Endocrinology- Thyroid & Parathyroid

Question 1

S&S thyroid storm

Answer 1

Severe Hypertension, 
Tachycardia 
New-onset fever 
Agitation
Tremulousness

Question 2

Common precipitants of thyroid storm

Answer 2

Nonadherence medications
Acutely stressful events (surgery, trauma, infection)
Childbirth
Iodine contrast

Question 3

Hemodynamics changes of thyroid storm

Answer 3

↓SVR
↑CO (↑Stroke volume & ↑HR)
↑ Pulse pressure & ↑BP

High Venous O2 and return
↑pulmonary capillary wedge pressure

essentially: high-output heart failure

Question 4

Tyrotoxicosis with normal of ^ RAIU

Answer 4

Graves Disease
Toxic Multinodular goiter
Toxic nodule

Question 5

Thyrotixicocisis with decreased RAIU

Answer 5

Painless autoimmune thyroiditis (silent thyroiditis)
Subacute (de Quervain) thyroiditis
Amiodarone or Iodine Induced Thyroiditis
Extensive thyroid cancer metastasis

Question 6

S&S hyperthyroidism

Answer 6

Fatigue 
Weight Loss
Tremor
Decreased TSH
Elevated T3 & T4

Question 7

Most Common cause of hyperthyroidism and diferenciación

Answer 7

Graves’ disease
Painless autoimmune thyroiditis

Differentiate with RAIU

Question 8

Postpartum thyroiditis

Answer 8

A form of PAINLESS autoimmune thyroiditis the can occurs within 12 months of delivery.
Symptoms can be hyperthyroid, hypothyroid or combined.

Question 9

Diagnosis postpartum thyroiditis

Answer 9

Positive thyroid peroxidase antibody

Question 10

S&S Subacute granulomatous Thyroiditis (de Quervain)

Answer 10

Symptoms of hyperthyroidism
Prodrome URI
Severely PAINFUL, tender goiter

Question 11

S&S HYPOthyriodism

Answer 11

Fatigue 
Concentration Difficulties 
Constipation
Weight Gain 
Dry Skin/ coarse hair 
Hoarseness

Question 12

Amiodarone effects on thyroid

Answer 12

amIODarone has a high iodine content and has an intrisic effect on thyroid metabolism.

Decreased peripheral T4 conversion
Inhibition of thyroid synthesis
Amiodarone- induced thyrotoxicosis

Question 13

Diagnosis: Worsening fatigue, difficulty concentrating, abdominal pain, weight gain, Hx of cardiomyopathy with left ventricular systolic dysfunction and a-fib. Dry skin, elevated AST, ALT, and all phos.

Answer 13

HYPOTYROIDISM due to Amiodarone toxicity!

Question 14

Mechanism of AIT (Amiodarone induced thyrotoxicosis)

Answer 14

Type 1: iodine induced hormone synthesis. Common in pts with nodular and Graves.
Type 2: destructive thyroiditis

Question 15

Treatment of Amiodarone effects on thyroid

Answer 15

Stop Amiodarone.

Hypo: Levothyroxine
AIT type 1: Antithyroid drug
AIT type 2: Glucocorticoids

Question 16

Estrogen effect on thyroid metabolism

Answer 16

Estrogen up regulates the productions of thyroxine-binding globulin (TBG). Increased TBG cause a reduction in free T4 and T3

Question 17

ADR methimazole

Answer 17

Agranulocytosis
1st trimester teratogen
cholestasis

Question 18

ADR PTU

Answer 18

Agranulocytosis
Hepatic failure
ANCA- associated vasculitis

Question 19

Mechanism of hoarseness in hypothyroidism

Answer 19

matrix glycosaminoglycan accumulation in tissue interstitial spaces (also causes coarse hair and skin)

Question 20

S&S neonatal thyrotoxicosis

Answer 20

Warm moist skin
Tachycardia 
Poor feeding/ weight gain 
Irritability 
Low birth weigh/ premie

Question 21

Management neonatal thyrotoxicosis

Answer 21

Self resolved by 3mo

Methimazole plus B-blocker (severe symptomatic)

Question 22

Mechanism of neonatal thyrotoxicosis

Answer 22

transplacental passage of maternal anti-TSH receptor antibody