Endocrinology

Question 1

Hypothyroidism. Etiology

Answer 1

Eti: Hashimoto’s and idiopathic. Anti-thyroid Ab (autoimmune). 6x more common in women

Question 2

Hypothyroidism: Sxs

Answer 2

Sxs: enlarged thyroid, fatigue, weakness, lethargy, menorrhagia, brittle hair and nails, dry skin, weight gain, constipation, cold in tolerance, depression, delayed DTRs
- can cause increased LDL nd decrease HDL

Question 3

Hypothyroid: Dx, Tx, complications

Answer 3

Dx: TSH, T4, thyroid antibodies present
Tx: levothyroxine
Comp: myxedema coma (often due to stressor like infection, CVA, EHF, non-compliance with levo

Question 4

Hyperthroidism Etiology

Answer 4

Graves disease, toxic mulinodular goiter (Plummer Dz)
Graves: autoimmune; circulating TSH receptor anibodies cause increase in thyroid H synthesis
Plummer dz: autonomous functioning nodules (produce T4/T3 which decreases TSH levels)

Question 5

Hyperthyroidism: Sxs

Answer 5

Sxs: Graves: diffuse/enlarged thyroid (lumpy, irregular and asymmetric), bruits, ophthalmpathy, excessive sweating, weight loss, palpitations, muscle weakness, diarrhea, brisk DTRs
Plummer: same with eye and skin changes

Question 6

Hyperthyroidism Dx, tx, complications?

Answer 6

Dx: increased T4/T3 and decreased TSH levels
Tx: Graves: radioactive iodine (destroys gland), methimazole/PTU inhibit conversion of T4 to T3, beta-blockers for symptomatic relief, thyroidectomy
Comp: thyroid storm

Question 7

Thyroid neoplasm etiology

Answer 7

low % of nodules are malignant, high suspicion if

Question 8

Thyroid nodules

Answer 8

Eti: h/o of head/neck radiation, if benign most likely adenomas or cysts
Sxs: most ASX, otherwise compressive sxs
Dx: most are euthyroid
Tx: thyroidectomy, observation, suppressive tx with thyroid H

Question 9

Methimazole: Indication, AE

Answer 9

Usually used over propylthiouracil for hyperthyroidism
MOA: Blocks T3 and T4 synthesis
AE: Hypothyroidism, hepatic effects, lupus-like syndrome, vasculitis, bleeding, many interactions

Question 10

Propylthiouracil

Answer 10

Used for hyperthyroidism according to lecturer.
MOA: Blocks coversion of T4 to T3
AE: Black box: hepatotoxicity
Bleeding, bone marrow suppression

Question 11

Metabolic syndrome/ syndrome x: Criteria?

Answer 11

Criteria: 3 or more of :
Central obesity greater than 102 cm men, 88 cm female,
Hypertriglyceridemia: greater than 150 mg/dL
Hyperglycemia (fasting more than 100,
HTN: sys130, dia85

Question 12

Metabolic syndrome/ syndrome x: clinical significance, prevention?

Answer 12

Increased risk of cardiovascular disease (1.5 to3 fold increase) type 2 DM (3-5 fold increase)

Question 13

Pathophys of Type 1 diabetes vs type 2

Answer 13

Type 1 Eti: auto antibodies, insulin low or non existent
HLA positive
- pancreatic beta cell destruction
Type 2 Eti: No auto abs, insulin can be normal/increased or decreased
- Stronger genentic component than type 1
- Combo of insulin resistance and impairment to insulin secretion

Question 14

Epidemiology of Type 1 vs Type 2 DM

Answer 14

Type 1: young age of onset

Type 2: Usually adults, fam hx

Question 15

Symptoms of Type 1 vs Type 2?

Answer 15

Type 1: onset sudden
- thin
-ketosis common
- classic new onset symptoms: polyuria, polydipsia, polyphagia
Type 2: gradual onset
- frequently obese
- ketosis rare
- acanthosis nigricans, skin tags
- polyuria, polydipsia, polyphagia
- fatigue
- blurred vision
- candidal infections
- numbness/tingling in hands and feet