Endocrine Flashcards
MEN 1
Parathyroid, Pituitary adenoma, Pancreatic (insulin, gastrin, VIP)
MEN 2A
Parathyroid, Medullary thyroid Ca, Pheo
MEN 2B
Marfanoid, Medullary thryroid Ca, Pheo
Thyroid Storm Tx
- ABCs
- Supportive care
- Beta-blockers (careful with hemodynamic status!)
- E.g. Propranolol 60-80mg PO q4-6h
- PTU (usually 200 mg PO q4h) THEN 1 hr later
- Lugol’s iodine 10 drops q8h
- Glucocorticoids (often AI co-exists, also helps to reduce fT4 to fT3 conversion
TSH target during pregnancy
TSH <2.5
- Remember to if TSH >2.5 with positive TPO Ab—>Tx
if TSH 4.0-10 with negative TPO —>Consider Tx
If TSH >10 with negative TPO—> Defs Tx
Hypothyroidism in pregnancy, how much should synthroid dose be increased by?
20-30%, extra pill Saturday and Sunday.
Graves in pregnancy, what therapy should you use for first trimester? Beyond?
1st trimester= PTU
beyond=MMZ at lowest dose possible.
Indications for statin initiation with DM?
- Clinical CVD
- Age ≥ 40
- Age >30 and diabetes duration > 15 years
- Microvascular disease
- Other CV risk factors
If LDL not in target can use ezetimibe or evolocumab
Indications for ACE/ARB initiation with DM?
- Clinical CVD
- Age ≥ 55 with an additional CV risk factor or end organ damage (albuminuria, retinopathy, LVH)
- Microvascular disease
Define Primary Amenorrhea
- Absent menses at age 16
* Absent sexual characteristics at age 13
Define Secondary Amenorrhea
Definition: No cycles for >3 months in those with regular periods, or >6 months in those with irregular periods
PCOS diagnosis criteria
2 of:
• Menstrual irregularity
• Biochemical or clinical hyperandrogenism
• Ultrasound findings of polycystic ovaries
++ Symptoms, not very high prolactin = what effect?
++ Symptoms, not very high prolactin?
• Hook effect – lab peculiarity where very high levels of prolactin are read as low levels. If you dilute the sample, you can get a more accurate reading
++ Prolactin, not very many symptoms, caused by what phenomenon?
++ Prolactin, not very many symptoms
• Macroprolactin – a type of prolactin multimer which is biologically inactive. It can be in the serum in very high levels and cause no symptoms. It only sticks around because its clearance is slow.
High risk sonographic features of thyroid nodule?
– Hypoechoic
– Irregular margins – Microcalcifications – Taller than wide
– Extrathyroidal extension
– Interrupted rim calcifications – Lymphadenopathy
– >20% increase in 2 dimensions
Who needs Bx of thyroid nodule? (based on US features)
- High/Intermediate suspicion sonographic features:>1cm
- Low suspicion sonographic features:>1.5cm
- Could consider:Very low suspicion>2cm
- Do not biopsy:Purely cystic nodules
Diagnosis of DM (HgA1c, Fasting, 75 OGTT)
• Fasting glucose >= 7mmol/L • HbA1c >=6.5% • 2h 75g OGTT >=11.1 mmol/L • Random BG >=11.1 mmol/L (IFG: 6.1-6.9) (Pre diabetes: 6.0-6.4%)
Who needs FASTING lipid profile?
History of TG> 4.5 mmol/L
DIABETES
CKD
Lipid targets for treatment?
Target
LDL-C <2 mmol/L or >50% ↓ or
Non-HDL-C <2.6 mmol/L or
Apo B <0.8 g/L or
Note1: LDL>5 … 1o target is >50% ↓
Note2: If recent MI more aggressive consider target LDL <1.8 based upon IMPROVE-IT.
How does hypomagnesium affect the ability to correct hypocalcemia?
Magnesium deficiency reduces PTH secretion and causes PTH resistance. Therefore think of hypomagnesemia in someone with apparent hypoparathyroidism.
DDX for high RAIU (>25%) and low RAIU?
High= endogenous uptake (think PET SCAN). Therefore, Graves or toxic multinodular goiter Low= increased thyroid hormone but not increased production. ie. leak. Ex. Thyroiditis
What causes a falsely low RAIU? Ie. Graves disease but RAIU is low instead of high.
Ø CT scan (iodinated contrast)
Ø Amiodarone (iodine load)
Ø Iodine intake (e.g. kelp)
Should always use MMZ over PTU for treatment of hyperthyroidism (less hepatotoxicity). What are 3 instances that you would use PTU over MMZ?
Ø Pregnancy (risk of aplasia cutis & cleft palate)- Defs use PTU for T1, can switch to MMZ thereafter
Ø Thyroid storm
Ø Minor MMZ reactions (if severe, then shouldn’t use anti-thyroid drugs at all)
Sub-clinical hypothyroidism is defined at TSH up to 10 without changes to fT4. Treatment is indicated if TSH>10 or…
Ø Symptomatic
Ø Goiter
Ø Pregnant/pregnancy-planning
Ø Positive anti-TPO antibodies