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MedEd GKP/AB/VP > Endocrinology - Thyroid and Diabetes > Flashcards

Endocrinology - Thyroid and Diabetes Flashcards

1
Q

Hyperthyroid Signs and Symptoms

A 
Diarrhoea
Loss of weight
Increase in appetite
Sweating
Heat intolerance
Tremors
Irratibility
Oligomenorrhoea
Amenorrhoea
Fine, Straight hair
Bulging eyes
Enlarged thyroid
Breast enlargement
Localised oedema
Finger clubbing
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2
Q

Grave’s Disease

Presentation, Treatment

A

Autoimmune disorder, TSH receptor activating antibodies

Hyperthyroid picture:
Exopthalmos
Pretibial myxoedema
Acropachy

Grave’s is the commonest cause of a smooth diffuse goitre.

Rx:
Carbimazole
Propylthiouracil

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3
Q

Plummer’s Disease

A

A single toxic nodule (adenoma) which is present on a background of a suppressed multi-nodular goitre.

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4
Q

Thyroglossal cyst

A

A fibrous cyst that is a persistent remnant of the thyroglossal duct.
No hyperthyroid, benign and painless.
Moves upwards on protrusion of the tongue.

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5
Q

De Quervain’s Thyroiditis

Presentation and Treatment

A

Acute viral infection of the thyroid gland

Presentation:
Viral prodrome
Thyroid tenderness
Hyperthyroid, THEN Hypothyroid.

Treatment:
NSAID
Corticosteroids

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6
Q

Hypothyroidism Symptoms and Signs

A 
Constipation
Gain of weight
Tired/Sleepy
Memory/Cognition slowness
Cold intolerance
Cramps
Menstrual disturbance
Receding hairline
Facial and eyelid oedema
Dull-blank expression
Slow speech
Anorexia
Brittle nails and hair
Muscle aches and weakness
Dry skin - coarse and scaly
Apathy
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7
Q

Hypothyroidism late clinical manifestations

A 
Subnormal temp
Bradycardia
Wt gain
LOC
Thickened skin
Cardiac complications
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8
Q

Hashimoto’s Thyroiditis

Presentation

A

Autoimmune disease of the thyroid.
Antibodies against thyroid peroxidase (TPO).

Presentation:
Hypothyroidism
Swelling of the thyroid - firm/large

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9
Q

Common causes of hypothyroidism

A

Hashimoto’s Thyroiditis
Iodine deficiency
Post-thyroidectomy
Drug-induced - Amiodarone, Lithium, Iodine

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10
Q

Thyroid cancer types

A

Papillary - Most common [80%]
Follicular [15%]
Medullary [5%]
Anaplastic - V rare

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11
Q

Papillary carcinoma

RF, Prognosis

A

RF - Radiation Exposure
Most common in young people - presents in 20-55 age group.

Excellent prognosis

Papillary pattern
Calcified rings - Psamomma bodies
Clear nuclei - Orphan Annie Eye nuclei

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12
Q

Follicular Carcinoma

Presentation

A

Tend to metastasize to lung and bone
Presentation with Hurthle cells
Middle age

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13
Q

Medullary Carcinoma

Inheritance, Association, Pathogenesis

A

Familial pattern of inheritances

Associated with MEN 2A:
Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma

Arises from parafollicular cells - C cells
–> Increased secretion of calcitonin

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14
Q

Multiple Endocrine Neoplasias

A

MEN 1 - Pituitary adenoma, parathyroid hyperplasia, pancreatic tumours/insulinomas/gastrinomas, facial angiofibromas and collagenomas

MEN 2A - Parathyroid hyperplasia, Medullary thyroid carcinoma, Phaeochromocytoma

Men 2B - Mucosal neuromas, Marfanoid body habitus, Medullary thyroid carcinoma, phaeochromocytoma

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15
Q

A 42-year-old woman presents with visual disturbances. She reports having double vision which was intermittent initially but has now become much more frequent. In addition, she becomes breathless very easily and experiences palpitations. On examination, raised, painless lesions are observed on the front of her shins and finger clubbing.

De Quervain’s thyroiditis
Thyroid storm
Phaeochromocytoma
Graves’ disease
Plummer’s disease
A

Graves’ Disease

Visual disturbances
Double vision
Intermittent initially
Breathless easily
Palpitations
Raised painless lesions
Finger clubbing
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16
Q

A 16-year-old girl presents to her GP complaining of a swelling in her neck which she has noticed in the last 2 weeks. She has felt more irritable although this is often transient. On examination, a diffuse swelling is palpated with no bruit on auscultation. The most likely diagnosis is:

Hyperthyroidism
Simple goitre
Riedel’s thyroiditis
Thyroid carcinoma
Thyroid cyst
A

Simple goitre

16 yr old girl
Swelling in neck
Last two weeks
Irritable
Transient
Diffuse swelling
No bruit
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17
Q

A 58-year-old woman presents with an acutely painful neck, the patient has a fever, blood pressure is 135/85 mmHg and heart rate 102 bpm. The patient explains the pain started 2 weeks ago and has gradually become worse. She also notes palpitations particularly and believes she has lost weight. The symptoms subside and the patient presents again complaining of intolerance to the cold temperatures.

