Endocrine Flashcards
Hypothyroid: Hashimotos Thyroiditis
- increased risk of Non Hodgkins Lymphoma (if suspected Large needle biopsy)
- moderately enlarged non tender thyroid
- may be hyperthyroid prior to hypothyroid
- ***Antimicrosomal antibodies- (Anti-TPO) **
Hypothyroid: Subacute Thyroiditis
- self limited following flu like illness/viral illness
- findings: elevated ESR, jaw pain and very tender thyroid.
- due to release of preformed hormones (low radioiodine uptake) therefore antithyroid drugs will not work
- Raiu is low, t4 high, TSH low
- Tx: NSAIDS and Bblockers
Hyperthyroid: Graves
- autoimmune hyperthyroidism with thyroid stimulation TSH receptor antibodies
- findings: enlarged smooth non tender thyroid,
- increased radioiodine uptake
- Tx: radioactive iodine ablasion
if opthalmoplegias then pretreat with glucocorticoids to prevent worsening
in pregnancy use PTU (1st Trimester) Methimazole (2nd Trimester)
Hyperthyroid: Thyroid Storm
- stress induced catecholamine surge
- dx is clinically made
- glucocorticoids decrease T4–>T3 transition
- Other TOC: methimazole, PTU, propanolol
Hypothyroid: Postpartum
- painless
- release of preformed thyroid hormone
- decrease radioactive uptake of thyroid hormone
- may have positive Anti TPO antibodies
Thyroid Cancer: Papillary
- MC and excellent prognosis
- Tx: total thyroidectomy + radioactive iodine uptake followed by total body imaging to check for uptake
- levothyroxine is used to suppress TSH to below normal levels
Thyroid Cancer: Follicular
- good prognosis, slow progressing and palpable nodules
Thyroid Cancer: Medullary
- from parafollicular c-cells which produce calcitonin,
- Associated with MEN2 (link with pheo therefore measure metanephrine)
- associated with RET protooncogene
Thyroid Cancer: lymphoma
- RF is Hashimotos
- rapid enlargement is seen
- Pemberton Sign: presence of facial plethora or neck vein distention when arms are raised which confirms enlarged thyroid gland as cause of eosphageal obstructive symptoms.
Pheochromocytoma:
- associated with MEN 2 and medullary thyroid cancer
- look for urine metanephrine
- tx with phenoxybenzamine (alpha blocker) for 10-14 days prior to surgery
- also encourage increase intravascular compartment
- hypotension during surgery is common and responds to NS bolus followed by NS infusion
MEN II:
- RET proto-oncogene mutation
* ** medullary thyroid cancer, pheochromocytoma, hyperparathyroidism***
MEN I:
- hyperparathyroidism, gastrinoma, pituitary tumor**
- mutation of tumor suppressive Menin I
- gastrinoma (zollinger ellison)
tx: parathyroidectomy (3.5 glands)
Hyperparathyroid: Primary
Primary hyperparathyroid: adenoma, hyperplasia at level of paraythyroid hormone
- moans, groans and stones ( kidney stones, constipation and bone pain)
- inc. Ca, dec. Phosp, Inc. PTH
- indications for surgery: Symptomatic patient, asymp and ca>1 over upper limit of normal, Cr<2.5.
Hyperparathyroid: Secondary
Secondary Hyperparathyroidism: due to chronic hypercalcemia, kidney dysfunction, vitamin D deficiency
Hypercalcemia
Causes: 1. primary Hyperparathyroid 2. Malignancy (PTHrP)(generally very high Ca levels) 3. Vitamin D induced
Parathyroid Dependant: prim or tert hyperparathyroid, lithium dep, famil hypocalc, hypercalce.
Parathyroid Independant: maligna, vit D tox, granulom disease, milk alkali syndrome
