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Endocrine II Final > Parrot DSA Chapter 26 CMDT > Flashcards

Parrot DSA Chapter 26 CMDT Flashcards

1
Q

What is the most sensitive test for screening for primary hypo or hyperthyroidism?

A
  • TSH

- free thryoxin (T4)

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2
Q

How is TSH in hypothyroidism?

A

-high in primary, low in secondary

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3
Q

How are the antithyroglobulin and antithyroperoxidase antibodies in Hashimoto thyroiditis?

A

elevated

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4
Q

TSh in hyperthyroidism?

A

-suppressed except in TSH-secreting pituitary tumor or pituitary hyperplasia (rare)

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5
Q

T3 and free T3 in hyperthyroidism?

A

-elevated

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6
Q

I 123 uptake and scan in hyperthyroidism?

A

-increased uptake; diffuse versus “hot” foci on scan

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7
Q

Anti TPO and Anti TG antibodies in Graves Disease?

A

-Elevated

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8
Q

TSI and TSH receptor antibody in Graves?

A

-usually positive (65%)

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9
Q

What is the best diagnostic method for thyroid cancer if you see thyroid nodules?

A

-fine-needle aspiration (FNA) bioposy

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10
Q

How is cancer on a 123 I uptake scan?

A

-“cold”; less reliable than FNA

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11
Q

how does thyroid nodules look like on 99mTc scan?

A

-Vascular vs. Avascular

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12
Q

Thyroid nodule and ultrasonography

A
  • assist FNA biopsy
  • assessing risk of malignancy
  • monitoring nodules and patients after thyroid surgery for carcinoma
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13
Q

What are some common manifestations of Hypothyroidism?

A
  • weight gain, lethargy…. general hypo stuff

- palpably enlarged thyroid… b/c elevated serum TSH levels (Hashimoto’s)

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14
Q

Lab findings for hypothyroidism

A

-best is TSH (incrased in primary, decreased in secondary)
-FT4 will be low
-hyponatremia/glycemia
-abnormal sperm morphology
-if autoimmune, there will be antibodies (TPO, TG)
-

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15
Q

What is subclinical hypothyroidism?

A
  • having normal serum FT4 w/ TSH that is above reference range
  • 65 y/o
  • transient… it’s fine
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16
Q

Tx for hypothyroidism?

A

-levothyroxine

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17
Q

Where do we want to keep the TSH level at when treating hypothyroidism?

A

-0.4-2

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18
Q

What would require a larger initial dose of levothyroxine ?

A

Myxedema crisis

-can interfere with intestinal absorption of oral levo

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19
Q

What do we have to do before we start thyroid hormone therapy?

A

-look for adrenal insufficiency and angina

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20
Q

When would we need to increase the levothyroxine doseage?

A

-if there are other drugs that increase the hepatic metabolism of levo

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21
Q

If there is elevated serum TSH, what does that mean about the amount of thyroxine that we are giving them?

A
  • it’s not enough

- but make sure that they’re actually taking it…

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22
Q

If they have a normal TSH level, what do you do?

A
  • carefully assess them for other conditions…. like adverse drug rxn or something like that
  • if they have CAD, make it so that their TSH levels are a little more elevated
23
Q

If they have a low or suppressed serum TSH level, what do we do?

A
  • < .4
  • reduce it if it looks like hyperthyroidism
  • increased risk of A fib and osteoporosis if they have primary hypothyroidism and take levothyroxine…so lower the dose of levothyroxine
24
Q

Graves disease

A
  • mos common cause of thyrotoxicosis
  • women»>men
  • auto antibodies bind TSH receptors… thyroid hormone made
  • too much iodine can cause it
25
Q

Postpartum Thyroiditis

A

-hashimoto thyroiditis that occurs in the first 12 months after delivery

26
Q

Subacute Thyroiditis

A
  • De quervain or granulomatous thyroiditis
  • viral infection
  • differentiate from infectious (suppurative bacterial) thyroiditis
27
Q

Silent thyroiditis

A
  • subacute lymphocytic thyroiditis

- drugs can cause it (Lithium, amiodarone)

28
Q

Signs and symptoms of Hyperthyroidism

A
  • heat intolerance
  • irritability
  • diffusely enlarged thyroid
  • forceful heartbeat
  • exophthalmos
  • pretibial myxedema
29
Q

Lab findings for hyperthyroidism

A
  • thyroid hormones increased
  • suppressed TSH
  • subclinical hyperthyroidism: lowered TSH but normal T4 and 3
  • +TSI
30
Q

What drug will give people high levels of T4 and FT4?

