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MCQ Endocrine Review

Terms in this set (72)

Buzzword: Increased rT3
low T4, abnormally low T3, low, normal, or high TSH, patient has sepsis
Euthyroid Sick Syndrome
abnormal thyroid hormone seen w/ nonthyroidal illness
may mimic 2ndary hypothyroidism
cardiac disease, sepsis, malignancy, surgery etiologies
Child born w/ macroglossia, coarse features, umbilical hernia, and weight gain
Cretinism: congenital hypothyroidism

2/2 maternal hypothyroidism or infant hypopituitarism
Mental development issues if not corrected
How do you tx a baby w/ cretinism?
Levothyroxine (Thyroid hormone) to increase levels since they are in a hypothyroid state and you want to correct before cognitive delays are permanent
Levothyroxine is replacement _____. What do you need to do to the dose during pregnancy?
T4
Increase the dose during pregnancy (3rd tri)
nonpitting fluid retention state d/t mucopolysaccharide build up MC in the pre-tibial area
Myxedema (associated w/ hypothyroidism, some cases of hyperthyroidism-pre-tibial myxedema)
What are some secondary causes of hypothyroidism?
congenital hypopituitarism (can cause cretinism)
Sheehan Syndrome (pituitary necrosis)
TRH deficiency

Causes not involving the thyroid gland itself
Secondary or Tertiary
Involve pituitary or hypothalamus as issue
What ELE abnormality may occur w/ hypothyroidism?
hypothyroidism
may be 2/2 alteration in renal tubular sodium reabsorption
dull, not as sharp, less than full alertness
obtundation
Your patient presents w/ AMS, BP 95/60, random glucose 95, sodium 120, they are taking very shallow infrequent breaths w/ a RR of 12, Temp is 95 and they are very cold to touch. ABG reveals CO2 of 50. They have EKG changes consistent w/ NSTEMI and a hx of Hashimoto's disease. What do you think could be going on?
Myxedema Crisis
Severe, lifethreatening hypothyroidism
HALLMARKS: AMS, obtundation, CO2 retention (respiratory acidosis), hypoventilation, hypoglycemia, hyponatremia, hypothermia, hypotension, precipitated by sepsis, cardiac disease, exposure to cold, CNS issue, drug use, non-compliance w/ tx, respiratory distress
How should you treat a patient presenting acutely to the ER w/ myxedema crisis?
IV bolus of thyroxine (t4)
Want to get their thyroid hormone levels up bc the issue is an exacerbation of their hypothyroidism (low thyroid hormone).

Admin hydrocortisone if adrenal insufficiency is suspected.

Passive warming (blankets in a warm room), rapid warming is CI

NS (hyponatremia is common)
What should you NOT give a patient in myxedema crisis?
morphine
they are overly sensitive to it in myxedema crisis and it can cause death
What is the MC presentation of myxedema crisis?
MC in elderly woman w/ long standing hypothyroidism presenting in the winter (cold weather)
What could happen if a Graves patient who just had radioactive iodine ablation of the thyroid if you don't start them on levothyroxine after the procedure?
Myxedema crisis
now have hypothyroidism for rest of their lives after ablating their hyperthyroid
What is the most common infectious organism responsible for suppurative thyroiditis? (painful)
Gram + bacteria (s. aureus)
What test is required for dx and tx of suppurative thyroiditis? (painful)
FNA w/ Gram stain and culture
What is the MC cause of painful thyroid gland?
Painful Subacute Thyroiditis (de Quervain)
What is the tx of choice for subacute thyroiditis?
ASA



Steroids add no benefit
Can lessen sx w/ BB & iodinated contrast products
Antithyroid meds ususally of no benefit
What is the thyroid normally like in Hashimoto's thyroiditis?
diffusely enlarged w/ firm, small nodules
cold nodules on RAIU are ______ and require ______ because they pose a higher risk for thyroid cancer.
hypofunctioning
surgical excision
When would you do a RAIU if you palpate a nodule (usually >1cm if palpable)?
If the TSH is low (suspecting hyperthyroidism)
What is the most common type of thyroid nodule?
adenoma
Best initial test for evaluation of palpable thyroid nodule on physical exam.
FNA biopsy + US guided
What should the management be for hot nodules on RAIU?
US observation q 6-12mo.
Less likely malignant if hyperfunctioning (hot) nodule
MC type of thyroid cancer?
papillary

