Endocrine Diseases

Question 1

What are surrogate markers for hypothyroidism

Answer 1

• high CPK
• high LDL
• high triglycerides
• proteinuria
• normocytic anemia

Question 2

Starting dose of levothyroxine

• young
• elderly

Answer 2

young: 1.6 mcg/kg/day
elderly: 1.0-1.25 mcg/kg/day

Question 3

If TSH is therapeutic but pt not feeling well what should be considered?

Answer 3

• adjust tx until TSH < 2.5
• pt may have problems with conversion of T4 to T3
• exposures and nutrient deficiencies: heavy metals, iodine deficiency, vitamin deficiency

Question 4

Side effects of over-treating thyroid

Answer 4

A fib

increased bone turnover

Question 5

Workup of hyperthyroidism

Answer 5

SOR A: TSH, free T4 and T3, then radioactive uptake scan

SOR B: CBC

SOR C: ESR, ultrasound, thyroid Abs

Question 6

Treatment of choice for Graves disease

Answer 6

radioactive iodine

Question 7

Medications for treatment of graves disease

Answer 7

PTU or methimazole and beta blockers

• methimazole is safer than PTU
• PTU considered second line, except durine 1st trimester of pregnancy and during lactation

Question 8

Should all thyroid nodules be worked up?

Answer 8

Yes!! 5% are malignant

Question 9

Initial testing for thyroid nodule

Answer 9

TSH

Question 10

How do you use TSH to determine your workup of thyroid nodule?

Answer 10

Start with TSH and order ultrasound with the following:

Low TSH –> uptake scan –> Hot nodules go to surgery, cold nodules go to FNA

normal or high TSH –> go straight to FNA

Question 11

How is the thyroid affected in pregnancy?

Answer 11

• 10% increase in size
• 50% increase in thyroid hormones and in iodine needed
• 10% of women in first trimester will be + for thyroid peroxidase or thyroglobulin antibodies

Question 12

What is the TSH goal in pregnancy?

Answer 12

• TSH goal < 3.0

Question 13

Should you treat subclinical hypothyroidism in pregnancy?

Answer 13

• treat subclinical hypothyroidism with + TPO antibodies
• if subclinical hypothyroidism and not treated, check TSH and T4 every 4 weeks until 16-20 weeks, then once from 26-32 weeks

Question 14

How should you manage a woman’s levothyroxine dose during pregnancy?

Answer 14

women already on levothyroxine should increase dose by 25-50% during pregnancy

Question 15

What is the rule of 200s in prolactinoma?

Answer 15

prolactin level > 200 is almost always a prolactinoma

Question 16

Name the pituitary product whose overproduction results in the following symptoms:

Amenorrhea, galactorrhea, impotence

Answer 16

Prolactin

Question 17

Name the pituitary product whose overproduction results in the following symptoms:

Gigantism and acromegaly

Answer 17

Growth Hormone

Question 18

Name the pituitary product whose overproduction results in the following symptoms:

Cushing’s disease - striae, moon facies, buffalo hump, weight gain in midsection

Answer 18

Corticotropin

Question 19

Features of cushing’s syndrome

Answer 19

think increased cortisol

• central obesity
• ecchymoses
• plethora
• proximal weakness
• osteopenia/osteoporosis
• HTN
• WBC > 11
• purple striae > 1 cm wide

Question 20

How do you diagnose cushing’s disease?

Answer 20

• confirm excess cortisol production via 24 hour urine free cortisol
• Can use dexamethasone suppression test (administration of dexamethasone should suppress ACTH production in the pituitary and result in less cortisol production by adrenals)

Question 21

Clinical presentation of Addison’s disease

Answer 21

Think low cortisol and low aldosterone

• hyperpigmentation
• low BP
• weight loss
• salt craving
• malaise, fatigue

Question 22

Diagnostic testing for addison’s disease

Answer 22

think low cortisol and low aldosterone

• ACTH stimulation test
• CT/MRI adrenals
• blood glc, electrolytes, cbc

Question 23

Treatment of addison’s disease

Answer 23

• replace cortisol and aldosterone

Question 24

What is the test of choice for workup of multinodular thyroid for cancer?

Answer 24

dynamic contrast medium-enhanced MRI is more accurate than FNA in detecting cancer in a multinodular gland

NPV = 100%

Question 25

When should you treat subclinical hypothyroidism?

Answer 25

Treat in these scenarios

• TSH > 10
• pt attempting conception
• • thyroid peroxidase AB