Thyroid Papillary Carcinoma
Plummer’s Disease
De Quervain’s Thyroiditis
Hyperthyroidism
Thyroid Follicular Carcinoma
A

De Quervain’s Thyroiditis

Acutely painful neck
Fever, BP high
HR high
2 weeks ago
Palpitatoins
Lost weight
Subside
Intolerance to cold
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18
Q

A 35 year old female presents with amenorrhoea, galactorrhoea and visual disturbance. A prolactin level was noted as being very high. On further questioning, her mother had problems with recurrent renal stones and an operation on her neck. A relative has recently suffered with Pancreatic Cancer.

Multiple Endocrine Neoplasia 1 (MEN 1)
MEN 2a
MEN 2b
MEN 3
Von Hippel Lindau Disease
A

MEN 1

Amenorrhoea
Galactorrhoea
Visual disturbances
Recurrent renal stones
Operation on neck
Pancreatic cancer
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19
Q

Diabetic investigations

A

Fasting plasma glucose
Random plasma glucose
Oral Glucose Tolerance Test
HBA1c

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20
Q

Fasting plasma glucose

A

After 8hr fast
Diagnostic cut off > 6.9mmol/L
Impaired fasting glucose is between 6.1-6.9mmol/L

21
Q

Random plasma glucose

A

Non-fasting test
Convenient but less accurate
> 11.1mmol/L
used if symptoms of polyuria/polydipsia/wt loss present

22
Q

Oral Glucose Tolerance Test

A

2 hrs after an oral load of 75g glucose
Diagnostic cut off is >11.1mmol/L

Impaired OGTT:
Fasting plasma glucose is <7.0mmol/L
With OGTT of 7.8 - 11.0mmol/L

23
Q

HBA1c

A

Diagnostic is > 48mmol/mol (6.5%)

A form of haemoglobin which identifies 3 month average plasma glucose
Higher amounts of ABA1c in T2DM
Higher value represents poor control

Change of units:
Remember two values - 6% = 42mmol/mol and 7% = 53 mmol/mol

24
Q

Type 2 Diabetes Diagnosis

A

Symptomatic (e.g. poyuria/polydipsea/unexplained wt loss)
A single fasting plasma glucose >/= 7 mmol/L
OR
A single random plasma glucose >/= 11.1mmol/L

Asymptomatic:
A fasting glucose >/= 7 on tow separate occasions
OR
A random glucose >/= 11.1 on two separate occasions
OR
An HBA1c >/= 6.5% (48mmol/mol) on two separate occasions
OR
An HBA1c >/= 6.5% AND a single elevated plasma glucose (fasting > 7 or random > 11)

25
Q

Impaired fasting glucose diagnosis

A

Fasting plasma glucose 6.1-6.9mmol/L

26
Q

Pre-Diabetes diagnosis

A

HBA1c 6-6.4% (42-47 mmol/mol) [NICE]

HBA1c 5.7-6.4% (39-47mmol/mol) [American Diabetes Association]

27
Q

Impaired glucose tolerance diagnosis

A

Fasting plasma glucose <7.0mmol/L
AND
OGTT 7.8-11mmol/L

28
Q

Which of these fulfills the diagnostic criteria of Type 2 Diabetes

Polyuria and polydipsia, no further investigations necessary
Asymptomatic patient, single fasting plasma glucose >6.9 mmol/L
Asymptomatic patient, single reading of elevated HbA1c
Symptomatic patient, single reading, fasting plasma glucose> 6.9 mmol/L
Symptomatic patient, single reading, random plasma glucose <11.1 mmol/L

A

Symptomatic patient, single reading, fasting plasma glucose > 6.9mmol/L

29
Q

Which of these is used in the long term management of Type 2 Diabetes

HBA1c
Fasting Plasma Glucose
Random Plasma Glucose
2 hr OGTT
3 Day Fasting Glucose
A

HBA1c

30
Q

Impaired Fasting Glucose is

Fasting Plasma Glucose less than 7.0mmol/L
Fasting Plasma Glucose between 6.1 – 6.9mmol/L
Fasting Plasma Glucose between 7.0– 7.8mmol/L
Fasting Plasma Glucose between 7.8 – 11.0mmol/L
Fasting Plasma Glucose between 5.5-6.5mmol/L

A

Fasting plasma glucose between 6.1-6.9mmol/L

31
Q

What must a HBA1c be in excess of to diagnose Type 2 Diabetes

59mmol/mol
52mmol/mol
48mmol/mol
42mmol/mol
38mmol/mol
A

48mmol/mol

32
Q

Insulin effects

A 
Reduces:
Glucogenesis
Glycogenolysis
Lipolysis
Ketogenesis
Proteolysis

Increases:
Glucose uptake in muscle and adipose tisue
Glycolysis
Glycogen synthesis
Protein synthesis
Uptake of ions (especially K+ and PO4 3-)

33
Q

Type 1 Diabetes

A

Autoimmune condition where beta cells are destroyed
Patients present when beta cells have been severely depleted
No insulin producing cells
Chronic and lifelong disease.

