Endocrine

Question 1

Thyrotoxic storm sx

Answer 1

fever over 103, sweaty and heat intol, exophthalmos, HR over 140, hyperT then hypoT, a-fib/flutter, HF, n/v, agitation, tremor, audible bruit, psychosis, insomnia, stupor, coma, death w/i 48h

Question 2

Causes of thyrotoxic storm

Answer 2

Excess T3/4, thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion (Jod-Basedow Syndrome), excessive thyroid hormone replacement

Question 3

Graves storm patho

Answer 3

thyroid stimulating antibodies bind to receptors -> tell T4 to convert to T3 -> cause gland to enlarge -> negative feedback decreases TSH but the thyroid doesn’t listen

Question 4

Thyrotoxic storm meds

Answer 4

• Propranolol q6h
• PTU (prevent synth of T4-T3) q4h
• iodine after PTU
• Glucocorticoids q8h
• bile acid sequestrans to dec thy hor levels q6h

Question 5

glucocorticoids for thyrotoxic storm

Answer 5

• dec T3 and T4 conversion, promote vasomotor stability, may tx assoc adrenal insuff
• does not affect mort
• only for clear evidence of thy storm

Question 6

Bile acid sequestrant MOA

Answer 6

• interfere with enterohepatic circ (bile acid prod in liver to abs in sm int)
• thy hor metab in liver, released and reabs in intestines, excreted in bile

Question 7

rf for thyrtoxic storm

Answer 7

• Surgery, trauma, infection
• Long-standing untreated thyroid disease with precipitating event that may/may not involve thyroid
• Irregular or abrupt d/c of thyroid drugs
• fam hx, >40, F, white, meds (amiodarone), increased Iodine intake, preg (hormones similar to TSH)

Question 8

myxedema coma s/s

Answer 8

• Decreased mental status, hypotherm (predicts death), slow function of organs
• decreased mental status (coma)
• hypoT, bradycardia, hypogly, hypovent (resp acidosis)
• hypoNa: mental change, dilutional bc H2O excreted

Question 9

patho of myxedema coma

Answer 9

• Med emergency with high mortality rate, but uncommon due to earlier diagnosing capabilities
• severe long term hypothyroid

Question 10

when are meds begun for myxedema coma

Answer 10

ASAP w/o lab results

Question 11

Meds for myxedema coma

Answer 11

• T3 and T4 for slow bolus then daily (combo best)
• IV glucocorticoids until adrenal insuff fixed (q8h)
• supportive—ICU, IVF, electros, mech vent, gluc, hypotherm, treat underlying infx

Question 12

Priority for myxedema tx

Answer 12

hypotherm

Question 13

rf for myxedema

Answer 13

• Severe, long-term hypothyroid w/ precipitating event (infx, MI, extreme cold, surg)
• Sedatives like opioids

Question 14

Addisonian crisis sx

Answer 14

• sudden pain in lower back, abd, legs from hypoNa
• severe v/d, dehyd, hypoT, hyperK, hypoNa
• salt crave
• dec LOC, conf, slur

Question 15

Patho of addisonian crisi

Answer 15

sudden insuff of corticosteroids

Question 16

Meds for addisonian crisi

Answer 16

• IV hydrocortisone 100mg IV bolus then 50mg q6h (taper to maintenance and PO when able)
• 1-3L NS and 5% dextrose for energy

Question 17

rf for Addisonian crisi

Answer 17

Primary adrenal insuff

Question 18

Hashimoto’s patho

Answer 18

antibodies attack thyroid;
thyroid receptor antibodies, antithyroglobulin antibody
- Hallmark of disorder: antithyroperoxidase antibody