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PANCE/EOC > Endocrine #3 > Flashcards

Endocrine #3 Flashcards

1
Q

What is a pheochromocytoma?

A

-Catecholamine secreting adrenal tumor (dopamine, norepinephrine, epinephrine)

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2
Q

True or False: 90% of pheochromocytoma are benign?

A

True

Only 10% are malignant

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3
Q

Triggers of a pheochromocytoma

A
  • Surgery
  • Exercise
  • Pregnancy
  • Medicaitons (TCA, opiates, histamine, glucagon)
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4
Q

Symptoms of a pheochromocytoma

A
  • Hypertension (most consistent finding)

- PHE: Palpitations, headache (MC), excessive sweating

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5
Q

Confirmation diagnostic for pheochromocytoma

A

-24 hour urinary fractionated catecholamines including metabolites (increased metanephrines and vanillylmandelic acid)

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6
Q

Preoperative management for pheochromocytoma

A
  • Nonselective alpha blockade (Phenoxybenazmine or Pehntolamine) for 1-2 weeks followed by beta-blockers to control BP
  • DO NOT INITIATE THERAPY WITH BETA-BLOCKADE
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7
Q

Definitive management for pheochromocytoma

A

-Complete adrenalectomy after 1-2 weeks of medical therapy

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8
Q

Iatrogenic hypothyroidism is often due to

A

Treatment for hyperthyroidism with radioactive iodine or surgery without subsequent thyroid hormone replacement

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9
Q

Three medications that cause iatrogenic hypothyroidism

A
  • Amiodarone
  • Alpha-Interferon
  • Lithium
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10
Q

What is cretinism?

A

Untreated congenital hypothyroidism

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11
Q

Etiologies of cretinism

A
  • Lack of maternal iodine intake in developing countries

- Dysgenesis of thyroid gland in developed countries

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12
Q

Symptoms of cretinism

A
  • Mental developmental delays
  • Short stature
  • Symptoms of hypothyroidism: cold intolerance, dry skin, constipation, weight gain, menorrhagia, weakness, lethargy
  • Goiter symptoms: hoarseness and dyspnea
  • Coarse facial features: macroglossia, hypotonia, umbilical hernia
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13
Q

Treatment for cretinism

A

Levothyroxine (synthetic T4)

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14
Q

What do labs for cretinism show?

A

Hypothyroidism labs: increased TSH and decreased free T3 and T4

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15
Q

MCC of hypothyroidism in the US

A

Hashimoto Thyroiditis

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16
Q

Pathophysiology of Hashimoto Thyroiditis

A

-Autoimmune thyroid cell destruction by anti-thyroid peroxidase an anti-thyroglobulin antibodies

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17
Q

Symptoms of Hashimoto Thyroiditis

A
  • Symptoms of hypothyroidism
  • Galactorrhea
  • Goiter
  • Bradycardia, loss of outer 1/3 of eyebrows
  • Myxedema (non pitting edema - periorbital or peripheral)
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18
Q

What antibodies are present in Hashimoto Thyroiditis?

A

-Antithyroid peroxidase and/or anti-thyroglobulin antibodies

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19
Q

Although a biopsy is rarely done for Hashimoto Thyroiditis, what is seen if it is done?

A

-Lymphocytic infiltration with germinal centers and Hurthle cells (enlarged epithelial cells)

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20
Q

Treatment for Hashimoto Thyroiditis

A

-Levothyroxine

21
Q

Levothyroxine is used first-line for Hashimoto and subclinical hypothyroidism with TSH _____ or greater

A

10 mIU/L or greater

22
Q

Levothyroxine has a half-life of

A

7 days

23
Q

What are the rules for monitoring with Levothyroxine?

A
  • Monitor TSH levels at 6-week intervals when initiating or changing dose
  • Increase dose if TSH is high and decrease dose if TSH is low
  • During pregnancy, the dose needs to be increased
24
Q

Adverse effects of Levothyroxine

A

-Overshoot can cause adverse cardiovascular effects and cause osteoporosis

25
Q

What is euthyroid sick syndrome?

A

Abnormal thyroid function tests in patients with normal thyroid function

26
Q

What lab is diagnostic for euthyroid sick syndrome?

A

Low T3 syndrome: decreased Free T3 and increased reverse T3 most common

27
Q

What is Reidel Thyroiditis?

A

-Chronic autoimmune thyroiditis characterized by dense fibrosis that invades the thyroid and adjacent neck structures

28
Q

Symptoms of Riedel Thyroiditis

A
  • Rock hard, nontender, rapidly growing fixed goiter
  • Airway compression
  • No cervical LAD
29
Q

What should be done to differentiate anaplastic thyroid carcinoma from Riedel Thyroiditis?

A

Open thyroid biopsy

30
Q

What other lab should be done for Riedel Thyroiditis?

A

IgG4 serum levels

31
Q

A myxedema coma is most commonly seen in

A

Elderly women with long-standing hypothyroidism during the winter

32
Q

Treatment for myxedema coma

A
  • IV Levothyroxine + supportive
  • Passive warming
  • IV Glucocorticoids
  • ICU admission
33
Q

What is subacute thyroiditis (DeQuervain Thyroiditis)?

A

-Often follows viral respiratory tracy infection or post-viral inflammation

34
Q

Presentation of a patient with subacute thyroiditis?

A
  • Hyperthyroidism is initial presentation
  • Followed by euthyroid
  • Then Hypothyroidism
  • Then resolution and restoration of normal thyroid function
35
Q

Symptoms of subacute thyroiditis

A
  • Painful thyroid gland, diffusely tender goiter

- URI symptoms: fever, malaise, myalgias, fatigue

36
Q

Diagnostics for subacute thyroiditis will show

A

High ESR + negative thyroid antibodies

37
Q

However, a biopsy will for subacute thyroiditis will show

A

-Granulomatous inflammation with multinucleate giant cells

38
Q

Treatment for subacute thyroiditis

A
  • Supportive

- NSAIDs or Aspirin for pain

39
Q

MCC of hyperthyroidism in the US

A

Graves Disease

40
Q

Although Graves Disease has symptoms of hyperthyroidism such as _______, what are some symptoms that are specific to Graves Disease?

A
  • Palpitations, heat intolerance, tremors, weight loss, atrial fibrillation
  • Graves: Ophthalmopathy: proptosis, exophthalmos, lid lag, diplopia & Pretibial Myxedema
  • Thyroid bruit
41
Q

Diagnostics for Graves Disease

A
  • Hyperthyroid profile: Low TSH and high T3/T4

- Thyroid stimulating immnoglobulins (TSH receptor antibodies) hallmark

42
Q

Treatment for Graves Thyroid Disease

A
  • Radioactive iodine: MC used

- Methimazole or PTU

43
Q

However, for ophthalmopathy what is the best treatment

A

Glucocorticoids

44
Q

Radioactive iodine is contraindicated in what people?

A

Pregnant and lactating women

45
Q

_____ is generally the preferred treatment for Graves Disease; however, _____ is preferred in the first trimester and for thyroid storm

A

Methimazole

PTU

46
Q

What is suppurative thyroiditis?

A

bacterial infection of the thyroid gland by Staph Aureus

47
Q

Symptoms of suppurative thyroidits

A
  • Thyroid pain and tenderness
  • Overlying erythema to the skin
  • Fever, chills, pharyngitis, dysphagia
48
Q

What diagnostic should be done if you suspect suppurative thyroiditis?

A

Fine needle aspiration with Gram Stain and culture

49
Q

The only two causes of a painful thyroid are ____ and _____

A

Subacute and Suppurative Thyroiditis

PANCE/EOC (63 decks)

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