Endocrine Diseases Flashcards
What are surrogate markers for hypothyroidism
- high CPK
- high LDL
- high triglycerides
- proteinuria
- normocytic anemia
Starting dose of levothyroxine
- young
- elderly
young: 1.6 mcg/kg/day
elderly: 1.0-1.25 mcg/kg/day
If TSH is therapeutic but pt not feeling well what should be considered?
- 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
Side effects of over-treating thyroid
A fib
increased bone turnover
Workup of hyperthyroidism
SOR A: TSH, free T4 and T3, then radioactive uptake scan
SOR B: CBC
SOR C: ESR, ultrasound, thyroid Abs
Treatment of choice for Graves disease
radioactive iodine
Medications for treatment of graves disease
PTU or methimazole and beta blockers
- methimazole is safer than PTU
- PTU considered second line, except durine 1st trimester of pregnancy and during lactation
Should all thyroid nodules be worked up?
Yes!! 5% are malignant
Initial testing for thyroid nodule
TSH
How do you use TSH to determine your workup of thyroid nodule?
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
How is the thyroid affected in pregnancy?
- 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
What is the TSH goal in pregnancy?
- TSH goal < 3.0
Should you treat subclinical hypothyroidism in pregnancy?
- 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
How should you manage a woman’s levothyroxine dose during pregnancy?
women already on levothyroxine should increase dose by 25-50% during pregnancy
What is the rule of 200s in prolactinoma?
prolactin level > 200 is almost always a prolactinoma
Name the pituitary product whose overproduction results in the following symptoms:
Amenorrhea, galactorrhea, impotence
Prolactin
Name the pituitary product whose overproduction results in the following symptoms:
Gigantism and acromegaly
Growth Hormone
Name the pituitary product whose overproduction results in the following symptoms:
Cushing’s disease - striae, moon facies, buffalo hump, weight gain in midsection
Corticotropin
Features of cushing’s syndrome
think increased cortisol
- central obesity
- ecchymoses
- plethora
- proximal weakness
- osteopenia/osteoporosis
- HTN
- WBC > 11
- purple striae > 1 cm wide
How do you diagnose cushing’s disease?
- 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)
Clinical presentation of Addison’s disease
Think low cortisol and low aldosterone
- hyperpigmentation
- low BP
- weight loss
- salt craving
- malaise, fatigue
Diagnostic testing for addison’s disease
think low cortisol and low aldosterone
- ACTH stimulation test
- CT/MRI adrenals
- blood glc, electrolytes, cbc
Treatment of addison’s disease
- replace cortisol and aldosterone
What is the test of choice for workup of multinodular thyroid for cancer?
dynamic contrast medium-enhanced MRI is more accurate than FNA in detecting cancer in a multinodular gland
NPV = 100%
When should you treat subclinical hypothyroidism?
Treat in these scenarios
- TSH > 10
- pt attempting conception
- thyroid peroxidase AB
