Endocrine Flashcards
Anti-thyroid peroxidase antibodies raised in what? clinical presentation?
Hashimotos- often a goitre too
Very low tsh high T4?
Thyrotoxicosis (with symptoms)
High tsh normal T4
Poor compliance or sub clinical
Sick euthyroid results? And in who?
Low TSH low T4, Tsh May be normal however T3 particularly low often hospital inpatient
Secondary hypothyroidism?
Low tsh low t4
What can give falsely low hba1c?
Sickle cells
Thiazides can cause what electrolyte problem?
Hypercalcaemia, hypokalaemia and natraemia
Very low TSH, high T4 and painful goitre? Scan shows?
De quervains (subacute hyperthyroidism) Can follow viral illness often become hypo after a short while, globally reduced uptake on radioisotope scan
Very low TSH, high T4 painless goitre?
Graves’ disease
TSH, T3 and T4 low? Often following hospital
Sick euthyroid
Primary Hyperparathyroidism bloods?
PTH high normal or high, calcium high
Patient presents with high PTH and low Ca2+? Usual cause?
Secondary hyperparathyroidism usually CKD often low vit D also
Conn’s syndrome symptoms?
Hypokalaemia, Hypertension, polyuria, confusion/difficulty concentrating, lethargy
Symptoms of Addison’s disease?
Anorexia, weight loss, hyperpigmentation, fatigue, uncommonly salt craving, hypotension.
Bloods in Addison’s?
Hyperkalaemia, Hyponatraemia, can be elevated urea, sometimes anaemia.
Addisonian crisis and treatment?
Hyponatraemia, Hyperkalaemia, Hypoglycaemia, Hypotension, headache, fatigue, confusion vomiting. Hydrocortisone and saline with dextrose do not delay treatment for bloods (FBC, UE, LFT, glucose, cortisol ACTH) consider ECG for potassium
What differentiates graves from other hyperthyroid disease?
Eye signs, TSH antibodies and high uptake on radio scan
Bloods in Hypercalcaemia due to malignancy?
High calcium, Low phosphorous, appropriately low PTH
Hypercalcaemia symptoms?
Polydipsia, polyuria, nausea, confusion, constipation, bone pain.
Common hypoglycaemia symptoms?
Confused, sweating, hunger, tremor, drowsiness, hunger, anxiety
Type of addisons in people who were receiving steroids?
Secondary- and no pigmentation
TSH antibodies in what disease?
Graves’
Graves symptoms?
Tremor, palpitation, goitre, tachy, murmur, sweating, heat intolerance- eye signs
Hypothryroid symptoms?
Weakness, weight gain, cold intolerance, constipation, menstrual irregularity, brady, coarse hair, delayed relaxing of tendon reflex.
Most common cause of hypothyroidism western world?
Autoimmune, thyroid antiperoxidase antibodies
Graves’ treatment?
Carbimazole, steroids, beta blockers
Treatment of hypoglycaemia IV?
75ml or 20% glucose 150ml of 10% glucose
When would glucagon be inappropriate to use?
Liver disease, alcohol, malnourished
Symptoms of DKA?
Weight loss, confusion, dehydration, abdo pain, nausea, headache and vomiting, weakness, tachy, hypotension.
Low Ca2+ High PO4- Low or normal PTH
Primary hypoparathyroidism
Hypocalcaemia symptoms?
Diarrhoea, muscles twitches and cramps, numbness and tingling, poor memory or slowed thinking.
Toxic multinodular goitre scan?
Patchy uptake
Common infections and drugs that may cause DKA?
UTI and pneumonia thiazides, antipsychotics, steroids
In DKa when to introduce gucose again?
Introduction of 10% glucose is recommended when the blood glucose falls below 14.0mmol/L. It is important to continue 0.9% sodium chloride solution to correct circulatory volume
Rate of insulin in DKA?
Fixed 0.1 units/kg/hr
What should you do with SC insulin in DKA?
Continue as normal
When to replace potassium in DKA and how much?
After first litre of fluid providing the potassium is 3.5-5.5 not needed if >5.5 Give as 40mmol per additional litre of fluid
Along with fluids, insulin and potassium what else is given in DKA as per NICE?
LMWH
Aim for what HBa1c in type 1 diabetes?
48 or less
How many times a day to test blood glucose in type 1?
at least 4 before meals and before bed too
Diagnosis of type 1 diabetes random and fasting?
Random >11.1 or fasting >7 with symptoms
Differentiate between type 1 and 2 diabetes blood test?
C-peptide or GAD (90%) not measured routinely
Diagnose type 1 in who with hyperglycaemia?
ketosis rapid weight loss age of onset below 50 years BMI below 25 kg/m2 personal and/or family history of autoimmune disease
Diagnosis of diabetes based upon :
Diabetes symptoms + a random venous plasma glucose concentration ≥ 11.1 mmol/l or a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or
If no symptoms what do you need to do to diagnose diabetes?
Have two elevated readings
Type 2 diabetes educational program?
DESMOND
Recommended target HbA1c for type 2 managed by lifestyle and or metformin?
48mmol
If HbA1c not controlled below 48 on one drug and rises to 58 or more, new target?
53mmol and intensify antidiabetic treatment
When to stop metformin egfr?
<30ml
Course for type 1 diabetics?
DAFNE
What is shown why has it happened? Treatment?
Diabetic neuropathy causes unstable gait and bone deformity, can be casted
Statin therapy in type 1 diabetes?
All adults with type 1 diabetes who are aged over 40 years or have had diabetes for more than 10 years, or have established nephropathy or have other cardiovascular risk factors.
Ck in statin therapy with muscle pains?
Normal continue if tolerated give at night
>x10 upper limit is rhabdomyolysis
Target in cholesterol reduction?
Target should be a greater than 40% reduction in non-HDL cholesterol.
What endocrine condition is this associated with? What is it?
Thyroid acropachy, Graves’ disease
