Med III Lowy Exam 2 - Endocrine

causes of unintentional weight loss

dec intake, dec absorption, inc metabolism, inc caloric loss

the Ds of dec intake

depression, dementia, dentition, dysgeusia (altered taste)

what d/o cause anorexia leading to dec intake

malignancy, heart dz, lung dz, HIV, adrenal insufficiency, hypercalcemia

what dz cause abd pain leading to dec intake

cholelithiasis, chronic mesenteric ischemia, gastric ulcer

what are some causes of dec absorption leading to weight loss

amyloidosis, pancreatic insufficiency, celiac sprue, IBD, parasites, cholestatic liver dz

what are some causes of inc metabolism leading to weight loss that has to do with inc expenditure/demand

hyperthyroidism, chronic infxn, malignancy

what are some causes of inc metabolism leading to weight loss that has to do with inc adrenergic state/met demand

pheochromocytoma, amphetamine use

what are some causes of inc metabolism leading to weight loss that has to do with medicine exposure

exogenous thyroid hs, iodine exposure, amiodarone

what are some causes of inc caloric loss leading to weight loss

persistent vomiting, chronic diarrhea, fistula drainage, diabetic glycosuria

unintentional weight loss - you should always think of

GI, depression, malignancy, endocrine (adrenal insuff, hypercalcemia, hyperthyroidism, pheochromocytoma, diabetic glycosuria)

what is most likely to be rec’d as initial screening tests for unintentional weight loss

CBC w diff, ESR, albumin, LFTs, s. Ca, TSH, fasting glucose, UA, CXR, HIV Ab test, further testing

sx of hyperthyroidism

heat intolerance, diaphoresis, palpitations, weight loss, inc appetite, nervousness, anxiety, fatigue, weakness, oligomenorrhea, diarrhea/freq loose bowel movements, apathetic hyperthyroidism (weight loss, anorexia, fatigue), neck pain, warm skin, proptosis, pretibial myxedema

what are tests that should be ordered for hyperthyroidism suspicion

TSH, free T4, T3, TSH receptor ab, thyroid scan, ECG, biopsy

if pt has graves dz what are values of TSH, T4, T3

dec, inc, inc

if pt has secondary hyperthyroidism what are values of TSH, T4, T3

inc, inc, inc

if pt has subclinical hyperthyroidism what are values of TSH, T4, T3

dec, nl, inc/nl

what is the result of the thyroid scan most likely to indicate in graves

inc uptake

what is the result of the thyroid scan most likely to indicate in toxic multinodular goiter

inc uptake

what is the result of the thyroid scan most likely to indicate in thyroiditis

lo uptake

what is the result of the thyroid scan most likely to indicate in solitary adenoma

inc uptake

what is the result of the thyroid scan most likely to indicate in TSH secreting pituitary tumor

inc uptake

what is the result of the thyroid scan most likely to indicate in exogenous thyroid use

low uptake

what is the result of the thyroid scan most likely to indicate in metastatic thyroid cancer

low uptake

how to tx pt with hyperthyroidism

sx relief = propranolol. to dec T4 production = RAI, MMI, PTU, surgery

what sx does propranolol use for hyperthyroidism relieve

inc HR, palpitations, tremors, anxiety

RAI should be avoided in

pregnancy

MMI is indicated for pregnancy during

2nd and 3rd trimester

PTU is indicated for pregnancy during

1st trimester

SE of antithyroid drugs MMI and PTU

agranulocytosis, hepatitis

what are common first signs of agranulocytosis

fever, sore throat

sx of hypothyroidism

cold intolerance, weight gain, fatigue, constipation, hoarseness, depression, memory loss, menstrual changes, decreased libido, dry skin, goiter, delayed DTRs, periorbital and pretibial edema, carpal tunnel syn

is hashimoto thyroiditis a primary or secondary hypothyroidism

primary

is iodine deficiency a primary or secondary hypothyroidism

primary

is panhypopituitarism a primary or secondary hypothyroidism

secondary

is lithium a primary or secondary hypothyroidism

primary

is amiodarone use a primary or secondary hypothyroidism

primary

is radiation therapy a primary or secondary hypothyroidism

primary

is hypothalamic dz a primary or secondary hypothyroidism

secondary

is amyloidosis a primary or secondary hypothyroidism

primary

is sarcoidosis a primary or secondary hypothyroidism

primary

is scleroderma a primary or secondary hypothyroidism

primary

what dz that cause primary hypothyroidism are considered infiltrative dz

amyloidosis, sarcoidosis, scleroderma

what tests do you order in a pt suspected to have hypothyroidism

TSH, T4, T3, TPO ab, CBC (anemia), cholesterol/triglycerides, Cr phosphokinase, ECG (t wave flattening)

what are the values of TSH, T4, and T3 in a pt with hashimoto thyroiditis

inc, dec, dec

what are the values of TSH, T4, and T3 in a pt with secondary hypothyroidism

dec dec dec

what are the values of TSH, T4, and T3 in a pt with subclinical hypothyroidism

inc, nl, dec/nl (values like primary)

rec’d tx for hypothyroidism

synthroid. monitor TSH every 6-8 wks

SE of overreplacement of thyroid hs

a fib, bone loss

causes of inc calcium

primary hyperparathyroidism, malignancy, sarcoidosis, thiazide diuretics, vit A/D intox, hyperthyroidism, lithium, in cbone turnover, dec renal excretion of calcium (CKD, diuretics)

causes of dec calcium

primary hypoparathyroidism, CKD, vit D def, alcoholism, malabsorption, diuretics, aminoglycosides

