Our questions - I feel they are very good and make quite a good summary

Which gland produces a hormone that helps with falling asleep?

Pineal gland (hormone is melatonin)

A patient presents with a fragility fracture in their spine. Which hormone is possibly being overproduced?

Parathyroid hormone (PTH)

A patient presents with weakness, weight loss, nausea and vomiting, abdominal pain, and skin hyperpigmentation. What is the most likely cause?

Adrenal insufficiency (low cortisol)

(Would probably also Addison’s disease cause it’s usually the cause of it)

What condition did Andre the Giant have?

Acromegaly

What gland is responsible for the fight-or-flight response?

Adrenal gland (specifically adrenal medulla)

A female patient presents with abnormal periods, acne, and chin hair. What hormone abnormality would you expect?

High androgen levels (testosterone) and an imbalance of reproductive hormones

What labs would you expect in a patient with overt hypothyroidism?

High TSH

Low T4

What symptom is associated with high TSH and low T4 in elderly people?

Cognitive decline

If a patient with Addison's disease stops treatment and develops an electrolyte imbalance, what condition can result?

Adrenal crisis

What does the hormone prolactin do?

Stimulates milk production in the breasts

What effect does luteinizing hormone (LH) have on the body?

Regulates estrogen production in women and testosterone production in men

A patient presents with decreased bone density and fragility fractures. What decreased hormone level could be the cause?

Estrogen

Testosterone

A patient presents with no periods for 3 months. What are likely natural causes?

Pregnancy or menopause

What is considered the master gland of the endocrine system?

Pituitary gland

A patient presents 3 weeks postpartum with difficulty producing breastmilk. What hormone abnormality would you expect?

Low prolactin

Too much cortisol production is indicative of what condition?

Cushing syndrome

A patient presents with weight gain, easy bruising, and proximal muscle weakness. What hormone abnormality would you expect?

High cortisol

A patient presents with progressively increasing hand and foot size. What hormone abnormality would you expect?

High growth hormone (GH)

What hormone abnormality is associated with amenorrhea?

Low estrogen

What does the adrenal cortex regulate?

Electrolytes, blood sugar, and sexual function

What are two drugs that can cause hypothyroidism?

Amiodarone and lithium

What is a complication of untreated hypothyroidism?

Myxedema crisis

A patient presents with goiter, weight gain, and peripheral edema. What is the treatment for the most likely cause?

Levothyroxine (1.6 mcg/kg/day or 25–50 mcg/day in elderly patients over 65)

What is the most common cause of hypothyroidism?

Autoimmune disease (Hashimoto's thyroiditis)

What is the treatment for subclinical hypothyroidism?

Observation and monitoring labs

What type of anemia is common in hypothyroidism?

Normocytic anemia

What patient education should be provided when starting levothyroxine?

Take first thing in the morning on an empty stomach. Wait 1 hour before eating or taking other medications. Take a double dose the next day if a dose is missed.

If a patient has positive TPO antibodies, high TSH, and low T4, what symptoms would they complain of?

Weight gain, cold intolerance, goiter, hair thinning/loss, peripheral edema, and depressed mood

What are the lab findings in secondary hypothyroidism?

Low TSH, low T4

A patient has exophthalmos, periorbital edema, and conjunctival edema. Labs show low TSH and high free T4. What condition causes these findings?

Graves disease

What medication is used to treat Graves disease?

Methimazole

Propylthiouracil (Pregnant and/or breastfeeding)

Beta blockers (symptoms)

What medication is used for Graves disease during pregnancy or breastfeeding according to the provided study notes?

Propylthiouracil (PTU)

A patient presents with anxiety, weight loss, sweating, and insomnia. What is the most likely diagnosis?

Hyperthyroidism

What physical exam findings can be associated with hyperthyroidism?

Pretibial myxedema, exophthalmos, periorbital edema, lid lag, thyroid bruit, tachycardia, hypertension, warm/moist skin, hyperreflexia, and fine/thinning hair

What labs would a patient with overt hyperthyroidism present with?

Low TSH, high free T4

What population should not undergo radioactive iodine uptake and scanning?

Pregnant and breastfeeding patients

When diagnosing Graves disease, what diagnostic studies can be performed other than RAIU?