MC in young females
associated w/ childhood radiation exposure
least aggressive
Thyroid cancer associated w/ Multiple Endocrine Neoplasia Type II and not w/ radiation exposure. Arises from the parafollicular (C) cells that secrete calcitonin.
medullary thyroid cancer
Thyroid cancer most likely to present w/ mets.
follicular thyroid carcinoma
most aggressive type of thyroid cancer.
anaplastic carcinoma
What are the MC type of mets associated w/ papillary thyroid cancer?
local cervical lymph node mets
Which kind of thyroid cancer are you at higher risk for w/ iodine deficiency?
follicular carcinoma

local mets, distant uncommon
more aggressive than papillary but still very slow growing
T or F: medullary thyroid cancer takes up iodine.
False
What kind of sx do patients w/ anaplastic thyroid carcinoma usually present with?
compressive sx

may invade the trachea

poor prognosis
What is the other name for toxic multinodular goiter?
Plummers Disease
autonomous functioning nodules
MC in elderly
clinical hyperthyroidism
diffuse, enlarged goiter
No skin or eye changes!
palpable nodules may be present
compressive sx
hyperthyroid function tests
RAIU: patchy area of both increased uptake and decreased uptake
MC therapy: radioactive iodine, if compressive sx present then subtotal thyroidectomy
methimazole or PTU
Toxic Multinodular Goiter (TMG)
Plummer's Disease
Same presenting sx as Plummer's disease (hyperthyroid like sx)
but one autonomously functioning thyroid nodule
hot nodule with increased uptake on RAIU
Same tx: radioactive iodine (MC) or Methimazole or PTU
Toxic Adenoma
What are compressive sx?
dyspnea
dysphagia
stridor
hoarseness
laryngeal compression
Side effects of methimazole and PTU
Agranulocytosis (so monitor WBC levels)
hepatitis
Which drug is preferred in 1st tri of pregnancy?
PTU
If your patient has a TSH pituitary adenoma, what would the uptake be like on RAIU?
diffuse uptake
transphenoidal surgery is the MC way to remove the tumor
What is a drug used for sx relief in thyroid storm?
BB
In addition to antithyroid meds what else might you give a patient in thyroid storm?
oral/iv sodium iodide to decrease thyroid hormone synthesis
What drug should you avoid in thyrotoxicosis crisis?
ASA (increases the release of T3/T4).
What do glucocorticoids do in the setting of thyroid storm?
IV glucocorticoids inhibit the conversion of T4 to T3 peripherally and inhibits thyroid hormone production
2nd MC cause of hyperthyroidism behind Graves (#1)
Toxic Multinodular Goiter (Plummer's Disease)
In which thyroid condition may you see onycholysis?
Hyperthyroidism
Graves
3 complications of chronic thyrotoxicosis?
osteoporosis
finger swelling
clubbing

Thyroid acropachy (thyroid osteopathy)

extreme manifestation of autoimmune thyroid disease

digital clubbing, swelling of digits, and periosteal reaction of extremity bones

Almost always associated w/ opthalmopathy and thyroid dermopathy
what is a cardiac complication of thyrotoxicosis?
A-Fib
tx w/ warfarin for anticoagulation to prevent thromboembolic events
state of thyrotoxicosis 2/2 to ingesting too much exogenous thyroid hormone
thyrotoxicosis factitia
rare
diastolic HTN
Systolic HTN w/ wide pulse pressure
Diastolic HTN: hypothyroidism

Systolic HTN w/ wide pulse pressure: Hyperthyroidism
2 MC causes of primary hyperparathyroidism: excess (inappropriate) PTH secretion.
High PTH, High Ca, Low Phos

1) parathyroid adenoma (MC)80%
2) parathyroid hyperplasia

can also occur in patients taking lithium or in MEN 1 or 2a
What is the MC 2ndary cause of hyperparathyroidism (high PTH d/t hypocalcemia or vitamin D deficiency)?
Chronic Kidney disease

(BC kidneys convert VIt D to its usable form)

Severe calcium or vit D deficiency can cause secondary hyperparathyroidism too. (less common compared to CKD though)
2 MC causes for hypoparathyroidism.
Low PTH, Low Ca, High Phos

1) postsurgical (thyroidectomy, etc.)