2 m/c causes of hypercalcemia

primary hyperparathyroidism and malignancy

what are dz that can cause primary hyperparathyroidism

parathyroid adenoma, parathyroid hyperplasia, multiple adenoma, parathyroid cancer

what malignancies cause hypercalcemia

lung ca (esp squamous cell), head and neck ca, renal ca, T cell leukemia, breast ca, MM

vit D mediated reasons for hypercalcemia

excess vit D ingestion, granulomatous dz (sarcoidosis, TB), hodgkin dz, NHL

what dz of inc bone turnover causes hypercalcemia

hyperthyroidism, immobilization, vit A tox

what dz of dec renal excretion cause hypercalcemia

thiazide diuretics, milk alkali syn

pts with inc lithium use present w

high PTH, high Ca

what test is the most helpful in differentiating the cause of hypercalcemia

intact PTH assay

aside from ordering PTH assay to differentiate cause of hypercalcemia what else can you order

PTHrP

what other studies are ordered for hypercalcemia

UA, CXR, serum electrophoresis, urine electrophoresis, chest CT, abd CT

why do we look at UA for hypercalcemia pts

looking for RBCs to r/o malignancy

why do we order ECG in hypercalcemia pts

shortened QTi. to see electrolyte issues

how to tx hypercalcemia

IV saline to inc renal ca excretion. tx underlying cause (if its primary hyperparathyroidism then surgical excision)

causes of a goiter

iodine def, cretinism, drug rxns, hashimoto’s thyroiditis, pituitary adenoma, graves dz, thyroiditis, thyroid ca, benign thyroid neoplasm, thyroid hs insensitivity

iodine def causes

hypothyroidism

cretinism

congenital hypothyroidism

hashimoto’s thyroiditis

autoimmune, infiltration of lymphocytes

pituitary adenoma

hypersecretion of TSH by adenoma, rare

thyroiditis

disorders being acute, subacute, or chronic causing thyroid gland inflammation. hyperthyroidism progresses to hypothyroidism

benign thyroid neoplasm

usually hyperthyroid

thyroid hormone insensitivity

secretional hyper / sx hypothyroidism

excess thyroid hormone production and secretion

hyperthyroidism/thyrotoxicosis

hyperthyroidism/thyrotoxicosis sx

inc appetite, diarrhea weight loss, fatigue, inc pulse pressure, palpitations, heat intolerance, diaphoresis, hyperactivity, irritability, nervousness, anxiety, tremor, SOB, oligomenorrhea

primary hyperthyroidism

graves dz, TMNG, toxic adenoma

ex of secondary hyperthyroidism

pituitary adenoma

what happens to TSH, T4, and T3 in primary hyperthyroidism

dec, inc, inc

what happens to TSH, T4, and T3 in secondary hyperthyroidism

inc, inc, inc

what happens to TSH, T4, and T3 in subclinical hyperthyroidism

dec, nl, nl

what is hyperthyroidism thyroid storm

thyrotoxicosis, thyrotoxic crisis (life threatening emergency).

causes of thyroid storm

tumor, excessive manipulation during surgery, infxn, trauma, comp. of Graves, taking excessive hs, abruptly stopping antithyroid meds

pt has hi fever, extreme irritability, n/v/d, dehydration, HF, arrhythmias (a fib), disoriented, delirium, seizures, coma, death

thyroid storm

how to tx thyroid storm

immediate, without waiting for panel. give BB, thioamides (MMI, PTU), iodine to stop release of thyroid hs, bile acid sequestration (slow liver recycling of hs), GCC (dec T4→T3 conversion)

after thyroid storm crisis is stable what do you do

radioactive iodine or surgery

pt has fatigue, cold intolerance, weight gain w dec appetite, constipation, forgetfulness, dry skin w puffy face, heavy irregular menses, infertility.

hypothyroidism

dec HR, HF, heart block, cardiomegaly, pericardial effusion, dec CO. inc cholesterol, pleural effusion, inc RR/hypoxia, hypercapnia, depression, preg/fetal issues

hypothyroidism

#1 cause of primary hypothyroidism

iodine def

what causes primary hypothyroidism

genetics, viruses (HCV), meds like lithium/amiodarone, radiation.

chronic autoimmune mediated hypothyroidism, where immune system attacks thyroid.

hashimotos

who is affected by hashimotos

females, 30-50, assoc w celiac dz, SLE, RA, sjogrens, DM1

ex of secondary hypothyroidism

panhypopituitarism

what are lab values of TSH T3 and T4 in a pt with primary hypothyroidism

inc, dec, dec. +TPO = hashimoto’s

what are the lab values of TSH T3 and T4 of secondary hypothyroidism

dec dec dec

extreme decompensated hypothyroidism, rare but fatal.

myxedema coma

myxedema coma is caused by

stress from infxn (PNA, cellulitis, urosepsis), MI, stroke, hypothermia, surgery, burns

lab values for myxedema coma

dec glucose, dec Na/acidosis, inc calcium. dec temp, hypovolemia = dec BP, dec HR, dec RR/hypercapnia

cretinism lab values

inc TSH, dec T3/T4, tested at birth to avoid mental retardation

what causes thyroiditis

Ab, infxn (acute = bacterial, subacute - viral), drugs (interferon, amiodarone, lithium)

acute infectious thyroiditis causing suppurative thyroiditis

acute thyroiditis

pathogens of acute thyroiditis

s. aureus, s. pyogenes, s. epidermidis, s. pneumo

sx of acute thyroiditis

fever, dysphagia, hoarseness, pain, firmness, tenderness, redness, swelling