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PANCE/EOC > Endocrine #4 > Flashcards

Endocrine #4 Flashcards

1
Q

Clinical manifestations of thyrotoxic crisis (thyroid storm)

A
  • Cardiovascular dysfunction (palpitations, tachycardia, A-fib, CHF)
  • High fever
  • CNS dysfunction (agitation, delirium, psychosis, coma)
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2
Q

Labs for thyrotoxic crisis

A

Primary hyperthyroid profile: increased free T3 and T4, decreased TSH

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3
Q

Management of Thyrotoxic Crisis

A

-IVF + Propanolol + antithyroid medication (PTU) + IV Glucocorticoids

  • Then, oral or IV sodium iodide
  • Cooling blankets
  • Avoid Aspirin because it can displace thyroid hormones off carrier proteins
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4
Q

MC thyroid cancer

A

Papillary thyroid carcinoma

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5
Q

Risk factors for papillary thyroid cancer

A
  • Radiation exposure of head and neck

- Family history of thyroid cancer

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6
Q

Workup if you think the patient may have thyroid cancer

A

Fine needle aspiration

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7
Q

Treatment of papillary thyroid carcinoma

A

-Thyroidectomy followed by postoperative Levothyroxine

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8
Q

What is the unique thing about follicular thyroid carcinoma?

A

Distant METS are more common than local METS (hematogenous spread)

-Lung, liver, brain, bone

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9
Q

Medullary thyroid carcinoma pathophysiology

A

-Derived from Calcitonin-synthesizing parafollicular cells

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10
Q

What gene mutations are associated with medullary thyroid carcinoma?

A

MENIIa and MENIIb (associated with RET mutation)

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11
Q

What do labs show for medullary thyroid carcinoma?

A

Increased calcitonin

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12
Q

Anaplastic thyroid carcinoma is the most aggressive of all thyroid cancers. What are some symptoms of this type of cancer?

A
  • Rapid growth, compressive symptoms

- Rock hard thyroid mass

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13
Q

What is the management of anaplastic thyroid carcinoma?

A
  • Most not amenable to surgical resection

- Palliative tracheostomy may be needed to maintain airway

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14
Q

What is the most common type of benign thyroid nodule

A

-Follicular adenoma

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15
Q

What are some physical exam findings of a thyroid nodule that is malignant?

A
  • Rapid growth
  • Fixed in place
  • No movement with swallowing
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16
Q

Workup for a thyroid nodule

A
  • Thyroid function testing
  • -If hyperthyroid, order radioactive iodine uptake scan (thyroid scintigraphy)
  • -TSH normal or high, FNA with biopsy
  • Thyroid US to determine if FNA with biopsy indicated
  • FNA guided by US
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17
Q

With a radioactive iodine uptake scan, explain what cold or warm nodule means

A

Cold (no or low iodine uptake): rule out malignancy

Hot (normal) have lower malignancy potential

18
Q

If thyroid cancer suspected, what is the treatment?

A

Surgical excision if cancer suspected, cold nodule, or indeterminate FNA

19
Q

90% of cases of hypercalcemia are due to

A

primary hyperparathyroidism or malignancy

20
Q

Other causes of hypercalcemia

A
  • Thiazide diuretics
  • Sarcoidosis
  • Vitamin D and A intoxication
21
Q

Symptoms of hypercalcemia

A

Stones (nephrolithiasis)
Bones (bone pain and fractures)
Abdominal Groans (ileus, constipation)
Psychiatric Moans (depression, anxiety)

Hypertension
Increased DTRs

22
Q

What does an ECG on hypercalcemia show?

A

Shortened QT interval, prolonged PR interval, QRS widening

23
Q

Management of mild hypercalcemia (< 12 mg/dL)

A

No immediate treatment needed

-Treat underlying cause and increase water intake (promotes calcium excretion)

24
Q

Labs for hypercalcemia

A
  • Ionized serum calcium more accurate than total serum calcium
  • Intact PTH: once hypercalcemia is confirmed to rule out primary hyperPTH
  • PTH-related protein: to rule out malignancy
25
Q

Management of moderate (12-14 mg/dL) hypercalcemia

A

IVF initial management of choice
IV loop diuretics (Furosemide) to promote excretion
Bisphosphonates with Calcitonin in malignancy

26
Q

MCC overall of hypocalcemia

A

Hypoparathyroidism: destruction or removal of parathyroid gland during neck surgery

27
Q

Other etiologies of hypocalcemia

A
  • Chronic renal disease
  • Vitamin D deficiency (osteomalacia or Rickets)
  • Hypomagnesemia
  • Diuretics, Bisphosphonates
28
Q

Symptoms of hypocalcemia

A
  • Increased muscular contractions: decreases excitation threshold
  • Muscle cramps, bronchospasm, circumoral paresthesias, Tetany
  • Chvostek Sign: facial spasm with tapping of facial nerve
  • Trousseau Sign: inflation of BP cuff above systolic causes carpal spasm
  • Increased DTR and seizures
29
Q

ECG for hypocalcemia shows

A

Prolonged QT interval

30
Q

Treatment for hypocalcemia

A
  • Mild: oral calcium + Vitamin D

- Severe or Symptomatic: IV calcium gluconate

31
Q

Causes of primary hyperparathyroidism

A
  • Parathyroid adenoma
  • Lithium
  • Men I and IIa
32
Q

What triad is associated with primary hyperparathyroidism

A

Hypercalcemia + Increased intact PTH + decreased phosphate

-Also increased 24 hour urinary calcium excretion

33
Q

Definitive management for primary hyperparathyroidism

A

Parathyroidectomy

-Vitamin D and calcium supplement afterwards

34
Q

What medication inhibits release of PTH in patients that are not surgical candidates with primary hyperparathyroidism?

A

Cinacalcet

35
Q

2 MCC of hypoparathyroidism

A

Post neck surgery

Autoimmune destruction of parathyroid gland

36
Q

With hypoparathyroidism, what symptoms are present?

A

-Signs of hypocalcemia: increased muscle contractions

37
Q

What triad is present in hypoparathyroidism?

A

-Hypocalcemia + decreased intact PTH + increased phosphate

38
Q

Treatment for hypoparathyroidism

A

-Calcium supplementation + activated Vitamin D (Calcitriol)

39
Q

Symptoms of growth hormone deficiency

A

Children or infants: short stature, dwarfism, fasting hypoglycemia
Adults: dyslipidemia, decreased CO, impaired concentration

40
Q

Diagnostics for GH deficiency

A

-Arginine and sleep stimulation test: no change in GH release if hypopituitarism

PANCE/EOC (63 decks)

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