Endocrinology from PANCE Pearls Flashcards

1
Q

What is Hyperthyroidism and what does it do in your body

A
High T3/T4
Increases Metabolism
Increases glucose absorption from GI
Catabolic effect on muscle mass
Increased CO and RR
Increased Catecholamine levels
Increased Oxygen Consumption
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2
Q

What is the most common cause of Hyperthyroidism

A

Graves
Autoimmune
Antibodies against TSH receptor

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3
Q

What is a common cause of Hyperthyroidism in the elderly

A

Toxic Nodular Goiter

Leads to thyrotoxicosis (Increased T3/T4)

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4
Q

Sx of Hyperthyroidism

A

Anxiety, Emotional Lability, Weight loss, Weakness, Tremor, Palpitations, Heat Intolerance, Warm, Moist Skin, Thin Hair, Tachycardia, Fine Resting Tremor, Hyper-reflexia

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5
Q

What is a unique sx seen in Graves

A

Exophthalmos

Proptosis, Lid Lag, Eyes Bulging

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6
Q

Dx of Hyperthyroidism

A

Low TSH
High T3/T4
If graves, see TSH Ig Antibodies

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7
Q

Tx of Hyperthyroidism

A

Anti-Hormonal Therapy: PTU (propylthiouriacil) or Methimazole Radiactive Iodine destroys gland

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8
Q

Which of the tx for Hyperthyroidism can be used during pregnancy

A

PTU

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9
Q

What drugs can you use to curb sx of Hyperthyroidism

A

Beta Blockers: Propranolol, decreases HR and BP

Glucocorticoids prevent conversion of T4 to T3

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10
Q

Dx of TSH secreting pituitary adenoma

A

High TSH
High T3/T4
MRI to look for pituitary mass

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11
Q

Tx of TSH secreting pituitary adenoma

A

Transphenoidal surgery to remove pituitary tumor

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12
Q

What is Hyperparathyroidism

A

Overactive Parathyroid glands that lead to increased calcium absorption

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13
Q

What is primary Hyperparathyroidism and what causes it

A

Excess inappropriate PTH production

Parathyroid Adenoma is the most common cause

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14
Q

What is secondary Hyperparathyroidism and what causes it

A

Increased PTH due to hypocalcemia or Vitamin D deficiency

Chronic Kidney Failure is the most common cause

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15
Q

Sx of Hyperparathyroidism

A

Bones, Stones, Groans and Psychic Groans

Bone pain, Kidney stones, Abdominal Pain Constipation, Depression and Confusion

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16
Q

Dx of Hyperparathyroidism

A
Increased PTH
Hypercalcemia
Decreased Phosphate
Check 24 hour urine calcium excretion
Osteopenia on bone scan
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17
Q

Tx of Hyperparathyroidism

A

Surgery
Parathyroidectomy
Vitamin D/Calcium supplement if secondary

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18
Q

What is Hypoparathyroidism

A

Due to low PTH or Insensitivity to its action

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19
Q

What are the more common causes of Hypoparathyroidism

A

Accidental damage/removal of parathyroid during neck/thyroid surgery
Autoimmune destruction of parathyroid gland

20
Q

Sx of Hypoparathyroidism

A

Hypocalcemia: Carpopedal Spasms, Trousseau and Chvostek Sign, Perioral Parasthesias, Increased DTR
Chvostek Sign: Tap on facial nerve and it causes twitching
Trousseau Sign: Blood pressure cuff on arm blocks flow to brachial artery, causes flexion in fingers, extension of wrist

21
Q

Dx of Parathyroidism

A

Hypocalcemia
Decreased PTH
Increased Phosphate

22
Q

Tx of Parathyroidism

A

Calcium Supplement and Vitamin D

Vitamin D helps to absorb calcium in gut (Ergocalciferol or Calcitriol)

23
Q

What is Primary Hypothyroidism

A

Increased TSH

Low T3/T4

24
Q

What is the most common cause of Hypothyroidism in the United States vs. world

A

United States: Hashimotos (Autoimmune Disorder)

World: Iodine Deficiency

25
Q

Sx of Hypothyroidism

A
Decreased Metabolic Rate
Cold intolerance
Weight gain
Dry, thick skin
Goiter
Fatigue, depression
Constipation, Bradycardia, Decreased CO
Menorrhagia
Hypoglycemia
26
Q

