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Ahmed Endo II Exam depression > Lecture 6: Thyroid and Parathyroid Disorders > Flashcards

Lecture 6: Thyroid and Parathyroid Disorders Flashcards

1
Q

If serum values of Ca2+ and PO4 are moving in the same direction (i.e., both ↓) this tell you that the problem is related to what?

A

Vitamin D

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2
Q

If calcium is high, but PTH is low, what are some of the underlying causes you need to investigate?

A
  • Malignancy + Metastasis + Lymphoma
  • Granulomatous disease
  • Drugs
  • Multiple myeloma
  • Vit D intoxication
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3
Q

Polyuria + dehydration + renal impairment are associated with (chronic or acute) development of hypercalcemia?

A

Acute

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4
Q

Which medication should be used in a patient with chronic hypercalcemia who has developed HTN?

A

Loop diuretics —> ↓ serum [Ca2+] and ↓ BP

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5
Q

If you suspect a vitamin D deficiency in a patient with ↓ Ca2+ and ↓ PO4, which form of vitamin D should you order a test for, why?

A
  • 25-OH Vitamin D = the storage form; important to check how depleted the pt is
  • 1,25-OH Vit D the active form should also be checked
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6
Q

What’s the formula for corrected calcium when albumin is low?

A

Cacorrected= measured Ca2+ + 0.8 (4.0 - serum albumin)

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7
Q

What would you expect the serum and urine calcium levels to be like in someone who is bed ridden and has normal kidney function?

A
  • Serum levels will likely be normal
  • Urine levels will be elevated = hypercalciuria
  • Due to ↑ osteoclast activity causing ↑ Ca2+ in blood and suppression of PTH from the high Ca2+ –> normal renal function maintains homeostasis
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8
Q

What is responsible for the hydroxylation of 25-OH vitamin D to 1,25-OH vitamin D?

A

PTH

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9
Q

What is a peripheral vs. central DEXA scan used for?

A
  • Central: used for larger bones like the spine or hips
  • Peripheral: used for screening ONLY: wrist, heel, leg, fingers
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10
Q

Which “T score” on a DEXA scan is considered indicative of osteoporosis?

A

T score < -2.5

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11
Q

What is the recommended type of calcium supplement for replacing the calcium in someone with hypocalcemia/osteoporosis; what if they have low stomach acid?

A
  • Calcium Carbonate (recommended)
  • Calcium citrate if LOW stomach acid
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12
Q

What EKG finding is indicative of hypercalcemia vs. hypocalcemia?

A
  • Hypercalcemia = shortened QT interval –> reflects accelerated repolarization
  • Hypocalcemia = prolonged QT interval
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13
Q

What are the actions of 1,25-OH-vit D on the bone, kidney, and gut?

A
  • Bone = ↑ Ca2+ resorption; stimulate osteoclasts
  • Kidney = ↑ Ca2+ and PO4 reabsorption
  • Gut = ↑ Ca2+ and PO4 absorption
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14
Q

↑ TSH and ↑ T4 would be indicative of what underlying condition?

A

TSH producing tumor

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15
Q

What are 2 opthalmic findings assoc. w/ hyperthyroidism?

A
  • Lid lag
  • Exophthalmos
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16
Q

What is often the only thing needed for the diagnosis of Graves disease?

A

History and PE

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17
Q

Which lab tests can be useful in supporting diagnosis of Graves disease, but are not needed?

A
  • TSH level (will be suppressed)
  • Thyroid scan will show unique homogenous uptake of 131I
  • TSI antibody, unique to Graves, but not needed for diagnosis
18
Q

What will a thyroid scan of someone with Graves show?

A

Homogenous DIFFUSE ↑ uptake

19
Q

What are 3 pitfalls to using a thyroid scan for Graves diagnosis?

A
  • Time consuming and expensive
  • The isotopecosts more (iodine)
  • Scanning at 6 hours and at 24 hours
20
Q

Which medication is of utmost importance in controlling the cardiovascular and neurological sx’s of Graves?

A

Beta blockers –> specifically non-selective beta-blockers

21
Q

If a patient cannot tolerate a beta-blocker, due to asthma, what else can be given for Graves disease?

A

Trial of CCB

22
Q

When evaluating a thyroid nodule found on exam, which test is critical to the work up, why?

A

TSH level –> critical to know if nodule or gland is hyperfunctioning

23
Q

If someone with a thyroid nodule has low TSH, what is the next step in diagnosing the patient?

A
  • Thyroid scan
  • Something is suppressing the TSH
24
Q

If someone with a thyroid nodule has normal TSH, what is the next step in diagnosis?

A
  • Fine needle aspiration (FNA)
  • If TSH is not suppressed, have to see what the nodule is doing; may be cold…. not producing thyroid hormone
25
Q
A

B. Toxic nodule

26
Q

What are some structures in the neck that you should be worried about a benign thyroid nodule potentially damaging?

A
  • Recurrent laryngeal N.
  • Parathyroid glands
27
Q

What are 5 pieces of information which are helpful in predicting that a thyroid nodule is benign?

A
  • Family hx of benign nodules
  • Hashimoto’s
  • TENDERNESS
  • Mobile nodule
  • Concomitant diagnosis of hypo- or hyperthyroidism
28
Q

What are 6 factors which help predict a thyroid nodule may be malignant?

A
  • Very young pt
  • Very old pt
  • MEN
  • Hx of neck irradiation
  • FIRM, FIXED nodules
  • Lymphadenopathy
29
Q

Why are we more worried about “cold” thyroid nodules?

A
  • Represent 85% of all thyroid nodules
  • 85% of them are benign, BUT 15% are malignant
30
Q

If a FNA comes back showing a thyroid nodule is benign, what is the next best step in treatment?

A
  • Monitor by US
  • Surgery if further growth or suspicious cytology
31
Q

What are the classic findings of TSH and T4 in a patient with pituitary adenoma as source of hyperthyroidism?

A
  • Very high TSH
  • High to very high T4
32
Q

What is your working diagnosis based off the labs?

A

Hypothyroid - Hashimoto burn out

33
Q

What would the seurm levels of TSH, T4, and T3 be like in patient with hypothyroidism due to pituitary failure?

A
34
Q

Loss of lateral aspects of eyebrows (Queen Anne Sign) is a finding associated with what endocrine abnormality?

A

HYPOthyroidism

35
Q

What cardiovascular findings are typical of hypothyroidism?

A
  • Bradycardia
  • ↓ systolic pressure
  • ↓ or ↑ diastolic pressure
  • Non-pitting edema (myxedema)
  • Pitting edema may be seen
36
Q

What is the most useful lab test in diagnosis hypothyroidism and should be the first test ordered to assess thyroid function?

A

TSH

37
Q

Which cause of hypothyroidism could be misleading based on TSH levels?

A

Pituitary dysfunction –> ↓ TSH (usually would expect ↑ TSH)

38
Q

With the availability of free T4, why should the measure of total T4 (or total T3) be avoided?

A

Total T4 and T3 is affected by the binding proteins

39
Q

Which serum antibody is the most helpful in making the diagnosis of autoimmune hypothyroidism?

A

Anti-TPO

40
Q

Thyroid stimulating immunoglobulins (TSI) levels can be useful in the diagnosis of what?

A

Graves

41
Q

What is the most important aspect of assessment when using thryoid replacement therapy?

A

- Clinical observation of the sx’s is most important

  • Watch for over treatment
  • Development of sub-clinical or overt HYPERthyroidism

Ahmed Endo II Exam depression (7 decks)

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