprotectinaemia: gynaecomastia, galactorrhoea
  • hypogonadism
  • signs pituitary tumour: hypopituitarism.
63
Q

Diagnosis acromegaly? (3)

A
  • Screen: serum IGF - 1 (levels correlate with gh secretion in last 24h)
  • definitive: OGTT with serum growth hormone. Gh is usually suppressed by glucose so should be undetectable. += not suppressed
  • MRI pituitary
  • pituitary function: hyper prolactinaemia, hypogonad
64
Q

Treatment acromegaly? (4)

A

Surgical

  • trans-sphenoïdal resection first choice.

Medical (needed post-op to keep suppressed)

  • somatostatin analogues: ocreotice monthly IM, lanreotide
  • gh receptor antagonist: pegVisomant
  • Dopamine agonists eg bromocriptine but not as effective

Radiotherapy if failed treatment or contraindications.

65
Q

Diagnosis and investigation Cushing’s syndrome? (8)

A

First line screening

  • overnight dexamethasone suppression test: give dexamethasone 1 mg po at midnight. Check serum cortisol before and at 8 am. Failure to suppress cortisol =+
  • 24h urinary cortisol (normal < 280 nmol /24h)

Second line screening tests of one of above abnormal

  • 48 hour dexamethasone suppression test: give 0,6 mg/6h po, measure cortisol at 0 and 48h.
  • midnight cortisol: normal circadian rhythm (cortisol lowest at midnight, highest early morning) lost.

If above positive, do localisation tests

  • plasma ACTH

→ if undetectable, likely adrenal tumour → do Ct adrenal
> if no mass on Ct: adrenal vein sampling or adrenal scintigraphy (radiolabelled cholesterol ),

→ if detectable, do one of following to distinguish pituitary vs ectopic ACTH production
> high dose 48h dexamethasone suppression test: 2mg/6h. Suppression = pituitary cause. None = ectopic ; or
> corticotrophin releasing hormone test: 100 microgram CRH iv. Measure cortisol at 2h. Cortisol rise= pituitary. None = ectopic.

66
Q

Approach to cushings syndrome causes? (7)

A

ACTH dependent (increased ACTH) (85%)

  • Cushing’s disease: pituitary adenoma
  • ectopic ACTH production: small cell lung carcinoma, carcinoid tumours.
  • ectopic CRF (corticotrophin releasing factor): medullary thyroid carcinoma, prostate ca
  • iatrogenic: ACTH administration

ACTH independent (low ACTH )

  • iatrogenic: steroids
  • adrenal adenoma / carcinoma
  • adrenal modular hyperplasia
  • rare: mccune Albright syndrome, carney complex
67
Q

Treatment cushings? (6)

A

Depends on cause.

  • iatrogenic: stop medications
  • Cushing’s disease: trans-sphenoidal resection of pituitary adenoma. Bilateral adrenalectomy if source can’t be located or recurrence post-op. Pituitary radiotherapy is effective in children + used in adults to prevent Nelson’s syndrome (post- adrenalectomy development of locally aggressive pituitary tumour - corticotrophinoma - due to lack of -ve feedback)
  • adrenal adenoma: adrenalectomy
  • adrenal carcinoma: adrenalectomy followed by radiotherapy, adrenolytic drugs eg mitotane
  • ectopic ACTH: surgery if tumour can be located and hasn’t spread.

Medical treatment with ketoconazole or metyrapone (adrenal enzyme inhibitors) reduce cortisol secretion pre-op or while waiting for radiotherapy to become effective.

68
Q

Cause acromegaly?