Dx of Hypothyroidism

A

If Hashimotos, Thyroid antibodies present

27
Q

Tx for Hypothyroidism

A

Levothyroxine

28
Q

What are risk factors for a thyroid nodule

A

Extremes of age (very young or very old)

Hx of head or neck irradiation

29
Q

Sx of thyroid nodule

A

Asymptomatic

Compressive sx: difficulty swallowing or breathing, neck jaw or ear pain, hoarseness

30
Q

Dx of Thyroid Nodule

A

Benign: Smooth, firm, irregular, sharply outlined
Malignant: Rapid growth, fixed, no movement with swallowing
Thyroid Function Test (Euthyroid = normal functioning thyroid gland)
FNA is best initial test
-Benign: Colloid
-Malignant: Follicular
Radioactive Iodine Uptake Scan, cold is suspicious for malignancy
Ultrasound

31
Q

Tx of Thyroid Nodule

A

Thyroidectomy
Observation with ultrasound
Suppressive therapy with thyroid hormone in attempt to shrink nodule

32
Q

What are the 4 forms of Thyroid Cancer
Which one is the most common
Which one is the most aggressive/worst and least aggressive/best

A

Papillary: Most common and Least Aggressive, Great prognosis
Follicular: More aggressive
Medullary: More aggressive, low cure rate
Anaplastic: Most aggressive, Rapid growth, Poor prognosis

33
Q

What is Pheochromocytoma

A

Catecholamine Secreting Adrenal Tumor

Secretes Norepinephrine and Epinephrie Autonomously and Intermittently

34
Q

Sx of Pheochromocytoma

A

HTN
Palpitations, Headaches, Excessive Sweating
Chest or abdominal pain, weakness, fatigue, weight loss

35
Q

Dx of Pheochromoctyoma

A

Increased 24 hour urinary catecholamines including metabolites (Metanephrine and Vanillylmadelic Acid)
MRI or CT

36
Q

Tx of Pheochromocytoma

A

Complete Adrenalectomy
Preoperative nonselective alpha Blockage (Phenoxybenzamine or Phentolamine for 7-14 days followed by beta blockers
Remember: Surgery causes a release of catecholamine release, so you want to block this prior to surgery)

37
Q

What is Cushings Disease

A

High Cortisol caused by excess ACTH secretion

38
Q

What is Cushings Syndrome

A

Signs and Sx related to Cortisol

39
Q

Sx of Cushings Disease

A
Central Trunk Obesity
Moon Facies
Buffalo Hump
Superclavicular Fat Pads
Wasting Extremities
Striae
HTN
Weight Gain
Osteoporosis, Hypokalemia
Acanthosis Nigricans
Hirtuism
40
Q

Dx of Cushings Disease (1st step)

A

Test to see that you have elevated Cortisol
24 hour urine
Salivary
Low Dose Dexamethasone

41
Q

What do the results of the Low Dose Dexamethasone tell you

A

Normal response is Cortisol suppression

No suppression = Cushings Syndrome

42
Q

Dx of Cushings Disease (2nd step)

A

Measure ACTH
If elevated ACTH: Dependent
If normal or reduced: Independent
If Independent it means the adrena glands are going crazy (adrenal tumor), so scan the adrenals and take out the tumor
If Dependent, it means Cortisol is being secreted as a response to high ACTH.
Now you need to figure out where its coming from. Could be Pituiatry Tumor or Ectopic Tumor

43
Q

Dx of Cushings Disease (3rd step - Where is the high ACTH coming from)

A

High dose Dexamethasone
If Cortisol is suppressed, it means excess ACTH is coming from Pituiatry tumor (adrenal glands are responding normally to suppression)
If cortisol is NOT suppressed, it means ACTH is coming from an ectopic location (mutated cells)

44
Q

Tx of Cushings Disease

A

Transphenoidal Surgery

45
Q

Tx of Cushings due to Ectopic or Adrenal Tumor

A

Remove Tumor

46
Q

Tx of Cushings if due to exogenous cause (like excess steroid use)

A

Withdraw gradually to avoid Addison Crisis