Y2 ENDOCRINE THYROID CONDITIONS AND TREATMENT Flashcards
management of medullary thyroid cancer in MEN2?
prophylactic thyroidectomy.
- raised serum calcium
- raised serum PTH or inappropriately normal
- increased urine calcium excretion.
primary hyperparathyroidism
Hypercalcaemia of malignancy due to?
- metastatic bone destruction
- PTH related protein from solid tumours
- osteoclast activating factors
management of primary hyperparathyroidism?
SURGERY OR NOTHING
what are the indications for parathyroidectomy?
- end organ damage (bone disease, gastric ulcers, renal stones, osteoporosis).
- v. high calcium
- if under 50
- if eGFR <60ml/min
primary overactivity of parathyroid e.g. adenoma.
primary hyperparathyroidism
physiological response to low calcium.
secondary hyperparathyroidism
parathyroid becomes autonomous after years of secondary disease.
tertiary hyperparathyroidism
what structures are at risk during thyroid surgery?
- recurrent laryngeal nerves
- parathyroid glands
what causes a midline neck mass in adults?
- enlarged thyroid gland
- enlarged lymph nodes
Rare outwith childhood: - thyroglossal cyst
- cystic hygroma
how do you differentiate between diffuse and focal thyroid pathology?
- radioisotope studies
- ultrasound
when do you ultrasound the thyroid?
- euthyroid patients with goitre/palpable nodules.
- hyperthyroid with focal masses/ radioisotope uptake
why use thyroid scintigraphy?
to assess pattern and quantity of tracer uptake.
- homogenous increased uptake = graves.
- homogenous reduced uptake = thyroiditis.
- focal uptake = multinodular goitre with dominant nodule
homogenous increased uptake in thyroid scintigraphy?
graves
homogenous reduced uptake in thyroid scintigraphy?
thyroiditis
focal uptake in thyroid scintigraphy?
multinodular goitre with dominant nodule
lytic lesion?
bone destruction
sclerotic lesion?
bone formation
diffuse brittle bones?
osteoporosis
diffuse soft bones?
- rickets/osteomalacia
- pagets disease
what may cause hypoparathyroidism?
- congenital absence (DiGeorge syndrome)
- destruction (surgery, radiotherapy, malignancy).
- autommune
- hypomagnesaemia
- idiopathic
management of hypoparathyroidism?
- 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.
calcium release from cells is dependent on?
magnesium
in magnesium deficiency, intracellular calcium is?
high
in magnesium deficiency, what happens to PTH release?
it is inhibited
management of hypomagnasaemia?
magnesium + calcium if low.
what happens to skeletal and muscle receptors of PTH in hypomagnasaemia?
they become less sensitive to PTH
causes of hypomagnasaemia?
- alcohol
- drugs e.g. thiazides and PPI
- GI illness, pancreatitis, malabsorption.
what biochemical abnormalities are seen in pseudohypoparathyroidism?
- low calcium
- elevated PTH
what biochemical abnormalities are seen in pseudopseudohypoparathyroidism?
- normal calcium
- high PTH
what may occur as a result of chronic renal disease?
- vit. D deficiency
- secondary hyperparathyroidism.
management of vit. D deficiency/secondary hyperparathyroidism due to chronic renal disease?
- phosphate binders
- titrate treatments to PTH levels
- check 1-25, OH vit. D
