Endocrine and Diabetes Flashcards
What is SIADH?
What are the symptoms and signs?
What are the levels?
Over production of ADH causing hypervoaemia and hypontremia
Symptoms -
- Nausea and vomiting
- Confusion
- Lethargy
- Delirium
- UMN signs due to cerebral swelling
Levels -
- Low serum osmolality
- Low serum sodium
- High urine osmolality
- High urine sodium
What are the common causes of SIADH?
Clasically SCLC
Also:
GI, genitourinary cancers
Drugs - Cipro, Carbamazepine
Pneumonia, asthma, TB
Neuro - meningitis, encephelatis, GBS, MS
What are the causes of hyponatremia?
What must you always check?
?Hypothyroid
?Addisons
What AI disease are linked together and what should you enquire about in a autoimmune patient?
DM
Thyroid disease
IBD
Asthma
What is subclinical hypothyroid and what increases the chances of it progressing?
Raised TSH, normal T3/T4
TPO antibodies or very high TSH
What is subclinical hyperthyroid?
How do you monitor
Low TSH and normal T3/T4
Do 6 monthly checks and monitor for other causes:
Pregnancy
Steroids
HPA insufficency
What is the most common thyroid cancer?
What is the investigation of choice?
Papillary thyroid carcinoma
Investigation - FNAB and CT/PET for ?mets - often to nodes and lungs
What is the management of thyroid cancer?
- Management - Curative is complete thyroidectomy and post operative iodine.
- Give lifelong thyroxine to supress TSH and this reduces recurrence.
- Monitor tumour marker thyroglobulin
- Can give stimulated thyroglobulin assessment with recombinant TSH to increases sensitivity of test
What is non thyroidal illness (Sick euthyroid)?
How do you manage?
This occurs in the context of illness and cauess widespread low thyroid enzymes.
Treat underlying cause - don’t give thyroxine
What is thyrotoxicosis?
What causes it?
This is the changes to the body that occur from having too much thyroid hormone.
It is not hyperthyroid in itself although can be caused by hyperthyroid.
Other causes:
- Amioderone
- Overtreatment with thyroxine
- Subacute (Dequervains) thyroiditis
- Ectopic thyroid tissue
What are the blood results for hyperthyroidism?
What are the symptoms?
What are the signs?
Primary - High t3/t4 and low TSH. Commonly Graves and Anti TSH
Secondary - High T3/T4 and high TSH
Symptoms:
- Hyperactivity, restlessness
- Palpatitions
- Sweating
- Diarrhoea
- Weight loss with no change in appetite
- Oligomennorrhea
- Heat intolerance
- Insomnia
Signs:
- Thyroid acropachy
- Pretibial myxodema
- Exopthalmos
- Lig lad
- Tachy/Hyper
- Brisk reflexes
- Tremor
- Hair loss
Muscle Wasting
Palmar erythema
Onycholosis
What is the treament of hyperthyroidism?
Medical - Carbamazepine, Propylthiouracil if child bearing age (NB agranulocytosis with Propylthiouracil)
Radioiodine - NB cant be around kids or become pregnany for 6 months and can cause hypothyroid
Surgery
What do you give for thyroid eye disease?
Prednisolone
What are the blood results for hypothyroidism?
What are the symptoms?
What are the signs?
What is the treatment?
Primary - Low T3/T4 high TSH - Commonly Hashimotos and Anti TPO
Secondary - Low T3/T4 low TSH
Symptoms:
- Tired, sluggish
- Cold extremities
- Fatigue
- Depression
- Menorrhagia
- Low visual acuity
- Hoarse voice
- Constipation
Signs:
- Ataxia
- Brady/hypo
- Macroglossia
- Periorbital puffiness
- Sparse hair
- Hyporeflexia
Treatment - Levothyroxine
What is congenital hypothyroidism?
What are the signs?
How is it managed?
an error in thyroid metabolism in neonates
Signs:
- Umbilical hernia
- Protruding tongue
- Jaundice
- Goitre
- Coase features - wide eyes, flat nose and protruding tongue
Treat with levythyroxine. if left untreated it can cause cretinism
What is the metformin treatment pathway?
This is when they can tolerate it
What is the non metformin treatment pathway?
when they cant tolerate it
