Y2 ENDOCRINE THYROID CONDITIONS AND TREATMENT

Question 1

management of medullary thyroid cancer in MEN2?

Answer 1

prophylactic thyroidectomy.

Question 2

• raised serum calcium
• raised serum PTH or inappropriately normal
• increased urine calcium excretion.

Answer 2

primary hyperparathyroidism

Question 3

Hypercalcaemia of malignancy due to?

Answer 3

• metastatic bone destruction
• PTH related protein from solid tumours
• osteoclast activating factors

Question 4

management of primary hyperparathyroidism?

Answer 4

SURGERY OR NOTHING

Question 5

what are the indications for parathyroidectomy?

Answer 5

• end organ damage (bone disease, gastric ulcers, renal stones, osteoporosis).
• v. high calcium
• if under 50
• if eGFR <60ml/min

Question 6

primary overactivity of parathyroid e.g. adenoma.

Answer 6

primary hyperparathyroidism

Question 7

physiological response to low calcium.

Answer 7

secondary hyperparathyroidism

Question 8

parathyroid becomes autonomous after years of secondary disease.

Answer 8

tertiary hyperparathyroidism

Question 9

what structures are at risk during thyroid surgery?

Answer 9

• recurrent laryngeal nerves

- parathyroid glands

Question 10

what causes a midline neck mass in adults?

Answer 10

• enlarged thyroid gland
• enlarged lymph nodes
  Rare outwith childhood:
• thyroglossal cyst
• cystic hygroma

Question 11

how do you differentiate between diffuse and focal thyroid pathology?

Answer 11

• radioisotope studies

- ultrasound

Question 12

when do you ultrasound the thyroid?

Answer 12

• euthyroid patients with goitre/palpable nodules.

- hyperthyroid with focal masses/ radioisotope uptake

Question 13

why use thyroid scintigraphy?

Answer 13

to assess pattern and quantity of tracer uptake.

• homogenous increased uptake = graves.
• homogenous reduced uptake = thyroiditis.
• focal uptake = multinodular goitre with dominant nodule

Question 14

homogenous increased uptake in thyroid scintigraphy?

Answer 14

graves

Question 15

homogenous reduced uptake in thyroid scintigraphy?

Answer 15

thyroiditis

Question 16

focal uptake in thyroid scintigraphy?

Answer 16

multinodular goitre with dominant nodule

Question 17

lytic lesion?

Answer 17

bone destruction

Question 18

sclerotic lesion?

Answer 18

bone formation

Question 19

diffuse brittle bones?

Answer 19

osteoporosis

Question 20

diffuse soft bones?

Answer 20

• rickets/osteomalacia

- pagets disease

Question 21

what may cause hypoparathyroidism?

Answer 21

• congenital absence (DiGeorge syndrome)
• destruction (surgery, radiotherapy, malignancy).
• autommune
• hypomagnesaemia
• idiopathic

Question 22

management of hypoparathyroidism?

Answer 22

• calcium supplement >1-2g/day.

vitamin D:

• tablets i.e. 1-alpha-calcidol 0.5-1mcg/day
• depot injection of cholecalciferol 300,000 units 6 monthly.

Question 23

calcium release from cells is dependent on?

Answer 23

magnesium

Question 24

in magnesium deficiency, intracellular calcium is?

Answer 24

high

Question 25

in magnesium deficiency, what happens to PTH release?

Answer 25

it is inhibited

Question 26

management of hypomagnasaemia?

Answer 26

magnesium + calcium if low.

Question 27

what happens to skeletal and muscle receptors of PTH in hypomagnasaemia?

Answer 27

they become less sensitive to PTH

Question 28

causes of hypomagnasaemia?

Answer 28

• alcohol
• drugs e.g. thiazides and PPI
• GI illness, pancreatitis, malabsorption.

Question 29

what biochemical abnormalities are seen in pseudohypoparathyroidism?

Answer 29

• low calcium

- elevated PTH

Question 30

what biochemical abnormalities are seen in pseudopseudohypoparathyroidism?

Answer 30

• normal calcium

- high PTH

Question 31

what may occur as a result of chronic renal disease?

Answer 31

• vit. D deficiency

- secondary hyperparathyroidism.

Question 32

management of vit. D deficiency/secondary hyperparathyroidism due to chronic renal disease?

Answer 32

• phosphate binders
• titrate treatments to PTH levels
• check 1-25, OH vit. D