A

amiodarone

  • type 1: TSI +
  • Type 2: IL-6+
31
Q

Tx of Grave’s disease

A
  • Propranolol
  • Thiourea drugs: methimazole and PTU.. blocks organification
  • Iodinated contrast agents: blocks T4-T3 conversion
  • Radioactive iodine: don’t give to preggo or lactating woman
  • Thyroid surgery: try not to take everything out… leave some behind
32
Q

Which is preferred, methimazol or PTU?

A

Methimazole unless it’s the first trimester of preggo…. then PTU
-methimazole is more convenient to use

33
Q

Tx of hyperthyroidism from thyroiditis

A
  • propranolol
  • Ipodate sodium or Iopanoic acid to correct T3 levels
  • Thioureas are ineffective
34
Q

Is hashimoto an autoimmune condition?

A

yes

35
Q

Subacute thyroiditis

A
  • granulomatous… dequervain’s
  • giant cell thyroiditis
  • relatively common
  • viral infection… upper resp tract infection
  • incidence peaks in the summer
  • middle aged women
36
Q

How does subacute thyroiditis present?

A
  • usually painful enlargement of thyroid gland
  • w/ dysphagia
  • if no pain, it’s called silent thyroiditis
37
Q

Lab values for Hashimoto’s

A
  • anti TPO

- anti TG

38
Q

Lab values for subacute thyroiditis?

A
  • ESR markedly elevated
  • anithyroid titers are low
  • in infectious thyroiditis, both the leukocyte count and the ESR are usually elevated
39
Q

Tx for hashimoto thyroiditis?

A

-levothyroxine

40
Q

Tx for subacute thyroiditis?

A
  • aspirin… relieves pain and inflammation
  • Thyrotoxic sx are treated with propranolol
  • Iodinated contrast agents work well
41
Q

Signs and sx of hypoparathyroidism?

A
  • hypocalcemia
  • can happen with PPI
  • tetany, cramps, spasm, irritability, tingling,
42
Q

Lab values for hypoparathyroidism

A
  • Ca is low
  • P is high
  • PTH is low
  • hypomagnesemia may exacerbate symptoms and decreased parathyroid function
43
Q

What is the most common cause of hypercalcemia?

A
  • primary hyperparathyroidism
  • women in 70s
  • hypersecretion of PTH
  • adenoma is most common
  • size of adenoma correlates with PTH level
44
Q

Clinical findings of hyperparathyroidism?

A
  • Skeletal (bones): loss of cortical bone and gain of trabecular bone… so low density… vertebral fractures
  • Hypercalcemia manifestations: depression, constipation, and bone and joint pain…. diminished DTRs… polyuria and polydipsia
45
Q

Complications with hyperparathyroidism

A
  • long bone fractures
  • UTI’s from stones
  • clouding of sensorium
  • kidney disease
  • peptic ulcer and pnacreatitis
  • insulinomas or gastrinomas
  • hypercalcemia during gestation produces neonatal hypocalcemia
46
Q

What drugs are contrindicated in hyperparathyroidism?

A
  • thiazide diuretics
  • large doses of Vit A
  • calcium-containing antacids or supplements
47
Q

What are the very basics of bone densitometry?

A
  • DXA= dual energy x-ray absorptiometry
  • neglible radiation
  • used to look at osteoporosis and osteomalacia.. but can’t tell them apart
  • Uses “T” score
  • do 2-3 sites… hip, lumbar spine
48
Q

What are the T score significant values?

A

->or =1 is norm
- -1 to -2.5 is osteopenia (low bone density)
-

49
Q

Tx options for osteoporosis?

A
  • Vit D and calcium
  • Sex hormons
  • Bisphosphonates
50
Q

What do the Bisphosphonates do?

A

-indicated for pts with pathologic spine fracture or a low impact hip fracture… and for pts with osteoporosis (

51
Q

Osteomalacia

A
  • painful proximal muscle weakness; bone pain and tenderness
  • decreased bone density from defective mineralization
  • Increased alkaline phosphatase, decreased 25-OH vit D, hypocalcemia, hypocalciuria, hypophosphatemia, secondary hyperparathyroidism
52
Q

Vit D deficiency and resistance

A
  • most common cause of osteomalacia
  • low sunlight
  • usually asymptomatic at first, then pain comes
  • hypocalcemia or hypophosphatemia
53
Q

Paget Disease of Bone

A
  • Often asymtomatic
  • Bone pain may be the first symptom
  • Kyphosis, bowed tibias, large head, deafness, and frequent fractures
  • Serum calcium and phosphate normal; alkaline phosphatase elevated; urinary hydroxyproline elevated
  • dense, expanded bones on radiographs
54
Q

Signs and symptoms of Paget disease of bone?

A
  • mild
  • pelvis, vertebrae, femur , humerus, skull
  • doesn’t involve additional bones in the course
  • pain is worse at night
  • “headaches and an increased hat size”
  • hearing loss b/c of involvement of petrous temporal bone

Endocrine II Final (3 decks)

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