Endocrine therapeutics

Question 1

What are four causes of thyrotoxicosis?

Answer 1

1. Autoimmune (Grave’s)
2. Single or multiple nodular
3. Drugs like amiadarone
4. Destructive thyroiditis

Question 2

In which type are eyes affected?

Answer 2

Autoimmine

Question 3

What are three treatments for thyrotoxicosis?

Answer 3

Thionamides

Radioactive iodine

Surgery

Question 4

How long does it take for thionamines to work?

Answer 4

4 weeks

Question 5

How long should thionamides be given for Graves?

Question 6

Name two thionamides

Answer 6

Carbimazole and propylthiouracil

Question 7

What do thionamides target?

Answer 7

Thyroid peroxidase

Question 8

Because it takes a while for thionamides to work, what treatments can be given initially?

Answer 8

Beta blockers

Question 9

What is a dangerous side effect of thionamides?

Answer 9

RARE: agranulocytosis

Question 10

What happens if a patient on a thionamide gets a cold or fever?

Answer 10

Should stop drug and go to GP or doctor

Question 11

What is the most common thyroid disease in UK? What cause?

Answer 11

Autoimmune hypothyroidism

Question 12

How is hypothyroidism treated?

Answer 12

50-150mcg of levothyroxine

Question 13

What is the ratio of T4:T3 in healthy people?

Answer 13

13:1

Question 14

What converts T4 to T3?

Answer 14

DIO2

Question 15

How are non functioning poituitary tumours treated?

Answer 15

Pressure on optic chiasm if Y (do sugery) and if N (surveillance)

Question 16

What is 1st and 2nd line treatment for prolactinoma?

Answer 16

1st line = dopamine agonists, 2nd line - surgery

Question 17

What is 1st, 2nd and 3rd line for other functioning pituitary tumours?

Answer 17

1. Surgery. 2. Medical treatment 3. Radiotherapy

Question 18

Name some drugs for Cushing’s?

Answer 18

Cortisol synthesis inhibitor: Medications to control the production of cortisol.

Ketoconazole . Mitotane . Metyrapone

Glucocorticoid type II receptor antagonist: Blocks the effect of cortisol.

Mifepristone

Question 19

What are side effects of somatostain analogues?

Answer 19

Gallstones, abdo cramps, diarrhea, hairloss, hyperglycaemia

Question 20

What is subacute thyroiditis?

Answer 20

Subacute thyroiditis (also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.

There are typically 4 phases;

phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR

phase 2 (1-3 weeks): euthyroid

phase 3 (weeks - months): hypothyroidism

phase 4: thyroid structure and function goes back to normal

Investigations

thyroid scintigraphy: globally reduced uptake of iodine-131

Management

usually self-limiting - most patients do not require treatment

thyroid pain may respond to aspirin or other NSAIDs

in more severe cases steroids are used, particularly if hypothyroidism develops

Question 22

What are the side effects of the drigs used in diabetes?

Answer 22

Biguanides

Lactic acidosis and GI disturbance.

Sulfonylureas

Hypoglycaemia and weight gain.

Thiazolidinediones

Fluid retention, weight gain and worsening heart failure.

SGLT2 Inhibitors

Diabetic Ketoacidosis when used with insulin and increased risk of urinary tract infections.

DPP4-Inhibitors

Hypoglycaemia and GI upset.

GLP1 Analogues

Hypoglycaemia, GI upset and may increase the risk of pancreatitis when used with DPP4-inhibitors.

Intestinal alpha-glucosidase inhibitors

Flatulence and GI disturbance.