(hans) endocrine p125 - 131 Flashcards
what are the 3 causes of hypothyroidism?
Hashimoto, Idodine def, Amiodarone
symptoms of hypothyroidism is characterized all bodily process being slowed down except for
menstrual flow
a 55 y/o female comes in for high cholesterol with chronic fatigue. blood work shows high TSH (less than double) with normal T4, what is the best next step
order antithyroid peroxidase/antithyroglobulin antibodies to check Hashimoto
how would you differentiate Graves dz from other types of hyperthyroidism?
only Graves has eyes (proptosis) and skin symptoms such as pretibial myxedema
what type of brain malignancy can cause hyperthyroidism?
pituitary adenoma by increasing TSH
what is the one thing that is commonly shared by all hyperthyroidism?
elevated T4
dx?
a pt comes in for recent hyperreflexia and you suspect hyperthyroidism and order T4, TSH, To your surprise both T4 and TSH were elevated.
pituitary adenoma the only cause of hyperthyroidism with elevated TSH
dx?
a pt comes in with hyperthyroidism with tender thyroid
subacute thyroiditis
dx?
a healthcare professional studying for step 2 ck who has access to a hospital pharmacy comes in with hyperthyroidism with involuted gland that is not palpable.
exogenous thyroid hormone use
in terms of the lab finding what is unique about Graves dz among other causes of hyperthyroidism?
only Graves has TSH receptor antibodies
a young female pt comes in with hyperthyroidism symptoms and you suspect Graves and want to test for antibody, however, before that you want to do one exam to differentiate, what would you do
radioactive iodine uptake (will be elevated unlike in other causes of hyperthyroidism)
best initial therapy for Graves ophthalmopathy?
steroids
in terms of clinical symptoms, what are signs you can differentiate low vs high calcium
low Ca2+ –> twitchy and hyperexcitable
high Ca2+ –> slow and lethargic
a pt with chronic liver dz comes in and you noticed that the pt has hypocalcemia, you want to treat, but before that what needs to be done?
check albumin, low albumin brings down total calcium but free Ca2+ is normal.
what are the 6 clinical symptoms of hyperexcitability in hypocalcemia?
- chvostek sign (facial nerve hyperexcitability)
- carpopedal spasm
- perioral numbness
- mental irritability
- seizures
- tetany (Trousseau sign)
if blood test is not readily available how would you diagnose hypocalcemia?
QT prolongation
name 3 causes for hypocalcemia
- primary hypoparathyroidism from prior neck surgery such as thyroidectomy where parathyroids gland is removed
- hypomagnesemia
- renal failure
what are the 2 diagnostic steps for thyroid nodule?
- perform thyroid function test (TSH, T4)
2. if normal, must biopsy the gland
treatment for acute hypercalcemia?
- saline hydration at high volume
2. bisphosphonate: pamidronate, zoledronic acid
what are the 2 major causes for hypercalcemia?
primary hypercalcemia and cancer
a pt with hyperthyroidism present with tender node, dx?
also what is the tx?
subacute thyroiditis, aspirin
treatment for Graves dz?
radioactive iodine
what are the 2 mech of propranolol for acute hyperthyroidism and “thyroid storm”
blocks target organ effect, inhibits peripheral conversion of T4 –> T3
what are the 7 causes for hypercalcemia
- primary hyperparathyroidism
- cancer
- vit D intoxication
- sarcoidosis/other granulomatosis dz
- thiazide diuretics
- hyperthyroidism
- metastases to bone and multiple myeloma
test of choice for bone effects of high PTH?
DEXA densitometry
primary hyperparathyroidism is from (3places)
- solitary adenoma (80-85%)
- hyperplasia of all 4 glands (15-20%)
- parathyroid malignancy (1%)
most common presentation of hyperparathyroidism?
asymptomatic elevation of calcium level found on routine blood work
what are the 4 slower manifestations of hyperparathyroidism?
- osteoporosis
- nephrolithiasis and renal insufficiency
- muscle weakness, anorexia, nausea, abdominal pain
- peptic ulcer dz (calcium stimulates gastrin)
what 2 drugs are used to stop the hormone production for hyperthyroidism?
methimazole and propylthiouracil
