MedEd thyroid and misc endo Flashcards
What cells produce T3 and T4?
Follicular thyroid cells
What does negative feedback to the pituitary?
T3 and T4
What are hyperthyroid symptoms?
Tremor Anxiety Palpitations Diarrhoea Oligomenorrhea
What are hypothyroid symptoms?
lethary weight gain cold intolerance constipation menorrhagia reduced deep tendon reflexes
What are causes of hyperthyroid?
Graves
toxic multinod goitre
viral thyroiditis
drugs
What drug causes hyperthyroidism?
Amiodarone
What are causes of hypothyroid?
hashimotos
de quervains thyroiditis (subacute)
drugs
iodine deficiency
what drugs cause hypothyroidism?
amiodarone
lithium
How is hyperthyroid amanged?
Propanolol
Carbimazole
Radioiodine
How does carbimazole work in hyperthyroidism?
It is a TPO inhibitor and TPO is needed to make thyroxine
What is a side effect of carbimazole?
angranulocytosis ie no neutrophils
how is hypothyroidism managed?
Levothyroxine
what causes exopthalamos?
anti TSH receptor antibodies binding to TSH receptors behind the eyes
what are the defining features of graves?
bilateral exopthalamos
lid lag
pre tibial myexodema
thyroid acropachy
what are features of thyroid cancer?
non functional painless rapidly growing solitary irregular in shape palpable nodule thats hard and fixed hoarse voice dysphagia haemoptysis airway obstrcution cervical lymohadenopathy
what is the most common thyroid cancer?
papillary carcinoma
what are defining features of thyroid cancer?
hoarse voice
what is seen on hisotology in papillary thyroid cancer?
psammoma body
what thyroid cancer is associated with low dietary iodine intake
follicular carcinoma
what thyroid cancer is associated with MEN 2A and MEN 2B
medullary
what is the GS ix for thyroid cancer?
fine needle aspiration with biopsy
what is MEN 1 syndrome? what organs and cells are involved
parathyroid adenomas which are functional
pancreatic islet cells
pituitary problems eg prolactinoma
other cells can also be involved
what 3 cells/organs are involved with MEN 1 syndrome?
parathyroid gland
pancreas
pituitary
what are hypercalcaemia symtpoms?
stones
abdo groans
bones
psychic moans
what is GS ix for MEN 1 syndrome?
CT/MRI body
what causes non MEN 1 gastrinomas?
zollinger ellinson syndrome
what characterises MEN 2A and 2B?
meduallry thyroid cancer
what organs/cells are involved with MEN 2A?
parathyroid
phaeochromocytoma
what tumors/features are involved with MEN 2B?
phaeochromocytoma
neuromas
marfanoid habitus
what MEN syndrome is someone with marfans like habitus likely to have? what are some examples of this?
MEN 2B tall stature pectus excavatum long limbs eye problems
what is GS ix for MEN 2A and 2B? what else might you do
genetic testing for RET oncogene might also do: calcitonin urine catecholamines CT/MRI
what gene is tested for in MEN 2A and B?
RET oncogene
what are the types of MEN syndrome, what are they associated with and hwo do you remember this?
MEN 1- parathyroid, pancreas, pituitary (3Ps)
MEN 2A- phaeo, parathyroid (2Ps)
MEN 2B- phaeo, neuromas, marfanoid habitus (1P)
3Ps, 2Ps, 1P
what is the most common feature of carcinoid syndrome?
flushing
what is carcinoid syndrome? ie how does it arose
uncontrolled division of neuroendocrine tumors which mets to the liver
what is there buildup of in carcinoid syndrome?
serotonin
bardykinin
histamine
what are features of carcinoid syndrome?
flushing dairrhoea SOB pulmonary stenosis abdo pain itching
how fastly do tumors grow in carcinoid syndrome
slow growing
what gene mutation is carcinoid syndrome associated with?
MEN 1 mutation
what are ix for carcinoid syndrome?
urinary 5-HIAA
CT scan
ocreotide scan- specific
what is a specific ix for carcinoid syndrome?
ocreotide scan
describe what LH acts on in males v females and what it produces
males: acts on leydig cells, makes testosterone
females: acts on theca cells, makes progesterone
describe what FSH acts on in males v females and what it produces
males: acts on sertoli cells and makes sperm (spermatogenesis)
females: acts on granulosa cells and makes oestrogen
what are features of PCOS?
hirtuism
oligomenorrhea
polycycstic ovaries
infertility/trouble concieving
what causes physiological hypogonadism?
pregnancy
what causes negative feedback onto the gonadotrophs on the anterior pituitary
LH and FSH
what is a defining symptom of kallmanns syndrome hypogonadism
anosmia
where are gonadotrophs found
anterior pituiatry
what are some causes of primary hypogonadism in females
degenesis of the gonadotrophs eg turners
gonadal damage
primary ovarian failure
pcos
what are some causes of secondary hypogonadism
kallmann syndrome pituitary or hypothalamic tumor hyperprolactinaemia functional (low bmi, excess exercise, stress) ocp use
what are some causes of primary hypogonadism in males
gonadal degenesis eg klinefelters, cryptorchidism
gonadal damage
post orchitis eg mumps
what are features of hypogonadism?
delayed puberty infertility reduced libido amenorrhea night sweats/hot flushes erectile dysfunction symptoms of cause eg visual changes if tumor
what ix are done for hypogonadism?
preg test LH/FSH prolactin testosterone/oestradiol TFTs karyotyping MRI
what does gnrh stimulate the production of and where does it act?
growth hormone- acts on all organs
igf-1- made in organs and also acts everywhere
what is acromegaly usually caused by?
pituitary adenoma
what are features of acroomegaly
coarse facial features large tongue large jaw spade like hands and feet excess sweating organomeagly headaches, visual disturbance (bitemp hemianopia), hyperprolactinaemia etc- due to tumor
what are common complications of acromegaly?
carpal tunnel syndrome
colorectal cancer
diabetes
hypertension
what investigation is done to diagnose acromegaly? what is seen?
OGTT
there will be a paradoxical rise in GH if the patient has acromegaly
how is acromegaly managed? give GS and other treatments
GS: trans sphenoidal surgery to resect tumor
can also do radiotherapy, somatostatin analogues, dopamine receptor agonists and GH receptor antagonists