A
  • 99% pituitary tumour → increased gh
  • rarely ectopic eg carcinoid syndrome
69
Q

Name 3 complications acromegaly

A
  • Gh suppress insulin → impaired glucose tolerance, dm
  • vascular: ht, lvh, cardiomyopathy, IHD, stroke (main cause death)
  • malignancy: colon polyps → colon ca.
70
Q

Which drugs should not be taken with levothyroxine

A

Preferably empty stomach 30 min before meals

Avoid taking with ppl + antacids, otherwise won’t absorb. Need acidic environment to absorb

71
Q

At what tsh level should subclinical hypothyroidism he treated

A

> 10

72
Q

Define conn’s syndrome

A

Hyperaldosteronism due to solitary aldosterone producing adenoma
Most common cause of hyperaldosteronism (then bilateral adrenocortical hyperplasia).

73
Q

Name 3 symptoms/signs conn’s syndrome.

A

Main cause of hyperaldosteronism.

  • Usually asymptomatic
  • hypokalaemia → weakness, cramps, paraesthesiae, polyuria, polydipsia
  • weight gain
  • hypertension
74
Q

When start patient with subclinical hypothyroidism on levothyroxine?

A

TSH > 10 mu/l

75
Q

Describe which eye symptoms all thyrotoxicosis vs only graves produces (6)

A

All cause: (due to potentiation of sympathetic innervation of levator palpebrae muscles)

  • lid retraction
  • lid lag

Only graves:

  • periorbital oedema
  • conjunctival irritation
  • exophthalmos
  • diploma
76
Q

Function aldosterone

A
  • Kidney reabsorb Na
  • excrete K
77
Q

Name 2 causes low uptake thyrotoxicosis

A
  • Transient thyroiditis!
  • extrathyroidal T4 source
78
Q

Name cause thyrotoxicosis with scintigraphy uptake in only 1 area

A

Toxic adenoma

79
Q

Name cause thyrotoxicosis with patchy, low scintigraphy uptake

A

Toxic multinodular yoitue

80
Q

Name cause thyrotoxicosis with diffuse scintigraphy uptake

A

Graves’ disease

81
Q

Which scoring system can be used for thyrotoxic crisis?

A

Burch - wartofsky

82
Q

Differential anterior neck swelling? (5)

A
  • goitre (moves with swallowing!)
  • lymphadenopathy
  • brAnchial cyst
  • dermoid cyst
  • thyroglossal duct cyst (move on protrusion of tongue)
83
Q

What will goitre ultrasound show in graves

A
  • Diffuse hypoechogenic (dark)
  • Doppler: increased thyroid blood flow
84
Q

Differential diffuse goitre? (9)

A

Hypothyroid

  • Hashimoto’s thyroiditis
  • iodine deficiency (endemic goitre)
  • Suppurative thyroïditis
  • transient thyroïditis
  • infiltrative: amyloidosis, sarcoidosis, Riedel’s thyroïditis

Hyperthyroid

  • graves

Other

  • drugs: iodine, amiodarone, lithium
  • simple goitre (no biochemical abnormality)
  • dyshormonogenesis
85
Q

Differential solitary thyroid nodule? (8)

A
  • Colloid cyst
  • hyperplastic nodule
  • follicular adenoma/ carcinoma
  • papillary carcinoma, (most common malignant tumour! )
  • medullary cell carcinoma
  • anaplastic carcinoma
  • lymphoma
  • metastasis
86
Q

Causes subacute (de Quervain’s) transient thyroiditis

A

After infection with coxsackie, mumps or adenovirus

87
Q

Treatment subacute (de Quervain’s) transient thyroiditis

A

NSAIDs
Temporary levothyroxone

88
Q

How does amiodarone affect thyroid

A

Hypothyroidism ( anti-arrythmic amiodarone contains lot of iodine + structurally similar to T 4)
OR
Hyperthyroid

89
Q

Usual treatment toxic multi nodular goitre?

A

Radioactive iodine

90
Q

Most common malignant thyroid tumour?

A

papillary carcinoma

91
Q

Diagnosis HHS (2)

A
  • Severe hyperglycaemia > 30
  • hyperosmolality >320

Internal Medicine (20 decks)

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