Thyroid-stimulating autoantibodies (TSI, TRAb) and Doppler ultrasound

A patient presents with inflammation of the thyroid gland following a viral illness. What is the most likely diagnosis?

Subacute thyroiditis (painful)

(Bacterial infection = Acute thyroiditis)

What thyroid function labs may appear shortly after the onset of acute thyroiditis?

Low TSH

High T4

A patient presents with insomnia, tremors, palpitations, and unintentional weight loss. Physical exam shows warm skin, lid lag, exophthalmos, periorbital edema, tremor, and tachycardia. What are three treatment options for hyperthyroidism?

• Medication

  • Methimazole

  • Propylthiouracil (pregnant and/or breastfeeding)

  • Beta blockers (symptoms)

• Radioactive iodine ablation

• Surgery

How are thyroid labs monitored after starting methimazole?

Check free T4 initially and every 4–6 weeks, along with TSH, until a maintenance dose is reached

If remission into hyperthyroidism, consider another TSI and surgery/radioactive ablation

How are thyroid labs monitored after radioactive iodine ablation?

Check TSH and free T4 every 4–6 weeks until the levothyroxine dose is stable

How are thyroid labs monitored after thyroid surgery?

Check free T4 at discharge and every 6–8 weeks with TSH

A patient presents 8 week after treatment for a viral infection with dysphagia, a tender thyroid, and thyroid erythema. What lab findings would you expect?

Increased ESR, increased leukocytes with left shift, negative TPO, negative thyroglobulin antibodies (Tg), low TSH, and high T4

(Check out PowerPoint 3, slide 18, because it determines whether you will be hyperthyroid or hypothyroid depending on the length of time) (Also, viral = subacute)

What physical exam findings are specific to Graves disease?

Exophthalmos and preorbital/conjunctival edema

Name two antibodies associated with Graves disease.

TSI (thyroid-stimulating immunoglobulin) and TRAb (thyrotropin receptor antibody)

A patient has low TSH, normal free T4, and no obvious symptoms of hyperthyroidism. How would you diagnose this patient?

Primary subclinical hyperthyroidism

What are three eye findings on physical exam of a patient with exophthalmos?

Bulging eyes, conjunctival injection (redness), and retracted eyelids (lid retraction/lid lag)

In primary hyperthyroidism, what are the lab findings in overt versus subclinical disease?

Overt: high free T4 and low TSH

Subclinical: normal free T4 and low TSH

A patient presents with exophthalmos, periorbital edema, and conjunctival edema. Labs show low TSH and high T3 and T4. What is the next step in treatment if they are not pregnant or breastfeeding?

Methimazole to control thyroid hormone production and beta blockers to control symptoms such as palpitations

A patient with Graves disease undergoes total thyroidectomy. What treatment is required after surgery?

Levothyroxine

What radioactive iodine uptake findings will a person with Graves disease have?

Diffuse uptake

Lab findings show normal free T4 and low TSH in an otherwise healthy patient. What is the next step in management?

No treatment required; monitor with labs

What important anatomical structures should be identified during thyroidectomy to avoid damage?

Recurrent laryngeal nerve

Parathyroid glands

A patient presents with facial edema, bulging veins, and shortness of breath that progresses to cyanosis when arms are raised. What is the condition and what might imaging show?

Superior vena cava syndrome; large substernal nodule on chest CT

What is one modifiable risk factor to reduce a patient's likelihood of developing thyroid cancer?

Thyroid irradiation exposure (avoid unnecessary radiation)

If a patient presents with a thyroid nodule, what signs and symptoms might they complain of?

Many are asymptomatic. Larger nodules may cause dysphagia, hoarse voice, neck fullness, or discomfort

A patient presents with hypothyroidism and abnormal findings on ultrasound. What is the next step?

Biopsy the nodule

When a patient presents with a thyroid nodule, what are indications for total thyroidectomy?

High-risk nodule on biopsy, bilateral nodules, family history of thyroid cancer, or personal history of head/neck radiation

What are the four types of thyroid cancer, and which has the worst prognosis?

Papillary (low risk

Follicular (low risk)

Medullary (Low risk if restricted to thyroid, high risk if metastasizing)

Anaplastic (high risk; worst prognosis)

What is the name of the maneuver that causes cyanosis and facial edema when raising arms above the head (checks for superior vena cava syndrome)?

Pemberton maneuver