34
Q

Type 1 Diabetes Management Rationale

A

Insulin is an anabolic hormone

Anabolism builds

Without insulin there is:
Glycogenolysis
Gluconeogenesis
Ketogenesis

Break down of muscle

Increase in circulating glucose

Increase in circulating ketones
Ketones are acidotic

Hyperglycaemia

Acidosis cause by ketones

…Therefore management is with Insulin

35
Q

Diabetic Ketoacidosis Management Rationale

A

Progression to a point where there is an impairment of normal function…
Hyperglycaemia
Acidotic

Hyperglycaemia leads to an osmotic diuresis; this can potentiate dehydration.
Acidity may cause vomiting, diarrhoea which worsens dehydration.

…Treat dehydration and glucose level
Dehydration provides greatest risk so treat this with fluid management

36
Q

Type 2 Diabetes

A

A long term metabolic disorder
Characterised by high blood sugar
Management is a stepwise method
1st Step is Diet and Exercise

37
Q

Metformin

A

Main method of action is to sensitise cells to insulin, allowing greater uptake of glucose.

1st line, particularly in obese patients.

Reduces hepatic gluconeogenesis
Reduces hepatic glycogenolysis
Increases skeletal muscle glucose uptake
Increases anaerobic glucose metabolism
Reduces fatty acid oxidation
Increases glycogenesis
--> In turn reducing hyperglycaemia.
38
Q

Sulphonylurea

A

Mechanism of action relates to increased secretion of insulin

e.g. Glibenclamide, Chlorpropamide, Tolbutamide.

Often in those with uncontrolled T2DM who are not obese.

39
Q

Alpha Glucosidase Inhibitors

A

Acarbose

Act as competitive inhibitors in the digestion of carbohydrates, preventing it.
Reduce amount of glucose entering blood.

Particularly used in those not tolerating other medication and those suffering with post-prandial hyperglycaemia.

40
Q

Diabetes Management Algorithm

A

Diet and Exercise

Metformin

Sulfonylurea

Basal insulin/Pre-mix Insulin OR a-glucosidase inhibitor/DPP-4 inhibitor/Thiazolidinedione

Basal + meal-time insulin

41
Q

A 19 year old male presented to A&E with abdominal pain, nausea and vomiting. He reports nocturia and examination reveals Kussmaul breathing

Insulin
Oral Glucose
Diet and Exercise
Fluid Replacement
Glibenclamide
A

Fluid and replacement

42
Q

A 40 year old women waiting in a diabetic clinic looks pale and complains of being tired and weak

Oral Glucose
Metformin
Diet and Exercise
Insulin Sliding Scale
Fluid Bolus
A

Oral Glucose

43
Q

A 55 Year Old obese diabetic man controls his diabetes with diet and exercise. On his review his HBA1c is 70mmol/mol and his fasting glucose is 10mmol/L

Stop Treatment
Start Metformin
Glucagon Injection
Continue Current Treatment
Fluid Bolus
A

Star Metformin

44
Q

A 17yr old boy presents to his GP with increased urinary frequency and increased thirst

Insulin
Metformin
Diet and Exercise
No Treatment Required
Fluid Replacement
A

Insulin

45
Q

Hypoglycaemia Symptoms

A 
Autonomic:
Sweating
Palpitations
Shaking
Hunger
Neuroglycopenic:
Confusion
Drowsiness
Odd behaviour
Speech difficulty
Incoordination

General Malaise:
Headache
Nausea

46
Q

Hypoglycaemia Management

Group 1 – Adults who are conscious and orientated

A

Give 15-20g of Quick Acting Carbohydrate such as Fruit Juice, Lucozade or sugar in water

Repeat Capillary Blood Glucose and repeat until it reaches 4.0mmol/L or more

If remains below 4mmol/L – Get Help! Consider 1mg Glucagon IM or IV 10% Glucose at 100ml/Hr

Once above 4.0mmmol/L give a long acting Carbohydrate such as biscuits, slice of toast or 200-300mL milk

47
Q

Hypoglycaemia Management

Group 2- Adults who are Conscious but confused, disorientated, unable to cooperate, aggressive but able to swallow

A

If possible, follow Group 1

If uncooperative but able to swallow give 1.5 – 2 tubes of glucogel squeezed onto the gums

If unable to do this consider 1mg Glucogon IM

If does not raise CBG to 4mmol/L consider IV 10% Glucose infusion at 100ml/hr and call for help

Once above 4.0mmol/L give a long acting carbohydrate

48
Q

Hypoglycaemia Management

Group 3 - Adults who are unconscious or experiencing seizures

A

Must take an ABC approach first

Stop any current insulin infusion

Consider 1 of the following 3 based on local guidelines:
1mg Glucagon IM
75-80mL 20% Glucose IV over 10-15mins
150-160 10% Glucose IV

Raise CBG to over 4.0mmol/L and regaining consciousness give a long acting carbohydrate meal

MedEd GKP/AB/VP (28 decks)

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