Endocrine 2

Question 1

Where are thyroid hormones stored?

Answer 1

Extracellularly for 2-3 months

Question 2

Hypothalamus secretes ___ which stimulates pituitary gland to secrete ___ which stimulates thyroid to secrete ___ and ____

Answer 2

TRH
TSH
T3/T4 can now turn off hypothalamus and pituitary

Question 3

percentages in pop with hypo or hyper thyroidism

Answer 3

80% have hypo. T3 and T4 are low. TSH is high.

20% have hyper T3 and T4 are high. TSH is low.

Question 4

1 cause of hypothyroidism in US and world.

Answer 4

US: Hashimotos 90-97%
World: Insufficient iodine intake

Question 5

Hypothyroidism ocular symptoms

Answer 5

1/3 of eyebrows missing (queen Ann’s sign)
Superior limbit keratoconj
Exophthalmos

Question 6

Symptoms of hashimotos

Answer 6

Myxedema- deposition of mucopolysaccharides. Causes edema.

Lethargy, cold intolerance, decrease ap, weight gain.

Question 7

Tx hashimotos with

Answer 7

levothyroxine / synthroid

Question 8

Main cause of hyperthryoidism

Answer 8

Graves autoimmune disease. 60-80%

Others: Goiter, excess iodine.

Question 9

What autoimmune disease is most commonly associated with TED

Answer 9

Graves

50% of graves pt’s develop TED

Question 10

Thyroid eye disease

Answer 10

Lymphocytic infiltration of orbital soft tissue.

Fibroblasts deposit mucopolysacharids and cause edema (myxedema) = enlarged EOMs.

Question 11

Most common cause of proptosis/diplopia in adults

Answer 11

TED.
Myxedema causing swelling/enlarged EOMs.
Could be unilateral or bilateral

Question 12

___% of graves pt’s develop TED

__% of TED patients have graves

Answer 12

50

85

Question 13

Is TED severity related to severity of systemic disease?

Answer 13

No

Question 14

Contraindications if pt has TED

Answer 14

smoking!

4x increased risk of TED

Question 15

Early and late signs of TED

Answer 15

Early- eyelid retraction (90%)

Late- exophthalmos (60%) and EOM restriction/diplopa (40%)

Question 16

TPO/thyroperioxidase

Answer 16

Enzyme that synthesizes T3/T4. May see TPO antibodies in both hashimotos and graves, although more common in hashimotos. (95%)

Question 17

Which thyroid disease would you see a TSH receptor antibody?

Answer 17

Graves (90%)

Question 18

Response to low serum calcium levels

Answer 18

Parathyroid secretes PTH to raise Calcium levels in the blood by increasing osteoclast activity and increasing calcium reabsorption

Question 19

Response to high serum calcium levels

Answer 19

Parafollicular cells in thyroid secrete calcitonin to lower serum calcium levels.
Calcitonin tones ur bones!

Question 20

75% of hypoparathyroidism is due to

Answer 20

Neck surgery

Question 21

Result of hypoparathyroidism

Answer 21

Hypocalcemia, increased phosphorus levels.
(PTH usually increases serum calcium levels. Without, will result in low calcium)

Causes muscle cramps and paresthesia.
Ocular: Cataracts

Decreased PTH, decreased calcium, increased phos

Question 22

85% of hyperparathyroidism is due to

Answer 22

Parathyroid adenoma.

Question 23

Result of hyperparathyroidism

Answer 23

Excess PTH secreted, resulting in an increased level of calcium in the blood. 
95% only involve 1 of 4 glands
Symptoms- 50-80% are asymptomatic 
Osteoporosis 
Kidney stones 

Will see increase in PTH, increase in calcium and decrease in phos

Ocular: Band keratopathy due to calcium build up
Conj concretions in palpebral conj

Question 24

Ocular results of hypo and hyperparathyroidism

Answer 24

Hypoparathyroidism- Decrease PTH = decrease calcium levels. Cataracts.

Hyperparathyroidism- Increase PTH= increase calcium levels. Band keratopathy and palpebral conj concretions.
*Most people are asymptomatic tho

Question 25

Vitamin D deficiency can result in what based off age

Answer 25

Rickets in children
Osteomalacia in adults
(Softening and weakening of bones)

Question 26

Pineal gland location

Answer 26

Posterior midbrain in the brainstem

produces melatonin

Question 27

Parinaud syndrome

Answer 27

Pineal gland tumor.
Upward gaze deficit - sunset
Dx with MRI
Due to pinealoma or hydrocephalus

Signs: Lid retraction, papilledema, nystagmus.

Question 28

Causes of parinaud syndrome/Dorsal midbrain syndrome.

Answer 28

Due to pinealoma or hydrocephalus (accumulation of CSF in the brain)

Question 29

Thyroid gland targets which cells in the body

Answer 29

All

Question 30

Thyroid gland regulates

Answer 30

The basal metabolic rate.

O2, body temp, gastric motility, HR

Question 31

Why do you get a goiter with hypo and hyperthyroidism?

Answer 31

Hypo- body trying to stimulate it

Hyper- due to overaction

Question 32

How to treat hyperthyroidism

Answer 32

Radioactive iodine= TOC

Question 33

Most common cause and symptoms of hypoparathyroidism and hyper

Answer 33

Hypo- neck surgery (80%), muscle cramps, numb limbs, brittle nails/hair.
Hyper-Parathyroid adenoma, asymptomatic