Endocrinology Flashcards
Investigation results in Graves disease
High T4, low TSH
Non-tender goitre
Nuclear scintigraphy - uniform uptake with diffuse enlargement
Investigation results in subacute thyroiditis (De Quervain’s)
High T4, low TSH
Raised ESR
Tender goitre
Associated recent viral illness
Investigation results in sick euthyroid syndrome (non-thyroidal disease)
Low T4, low/normal TSH
After recent period of illness
Toxic multinodular goitre investigations
Low TSH, high T4
Patchy uptake on nuclear scintigraphy
Paget’s disease of the bone
Increased uncontrolled bone turnover
Excessive osteoclast resorption followed by increased osteoblastic activity
Most commonly affects skull, spine/pelvis, long bones
Presentation of Paget’s disease of bone
Usually asymptomatic
Stereotypically older male with bone pain and isolated raised ALP
Bone pain - pelvis, lumbar spine, femur
Bowing of tibia
Frontal bossing of skull
Management of Paget’s disease of the bone
Not everyone needs treatment
Bisphosphonate
Osteoporosis management
First line - oral bisphosphonates
If had a hip fracture then IV zoledronate first line
Second line - denosumab
Other options - strontium ranelate, raloxifene, terparatide, romosozumab
Bone mineral density cut off following DEXA
T score of -2.5 or below
Bisphosphonate guidance
Should be on PO bisphosphonates for at least 5 years or IV for 3 years then re-assess fracture risk
PO should be taken with full glass of water on an empty stomach and patient should stay sat upright for 30 mins afterwards
Common SE - oesophagitis, hypocalcaemia, osteonecrosis of the jaw, atypical femoral fractures
Osteomalacia labs
Low calcium and phosphate
High ALP and PTH
Primary hyperparathyroidism labs
Low phosphate
High calcium, ALP and PTH
CKD (secondary hyperparathyroidism) labs
Low calcium
High phosphate, ALP and PTH
Paget’s disease labs
Normal calcium, phosphate and PTH
High ALP
