ENDOCRINE 4 Flashcards
hypothyroid values goitrous causes non goitrous causes self limiting causes ix rx when to check again
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
subclinical hypothyroid
secondary hyporthyyroid
increases TSH normal T3T4
normal/decreased TSH and decreased T3T4
hashimotos is what in who may be preceded by what risk of what where causes ix
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
congenital hypothyroidism if not treated by 4w leads to what
3m leads to what
symp
dx
irreversible neuro imp
cretinism
prolonged neonatal jaundice
heel prick
hyporparathyroidism levels
cause
symptoms
rx
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
psuedohypoparathyroidism symp
leves
what
decreased IQ, short, shortened 4th and 5th MCP
decreased calcium, increased phosphate/PTH
target cells insensitive to PTH
psuedopseudohypoparathyroidism
same PC but normal biochem
myxoedema coma in who mortality symptoms ECG and other ix treatment
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
hypocalcaemia causes
symp
hypoparathyroidism, vit D defic, CRF, mg défic
parasthesia, muscle cramos/weakness, fits, QT prolongation, chovestecks, trousseau, fatigue
vit D déficit causes
treatment
diet, malabsorption, CRF, lack of sunlight
CRF - titrate to PTH levels, phosphate and vin D supplements
osteomalacia levels
decreased vit D/ calcium/phosphate. increased alk phos/PTH
vit D resistant rickets (x linked) levels
increased vit D, decreased phosphate
acute hypocalcaemia
IV calcium gluconate 10mg 10% over 10 ,mins in 50mls saline/dextrose and ECG monitering
hyperthyroidism levels
cause
treatment
decreased TSH, increased T3/T4
graves, hyper functioning nodule/tumour, pit tumour, thyroiditis, ectopic production, exogenous intake, high iodine, amiodarone
carbimazole, BBs, radioiodine, surgery
subclinical hyper
decreased TSH, normal T3/T4
graves who cause symp ix treatment
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
toxic multi nodular who
levels
symptoms
treatment
elderly, insidious onset
decreased TSH, increased T3T4 ABs neg
assym goitre, high uptake on scintography
monitor, radiodine, surgery
de quirnivers thyroiditis is what triggered by what who symp phase 1 phase 2 phase 3 phase 4 ix treatment
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
thyroid storm cause
sympt
complications
treatment
withdrawal of drugs, infections, undx
hyperthermia, mental disturbance, hyperthyroid features
resp and heart arrest. exaggerated reflexes
fluids, BBs, anti thyroid drugs, steroids, moniter
hyperparathyroid primary levels
who
cayse
treatment
increased calcium/PTH decreased ophosphate
elderly females
adenoma, hyperplasia, carcinoma
high fluid intake, calcium, surgery
seoncdayr hyperparathyroid levels
what
treatemnt
decreased calcium, increased PTH
increased secretion of PTH due to decreased calcium due to kidney, liver or bowel disease
calcium and vit D supplements
tertiary hyperparathyroid is what
levels
autonomous sevcetrion of PTH due to CKD
increased PTH/calcium/alp phos
treatment of hyperparathyroid
parathyroidectomy <50 end organ damage calcium >2.85 GFR <60
acute symp of hypercalcaemia
chronic
causes
thirst, dehydration, confusion, polyuria
myopathy, osteopenia, fracture, depression, htn, abd pain
primary parathyroid/tertiary, drugs, malignancy, granulomatous, addiosn
hypercalcaemis of malignancy
increased calcium, increased alk phos
XR/CT/MRI
FHH
usually benign/asym
mild increased calcium. decreased urine calcium excretion
PTH slightly raised
acute hypercalcaemia
0.9% saline 3-4L in 24h loop diuretics once rehydrates calcitonin. bisphophonates steroids in sarcoid malig - chemo
