Endocrine - Thyroid/ Steroids

Question 1

Hyperthyroidism Biomarkers

Answer 1

High T3 & T4

Low TSH

Question 2

Hyperthyroidism symptoms

Answer 2

Hyperactivity
Insomnia
Diarrhoea
Weight loss
Increased appetite
Goitre

HIDWIG

Question 3

Hyperthyroidism Treatment 1st line?

Answer 3

Carbimazole

Question 4

Hyperthyroidism treatment 2nd line?

Answer 4

Propylthiourouracil

Question 5

Propylthiouraricil side effect?

Answer 5

Risk of Liver disorder or Jaundice

Question 6

Graves’ disease is hypo or hyper thyroidism?

Answer 6

Hyperthyroidism

Question 7

Graves’ disease treatment 1st line?

Answer 7

Radioactive iodine

Question 8

Graves’ disease remission treatment?

Answer 8

Consider carbimazole

Question 9

If iodine or surgery not tolerated in Graves disease then?

Answer 9

Carbimazole and levothyroxine (block and replace ) combo or alone
12-18 months

Question 10

Which drug to use in Hyperthyroidism in pregnancy 1st trimester?

Answer 10

Propylthiouracil

Question 11

Which drug to use in Hyperthyroidism in pregnancy 2nd and 3rd trimester?

Answer 11

Carbimazole

Question 12

Why can’t propylthioracil be used in 2nd or 3rd trimester?

Answer 12

Due to propylthiouracil being hepatotoxic in 2nd and 3rd trimester

Question 13

Hypothyroidism biomarkers?

Answer 13

Low T3 and T4

High TSH

Question 14

Hypothyroidism symptoms?

Answer 14

Fatigue
Weight gain
Cold intolerance
Constipation

Menstrual irregularities
Depression
Dry skin

Question 15

Hyperthyroidism metabolism?

Answer 15

Increased metabolism

Question 16

Hypothyroidism metabolism?

Answer 16

Decreased metabolism

Question 17

Hypothyroidism 1st line treatment?

Answer 17

Levothyroxine

Question 18

Monitoring in levothyroxine and how frequent?

Answer 18

Monitor TSH, 3months until stable then yearly

Question 19

Levothyroxine counselling?

Answer 19

Take in the morning, 30mins before breakfast or caffeine

Question 20

Benefit of Liothyroxine rather than levothyroxine?

Answer 20

More potent, more rapid output

Question 21

Which is more potent, levothyroxine or liothyroxine?

Answer 21

Liothyroxine

Question 22

Liothyroxine brand importance?

Answer 22

Non uk brand may not be bio equivalent

Question 23

Mineralcorticosteroid fluid retention and inflammatory effect?

Answer 23

High fluid retention and low inflammatory effect

Question 24

Highest mineralcorticosteroid activity drug?

Answer 24

Fludrocortisone

Hc also has high activity

Question 25

Postural Hypotension treatment?

Answer 25

Fludrocortisone (fluid retention)

Question 26

Mineralcorticoid steroid - Fludrocortisone side effect?

Answer 26

Hypertension Hypokalaemia Hypocalcaemia

Question 27

Corticosteroid anti inflammatory effect and fluid retention?

Answer 27

High Anti Inflammatory effect Low fluid retention

Question 28

Highest glucocorticoid activity drug?

Answer 28

Dexamethasone & Betamethasone

Question 29

Which other glucocorticoid steroids have high activity?

Answer 29

Prednisolone, prednisone, Deflazacort

Question 30

Glucocorticoids side effects?

Answer 30

Diabetes Osteoporosis Muscle wasting Gi ulcer & perforation

Question 31

Corticosteroid symptoms

Answer 31

Cushing syndrome Osteoporosis Retardation of growth Thin skin Immunosupression Chorioretinopathy Oedema STriae (stretch marks) Emotional disturbance Rise in BP Obesity Increase hair growth Diabetes (Hyperglycaemia) Ulcers Suppression Electrolyte imbalance (Hypokalaemia) ***CORTICOSTEROIDUSE***

Question 32

Moon face, Striae, Acne, Hirsutism describes what condition?

Answer 32

Cushing Syndrome

Question 33

Cushing syndrome treatment and management?

Answer 33

Treat with Ketoconazole Manage with Metyrapone

Question 34

How to stop insomnia from steroids?

Answer 34

One dose in the morning As cortisol is produced in morning

Question 35

Steroid use in children major side effect to consider?

Answer 35

Stunting growth even with inhalers

Question 36

Steroid immunosuppression - risk of which infections?

Answer 36

1) Chickenpox 2) Measles

Question 37

How to prevent steroid use chicken pox from occurring?

Answer 37

Varicella Zoster vaccines

Question 38

How to prevent steroid use measles infections from occurring?

Answer 38

Prophylaxis IM immunoglobulin

Question 39

MHRA warning associated with Corticosteroids?

Answer 39

Chorinoretinopathy Symptoms: Blurred vision, visual disturbances

Question 40

Corticosteroid other MHRA warning?

Answer 40

Psychiatric Reactions

Question 41

Steroid withdrawal criteria?

Answer 41

1) Over 40mg daily over 1wk 2) Repeating evening doses 3) Over 3week treatment 4) Short course with 1 year of stopping long term therapy 5) Other possible causes of adrenal suppression

Question 42

Topical steroid mild to very potent list?

Answer 42

Mild -> Hydrocortisone Mod -> Clobetasone Potent -> Betamethasone V. Potent -> Clobetasol ***Sol means sole one and only strong

Question 43

Adrenal insufficiency- Addison disease treatment?

Answer 43

Hydrocortisone Primary also treated with Fludrocortisone

Question 44

Adrenal crisis?

Answer 44

Severe Dehydration Seizure/ stroke Cardiac arrest