Endocrinology Flashcards
All tired patient should be offered a trial of thyroixine even if conventional thyroid function is normal. True or false?
False. Most tired patients do not have endocrine disturbances. They must have a diagnosis of endocrine disorder as excess inappropriate thyroid hormone can have side-effects and us unlikely to help symptoms
Thyroid releasing hormone (TRH) is the ideal way to assess thyroid hormone replacement. True or false?
False. Thyroid stimulating hormone should be used to access thyroid hormone replacement; TSH should be within the normal range.
Thyroxine 100mcg a day to cause the TSH to come into the normal range, is a safe starting dose in people with all ages. True or false?
False. In the long-temr, TSH should be kept within the normal range. However, in older patients it would be important to ensure they do ont have ischaemic heart disease which could be exacerbated by instantaneous normalising of thyroid function. The patient would eventually need a normal TSH; however, any heart condition may need treatment first.
Thionamides biochemically prevent thyroid hormone effect and control thyrotoxicosis whatever its aetiology. True or false?
False. The thionamides reduce thyroid hormone production, therefore they work best in high uptake (high thyroid hormone production) causes the thyrotoxicosis. They work far less well in low uptake thyrotoxicosis such as thyroiditis.
Thionamides can be used to control high uptake thyrotoxicosis. In addition, a substantial number of patients with autoimmune (Grave’s) thyrotoxicosis can go into long-term remission with thionamides (given over a year) and these can then be stopped. True or false?
True. Toxic multinodular goiter and single toxic adenoma will not go into remission with thionamides, however the patient could stay on thionamides for a long time if they did not want other definitive treatment.
Radioactive iodine ablative therapy for the thyroid should only be used where there is malignant disease. True or false?
If a patient wants definitive treatment for high uptake thyrotoxicosis then radioactive iodine is a very suitable and safe option. The patient should be offered long-term thionamides, surgery or radioactive iodine, many patients chose the latter with the only real effect that they are likely to become hypothyroid and require Thyroxine.
Beta blockers are suitable (if not contraindicated with asthma) in practically all thyrotoxic patients whatever the aetiology in order to help symptoms and protect the heart.
True.
Patients requiring glucocorticoid replacement can remain on the same dose for life. True or false?
False. It is no only important to adjust the dose of glucocorticoid to patients need over the longer-term - not an excess to cause Cushingoid problems, not a deficiency of its long-term effects - however it is also important for the patient to adjust the dose themselves at times of intercurrent stress. Patients with adrenal failure can die without an increment of steroids at intercurrent stress.
The glucocorticoid cortisol can have mineralocorticoid (aldosterone) like effects at high dose. True or false?
True. Excess glucocorticoid can affect the mineralocorticoid receptor in the distal tubule the kidney to cause hypertension and hypocalcemia.
The artificial mineralocorticoid, fludrocirtisone, should be given to replace aldosterone. True or false?
True
Primary hyperaldosteronism (or mineralocorticoid excess) can be treated with spironolactone. True or false?
True
Anti-diuretic hormone acts on the hypothalamus to prevent urine output. True or false?
False. Antidiuretic hormone acts on the collection ducts of the kidney to cause water re-absorption using the gradient already created by the loops of Henle.
ADH should be continued as the same dose twice a day. True or false?
False. It is best to have some dieresis particularly in the morning because it is difficult to give exactly the right amount of synthetic ADH.
For a patient who is unconscious either having anaesthesia or following an accident would not matter if they are not given DDAVP. True or false?
False. Patients with diabetes insipidus can protect themselves if they have thirst and are conscious, therefore able to drink large amounts of water. If they are unconscious they cannot do this and run the danger of dehydration and hypernatremia.
Somatostatin is useful in acromegaly (growth hormone excess). True or false?
Somatostatin which now can often be given once a month are useful in reducing growth hormone levels and reducing the size of the tumour.
