ENDOCRINE 4

Question 1

hypothyroid values 
goitrous causes 
non goitrous causes 
self limiting causes 
ix
rx
when to check again

Answer 1

increased TSH decreased T3/T4. low iodine intake
hashimotis, amiodarone
congenital, atrophic, post ablative/radio
post partum, subacute
increased LDH/PRL/CK, decrease NA
levothyroxine 50-100mcg in young, 25-50 in older and IHD
check TSH 2m after dose change

Question 2

subclinical hypothyroid

secondary hyporthyyroid

Answer 2

increases TSH normal T3T4

normal/decreased TSH and decreased T3T4

Question 3

hashimotos is what 
in who 
may be preceded by what 
risk of what where 
causes
ix

Answer 3

AI destruction of gland by CD 8 T cells
females 45-60s
transient thyrotoxicosis in acute phase 
lymphoma in affected gland 
genetic FH
painless goitre with rubber consistency and irregular surface, anti TPO and anti thyroglobulin ABs

Question 4

congenital hypothyroidism if not treated by 4w leads to what
3m leads to what
symp
dx

Answer 4

irreversible neuro imp
cretinism
prolonged neonatal jaundice
heel prick

Question 5

hyporparathyroidism levels
cause
symptoms
rx

Answer 5

decreased calcium, PTH, increased phosphate

post op , familial di george, mg défic, radiation

chovesteks, trousseaus, neuromuscular irritability, altered mental status, basal ganglia calcification, increased ICP, papilloedema, cataracts, prolonged QT

calcium and vit supplements, alfacalcidol, IV calcium if severe

Question 6

psuedohypoparathyroidism symp
leves
what

Answer 6

decreased IQ, short, shortened 4th and 5th MCP
decreased calcium, increased phosphate/PTH
target cells insensitive to PTH

Question 7

psuedopseudohypoparathyroidism

Answer 7

same PC but normal biochem

Question 8

myxoedema coma in who 
mortality 
symptoms 
ECG and other ix
treatment

Answer 8

elderly women with longstanding but undo hypothyroid

60%despite early recognition and treatment

LOC, seizures, hypothermia, hypothyroidism features
EG: brady, low voltage competes, HB, T wave inversion, prolonged QT
co existing adrenal failure in 10%

ABCDE. ICU. passively rewarm. ABs. thyroxine

Question 9

hypocalcaemia causes

symp

Answer 9

hypoparathyroidism, vit D defic, CRF, mg défic

parasthesia, muscle cramos/weakness, fits, QT prolongation, chovestecks, trousseau, fatigue

Question 10

vit D déficit causes

treatment

Answer 10

diet, malabsorption, CRF, lack of sunlight

CRF - titrate to PTH levels, phosphate and vin D supplements

Question 11

osteomalacia levels

Answer 11

decreased vit D/ calcium/phosphate. increased alk phos/PTH

Question 12

vit D resistant rickets (x linked) levels

Answer 12

increased vit D, decreased phosphate

Question 13

acute hypocalcaemia

Answer 13

IV calcium gluconate 10mg 10% over 10 ,mins in 50mls saline/dextrose and ECG monitering

Question 14

hyperthyroidism levels
cause
treatment

Answer 14

decreased TSH, increased T3/T4
graves, hyper functioning nodule/tumour, pit tumour, thyroiditis, ectopic production, exogenous intake, high iodine, amiodarone
carbimazole, BBs, radioiodine, surgery

Question 15

subclinical hyper

Answer 15

decreased TSH, normal T3/T4

Question 16

graves who 
cause
symp 
ix
treatment

Answer 16

females 20-40s

genetic, FH, smoking, viral trigger

diffuse enlargement of thyroid, lid retraction, lid lag, proptosis, diplopia, clubbing, pretibial myoexedema on shins

anti TPO, TSH receptor AB, anti thyroglobulin, smooth assym goitre, high uptake on scint

eyes-lubricants, stop smoking, decompression, surgery, radio
carbimazole reduce dose over 12-18months 50% resolve
BBs

Question 17

toxic multi nodular who
levels
symptoms
treatment

Answer 17

elderly, insidious onset
decreased TSH, increased T3T4 ABs neg
assym goitre, high uptake on scintography
monitor, radiodine, surgery

Question 18

de quirnivers thyroiditis is what triggered by what 
who 
symp
phase 1
phase 2
phase 3
phase 4
ix
treatment

Answer 18

painfull swelling of thyroid gland, viral infection

females 20-50s

pyrexia, pain in neck, viral symp

lasts 3-6 w - hyperthyroid
1-3w - euthyroid
weeks to months - hypothyroid
everything goes back to normal

globally reduced uptake on scintigraphy
BBs, painkillers, steroids if severe. SELF LIMITING

Question 19

thyroid storm cause
sympt
complications
treatment

Answer 19

withdrawal of drugs, infections, undx
hyperthermia, mental disturbance, hyperthyroid features
resp and heart arrest. exaggerated reflexes
fluids, BBs, anti thyroid drugs, steroids, moniter

Question 20

hyperparathyroid primary levels
who
cayse
treatment

Answer 20

increased calcium/PTH decreased ophosphate
elderly females
adenoma, hyperplasia, carcinoma
high fluid intake, calcium, surgery

Question 21

seoncdayr hyperparathyroid levels
what
treatemnt

Answer 21

decreased calcium, increased PTH
increased secretion of PTH due to decreased calcium due to kidney, liver or bowel disease
calcium and vit D supplements

Question 22

tertiary hyperparathyroid is what

levels

Answer 22

autonomous sevcetrion of PTH due to CKD

increased PTH/calcium/alp phos

Question 23

treatment of hyperparathyroid

Answer 23

parathyroidectomy 
<50
end organ damage 
calcium >2.85
GFR <60

Question 24

acute symp of hypercalcaemia
chronic
causes

Answer 24

thirst, dehydration, confusion, polyuria
myopathy, osteopenia, fracture, depression, htn, abd pain
primary parathyroid/tertiary, drugs, malignancy, granulomatous, addiosn

Question 25

hypercalcaemis of malignancy

Answer 25

increased calcium, increased alk phos

XR/CT/MRI

Question 26

FHH

Answer 26

usually benign/asym
mild increased calcium. decreased urine calcium excretion
PTH slightly raised

Question 27

acute hypercalcaemia

Answer 27

0.9% saline 3-4L in 24h
loop diuretics once rehydrates
calcitonin. bisphophonates 
steroids in sarcoid
malig - chemo