Endocrine

Question 1

AE of PTU/Methimazole

Answer 1

Agranulocytosis, Methimazole: 1st trimester tertogen, cholestatis
PTU: HEPATIC fail, ANCA vasculitis

Question 2

AE of radioactive iodine ablation

Answer 2

permanent hypothyroidism
worsening of exopthalmos/optho effects
radiation side effects

Question 3

Conn’s Syndrome

Answer 3

primary hyperaldosteronism
adrenal adenoma or bilateral CAH
hypertension, hypokalemia, metabolic alkalosis -
aldosterone increases Na absp, K secretion and Bicarb secretion

Question 4

Causes of hypercalcemia with low PTH

Answer 4

Malignancy
vit D toxicity
HCTZ/Theophylline - drug induced
thyroidtoxicosis, vitamin A toxicity
immobilization
miscellaneous - adrenal insufficiency , pheo, acromegaly

Question 5

hypercalcemia with elevated PTH causes

Answer 5

primary or tertiary hyperparathyroidism
familial
lithium induced

Question 6

MEN 1

Answer 6

primary hyperparathyroidism
pituitary
pancreatic tumors

Question 7

MEN 2A

Answer 7

RET- onco gene
FAMILY HISTORY
primary hyperparathyroid (hyper Ca)
medullary thyroid (anxious,  headache, palpitations) 
Pheo (HTN, papilledema, headaches)

Question 8

MEN 2B

Answer 8

MTC
Pheo
Marfan habitus
mucosal and intestinal neuroma

Question 9

Graves Disease pathophysiology

Answer 9

TSH stimulating IgG antibodies

• bind to receptors of TSH on the thyroid, cause synthesis of excess thyroid
• DIFFUSE uptake on radioiodine scan

Question 10

Multinodular toxic goiter aka Plummer Disease

Answer 10

hyperfunctioning of discrete areas
increased T4/t3, low TSH
patchy uptake on scan

Question 11

Subacute thyroiditis

Answer 11

causes transient hyperthyroidism

Question 12

diffusely enlarged thyroid gland, bruit, non tender, symmetric enlargement

Answer 12

graves disease

Question 13

tender thyroid, diffusely enlarged, viral illness

Answer 13

subacute thyroiditis

Question 14

bumpy, irregular thyroid, asymmetric

Answer 14

Hashimoto or multinodular toxic goiter

Question 15

Diagnostic w/u for hyperthyrid

Answer 15

1. TSH - high/normal - unlikely hyperthyroid
2. T4 - should be elevated in hyperthyroid
3. Radioactive iodine uptake - shows that T3 is bound to TBG. this shows true hyperthyroid
   - high TBG, consider pregnancy

Question 16

PTU mechanism of action

Answer 16

inihibits conversion of t4–> t3

Question 17

Hyperthyroid treatment

Answer 17

1. Bblocker for symptom
2. Methimazole
   - taper Bb
   - continue methimazole 1-2 years, measure TSH igG at 12 months

Question 18

hyperthyroid treatment for pregnant patients

Answer 18

PTU preferred

Question 19

Indications for 131 I

Answer 19

elderly patient w graves
solitary toxic nodule
patients with graves in which PTU/methimazole fails aka relapse or agranulocytosis

Question 20

Thyroid Storm

Answer 20

post infection, stress, DKA, trauma etc

• medical emergency
• tX; IV fluids, cooling blankets, glucose, PTU q 2 hours and bblockers
• give dexamethasone as well to prevent peropheral thyroid conversion

Question 21

3 causes of hypothyroid

Answer 21

1. Hashimoto aka chronic thyroiditis
2. Iatrogenic from hyperT treatment
3. Secondary hypothyroid - low TSH, low T4/3

Question 22

Lab findings in hypothyroid

Answer 22

High TSH, low T4 - primary
low TSG, low t4 - secondary
increased antimicrosomal antibodies - Hashimotos

Question 23

low radioactive iodine uptake, painful tender thyroid, hyperthyroid symptoms, post stress/illness

Answer 23

Subacute viral thyroiditis

131 I uptake is low because follicular cells are damaged – differentiates from graves!

Question 24

lab findings in subacute thyroiditis

Answer 24

low TSH, increased T4/3, high ESR

Question 25

subacute thyroiditis treatment

Answer 25

NSAID and ASA fo r mild sx
corticosteroids if pain is severe
recovery of function within 1 year is typical