2) autoimunne destruction of parathyroid glands
Why do you see increased DTR in Hypocalcemia?
decreased excitation threshold for heart, nerves, and muscle-less stimulation needed for actiavtion/contraction
What are the 2 types of primary osteoporosis?
Type I Postmenopausal 2/2 estrogen drop, decreases trabecular (spongy) bone that is located inside hard (cortical) bone

Type II Senile 2/2 age, usually >70yrs, thinning of both spongy and cortical bone
What are the MC causes of secondary osteoporosis?
chronic disease (ie, DM, hyperparathyroidism, CKD, Cushing's syndrome, thyrotoxicosis)

drugs (EXOGENOUS GLUCOCORTICOID USE)
MC pathologic fractures associated w/ osteoporosis (3)
Hip (femur head)
vertebral (spine)
distal radius (Colle's fracture)
D/t mainly trabecular bone loss in Type I Osteoporosis (postmenopausal) what are the most common fracture types?
increased vertebral compression
wrist fractures
d/t both trabecular and corticol bone loss--> MC fractures in Type II Senile Osteoporosis?
Hip/Pelvic fractures
MC areas of vertebral spine compression and loss of vertebral height (MC Type I postmenopausal osteoporosis)?
Thoracic and Lumbar vertebral spine compression
1st line agent for osteoporosis tx
Bisphosphonates (Alendronate aka Fosamax)

MOA: slows down bone loss by inhibiting osteoclast-mediated bone resorption

Take overnight fast, w/ water, no food, remain upright 30min after, empty stomach--breakfast 30-60min after

S/E: pill esophagitis, jaw osteonecrosis, pathologic femur fx

Most potent: IV Pamidoronate & Zoledronic acid
What SERM is used in post menopausal women to reduce progression of osteoporosis, protective vs breast CA, NOT associated w/ risk of endometrial CA?
Raloxifene
In estrogen deficient women w/ Type I Osteoporosis (post-menopausal) what other therapy may be useful (in addition or instead of a SERM)?
Estrogen
also helps w/ sx of menopause

S/E: increased risk of endometrial CA and breast CA, CAD, stroke, venous thromboembolism
blue tinted sclera and presenile deafness
severe osteoporosis and spontaneous fractures in childhood
osteogenesis imperfecta
Bone disorders associated w/ CKD
Osteoporosis but mainly.....

Osteomalacia AND ostetitis fibrosis cystica
what is the pathophysiology of renal osteodystrophy 2/2 ckd?
failure of the kidneys to eliminate phosphorous so you get elevated serum phosphorous, failure to reabsorb Ca and failure to make the active form of vitamin d (calcidilol to calcitriol) which works to stimulate gut resorption of Ca and bone resorption of Ca to increase serum Ca levels

So high phos, low ca, and high PTH
SECONDARY HYPERPARATHYROIDISM
soft bones
2/2 vitamin D deficiency
low calcium and low phosphate
high ALP
decreased mineralization of bone osteoid ONLY-cortical bone thinning
diffuse bone pain, muscular weakness, bowing of long bones
RadiographL looser lines (zones) pseudofracture lines, layers of demineralized bone
Osteomalacia (adults)
1st line tx for osteomalacia and rickets
ergocalciferol (Vit D)
delayed fontanel closure, growth retardation, delayed dentition, costal cartilage enlargement, long bones bow out, fuzzy cortex
rickets (children)
High ALP in which bone issues?
Renal Osteodystrophy
Osteomalacia

NOT osteoporosis
2 GI related complications of hypercalcemia.
Pancreatitis
PUD
Elevated calcium levels w/ low PTH suggest?
malignancy
Extreme elevations of both calcium and PTH suggest?
parathyroid cancer
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