Endocrine

Question 1

What is diabetes mellitus caused by?

Answer 1

lack or reduced effectiveness of endogenous insulin - hyperglycaemia

Question 2

Describe the aetiology of diabetes

Answer 2

Reduced insulin secretion and insulin resistance due to:
drugs - steroids, anti-osychotics, thizaides

pancreatic - surgery, trauma, ca,

hormonal - Cushing’s, acromegaly, PCC, hyperthyroidism

congenital lipodystrophy and glycogen storage disease

Question 3

What are the symptoms of hyperglycaemia?

Answer 3

polyuria
polydipsia
unexplained weight loss
visual blurring 
genital thrush
lethargy

Question 4

Describe the pathophysiology of diabetes?

Answer 4

Increased carb intake
increased hepatic glucose production
decreased insulin secretion and decreased peripheral glucose uptake

all lead to increased blood glucose

Question 5

What are the risk factors of diabetes?

Answer 5

obesity
lack of exercise
calorie and alcohol excess
genetics

Question 6

What investigations are done for diabetes?

Answer 6

venous glucose - fasting >7mmol/l or random >11mmol/L

HBA1c >48 mmol/L –> 6.5%

Question 7

What is the first line treatment for type 2 diabetes?

Answer 7

Metformin

Question 8

What is the second line treatment for diabetes?

Answer 8

Sulphonylurea

Question 9

What is the third line treatment for diabetes?

Answer 9

basal insulin or pre mix insulin

Question 10

What is the fourth line treatment

Answer 10

Basal and meal time insulin

Question 11

What is the classic cause of the diffuse goitre?

Answer 11

Grave’s disease

Question 12

Describe the epidemiology of Grave’s disease?

Answer 12

Female: Male - 9:1

typical age - 40-60 years old

Question 13

What is the cause of Grave’s disease?

Answer 13

circulating igG autoantibodies (thyroid stimulating immunoglobulins TSI) bind to and activate G-protein coupled TSH receptors which cause smooth thyroid enlargement and increased hormone production

Question 14

What are the triggers for Graves’ disease?

Answer 14

Stress
infection
childbirth

Question 15

What are the signs of Graves disease?

Answer 15

eye disease (exophthalmos, ophthalmoplegia, pretibial myxoedema, thyroid acropachy (clubbing, painful finger and toe swelling periosteal reaction, goitre

Question 16

What is a toxic adenoma?

Answer 16

a solitary nodule producing T3 and T4

On isotope scan, the nodule is hot and the rest of the gland is suppressed

Question 17

Who gets a toxic multi-nodular goitre?

Answer 17

Elderly
iodine deficient areas
nodules that secrete thyroid hormones

Question 18

What other forms of hyperthyroidism are there?

Answer 18

thyroiditis - thyrotoxicosis without hyperthyroid

excess exogenous thyroid hormone

drug induced (amiodarone, lithium)

TSH-secreting pituitary tumour

Question 19

What are the causes of hypothyroidism?

Answer 19

Primary atrophic hypothyroidism

Post-thyroidectomy

Post radioactive iodine

Hashimoto’s thyroiditis

Question 20

What is Hashimoto’s hypothyroidism?

Answer 20

Primary autoimmune hypothyroidism

autoantibody titres are very high (against TOP) - enzyme that oxidises iodine to be incorporated into thyroid hormones

Question 21

What are the signs and symptoms of hyperthyroidism

Answer 21

Diarrhoea
weight loss
increased appetite 
sweats
heat intolerance
palpitations 
tremor 
irritability 
labile emotions 
oligomenorrhoea +/- infertility 

pulse fast 
warm, moist skin
palmar erythema 
thin hair 
lid lag 
exophthalmos

Question 22

What are the symptoms and signs of hypothyroidism?

Answer 22

tired and lethargic 
decreased mood
cold intolerant
weight gain
constipation
menorrhagia
hoarse voice
memory or cognition decreased
dementia
myalgia
cramps weakness

Question 23

What are the examination findings of hypothyroidism?

Answer 23

bradycardia
reflexes relax slowly
ataxia 
dry, thin hair/skin
yawning/drowsy
cold hands/decreased temperature 
ascites +/- non-pitting oedema 
round puffy face/double chin/obese 
defeated demeanor
immobile 
CCF

Question 24

What investigations can be done for hyperthyroidism?

Answer 24

TFT: <0.01mIU/L TSH in hyperthyroid

if TSH normal, diagnosis excluded

Free T3/T4 is elevated

If TSH low but free T3/T4 normal = subclinical hyperthyroidism

Question 25

What investigations can be done for hypothyroidism?

Answer 25

Increased TSH >5mIU/L, decreased T4 - clinical hypothyroidism

increased TSH, normal T4 –> subclinical hypothyroidism

Question 26

What is the Tx for hyperthyroidism?

Answer 26

In primary care: propanolol

Antithyroid drugs: carbimazole

RAI therapy

Surgery

Question 27

What are used for symptomatic relief of hyperthyroidism?

Answer 27

Beta blockers

Question 28

What is the tx of hypothyroidism?

Answer 28

levothyroxine - 25-50mcg daily and titrate up every 3-6 weeks