Endocrine Diagnosis and Treatment Flashcards
Diagnosis of pregnancy induced hyperthyroidism
High TBG
T3 uptake will decrease (by resin)
radionucleotide uptake of plummer’s disease (multinodular toxic goiter)
Decreased TSH
Patchy uptake
Atrophy of thyroid gland
Radionucleatide uptake of toxic thyroid adenoma
Atrophy of rest of thyroid
Low TSH
increased uptake in one area
Treatment of hyperthyroidism
Immediate control: B blockers
sodium ipodate or iopanoic acid if don’t respond to conventional therapy
Non pregnant:start metimazole
Taper B blocker after 4-8 weeks
Continue methimazole for 1-2 years then measure TBG IgG Ab at 12 months if absent can discontinue therapy, 1 more year of therapy if present
Pregnant: Endocrinology consult
PTU preferred
Elderly, solitary nodule, antithyroid therapy fails: radioactive iodine ablation therapy
Thyroidectomy: reserved for large goiters, allergic to antithyroid drugs or if they prefer surgery
Treatment of Thyroid storm
IV fluids, cooling blankets, and glucose
PTU every 2 hours followed by iodine to inhibit thyroid hormone release
B blockers for HR
Dexmethasone impairs T4 to T3 conversion and provides adrenal support
Diagnosis of Graves Disease
IgG binds to TSH receptors
Thyroid bruit
Low TSH level-initial test of choice
Next order-T4 level
Radioactive T3 uptake: (give radioactive T3 with resin testing to see if TBG is “filled” and uptake by resin)
Diffuse uptake of radioactive T3
Diagnosis and treatment of Hashimotos (chornic lymphocytic thyroiditis)
Goiter is rubbery, nontender and nodular
High TSH
Low free T4
Decreased/ irregular uptake of radionucleotide iodine-
Increased antimicrosomal Abs, antiperoxidase, antithyroglobulin Abs
Elevated LDL and decreased HDL, hypertriglyceridemia, increased AST and ALT, increased creatinine kinase
Treatment: levothyroxine
Anemia: nomracytic
Treatment and diagnosis of sublclincal hypothyroidism
TSH elevated with normal T4 level
Elevated LDL levels
Treat with thyroxine if: patient develops goiter, hypercholesterolemia, symptoms of hypthyroidism, or significantly elevated TSH level
Treatment and Diagnosis of subacute (viral) thyroiditis
Assoiciated with HLA;B35
painful, tender thyroid gland
Radioiodine uptake is low
Low TSH (transient hyperthyroid state)
High ESR
Treatment: NSAIDs and aspirin for mild symptoms
Corticosteroids for more severe pain
Most recover within a few months to one year
Treatment and diagnosis of subacute lymphocytic thyroiditis
Transient thyrotoxic phase of 2 to 5 months followed by hypothyroid phase
Low radioactive iodine uptake-differentiates it from Graves’ disease
no pain or tenderness of thyroid gland
Pituitary adenoma diagnosis and treatment
Can release GH, prolactin, ACTH and TSH
Diagnosis: MRI, horomone levels
Treatment: transsphenoidal surgery (except prolactinomas)
Radiation therapy and medical therapy adjunct
Hyperprolactinemia diagnosis and treatment
Prolactinoma, psychiatric medications, H2 blockers, metoclopramide, verapamil, estrogen, pregnancy, hypothyroidism
Diagnosis: elevated serum prolactin level
order a pregnancy test and TSH level
CT scan or MRI to identify mass lesions
Treatment: bromocriptine or cabergoline for 2 years
transesphenoidal surgery if non responsive (recurrence is high)
Acromegaly diagnosis and treatment
Diagnosis: IGF-1 (somatomedin C) elevated
Oral glucose suppression test-glucose fails to suppress GH (as it should in healthy individuals)
MRI of pituitary
Hyperprolactinemia, hyperglycemia, hypertriglyceridemia, and hyperphosphatemia may be seen
Treatment:
Transspenoidal resection of pituitary adenoma-treatment of choice
radiation thearpy if IGF-1 remain elevated
Octreotide to suppress GH secretion
Hypopituitarism causes, diagnosis and treatment
causes: radiation therapy, sheehans syndrome, infiltrative processses-sarcoidosis, hemochromatosis, head trauma, caernous sinus thrombosis, surgery
Diagnosis: low levels of target hormones with normal trophic hormones
MRI of the brain
Treatment: replacement of hormones
if want to conceive refer to endocrinologist
Central Diabetes insipidus causes, diagnosis and treatment
Causes:
idiopathic, trauma, sarcoidosis, Tb, syphilis, encephaltiis
Diagnosis: colorless urine, thirst and polydipsia, polyuria, hypernatremia
Low urine specific gravity, low osmolality
Plasma osmolality: 280-310
Low ADH level
water deprivation test: no increase in urine osmalality above 280 mOsm/kg after 24 dehydration
Increase in urine osmolality after ADH given
Treatment: Desmopressin
Chlorpropamide increases ADH secretion