Hyperthyroidism and Myxedema Coma Quiz

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Questions and Answers

What is a common indicator that hyperthyroidism may be present in a patient?

Hyperplastic thyroid tissue

Low TSH levels

Thyroid receptor antibodies

Presence of a goiter (correct)

Which factor can cause a falsely low Radioactive Iodine Uptake (RAIU) result?

Iodine deficiency

Recent iodine load via IV contrast (correct)

High levels of TSH

Increased synthesis of thyroid hormones

Which condition is specifically indicated by the presence of ophthalmopathy?

Sub-acute thyroiditis

Hashimoto's thyroiditis

Graves disease (correct)

Amiodarone-induced thyroiditis

What treatment is suggested for symptomatic patients with hyperthyroidism?

Beta-blockers Signup and view all the answers

What initial step is recommended before conducting a CT scan that requires iodinated contrast in a patient with untreated hyperthyroidism?

Administering thionamide medications Signup and view all the answers

What is a common clinical manifestation of myxedema coma?

Bradycardia Signup and view all the answers

What initial IV treatment is recommended for myxedema coma?

IV levothyroxine load Signup and view all the answers

Which laboratory finding is often seen in myxedema coma?

High TSH levels Signup and view all the answers

What should be considered when determining the dose of levothyroxine for elderly patients in myxedema coma?

Lower dose due to cardiac history or age Signup and view all the answers

What supportive measure is essential in managing a patient with myxedema coma?

ICU monitoring Signup and view all the answers

Which statement about smoking and thyroid eye disease (TED) is correct?

Smoking is known to significantly worsen the severity and progression of TED Signup and view all the answers

What occurs to TED symptoms after treatment of hyperthyroidism?

TED symptoms may persist or worsen after treatment Signup and view all the answers

What is the most common initial symptom of thyroid eye disease (TED)?

Eye redness and irritation Signup and view all the answers

In which instances can thyroid eye disease (TED) occur?

In both hyperthyroid and euthyroid patients Signup and view all the answers

When should treatment be considered for subclinical hypothyroidism?

When TSH is above the upper limit of normal Signup and view all the answers

What is the recommended approach for pregnant women with a TSH level between 2.5 and 4.0 who are positive for TPO antibodies?

Consider treating if TSH is above 10 Signup and view all the answers

What should be done for a pregnant woman with pre-existing hypothyroidism?

Increase LT4 by 30-35% Signup and view all the answers

Which of the following medications is recommended for use in the first trimester of pregnancy for treating Graves’ disease?

Propylthiouracil (PTU) Signup and view all the answers

What risk is associated with long-term use of beta-blockers in pregnant women with hyperthyroidism?

Intrauterine growth restriction (IUGR) Signup and view all the answers

When should TSH receptor antibodies (TSH-R Ab) be checked in pregnant women with Graves' disease?

Second trimester Signup and view all the answers

What recent finding was noted in the CXR during exacerbation?

New vertebral fracture at T7 Signup and view all the answers

What is the patient's calculated 10-year risk of major osteoporotic fracture?

16% Signup and view all the answers

Which calcium level is indicated for this patient?

Ca 2.17 Signup and view all the answers

What lifestyle modification is suggested for the patient?

Exercise and resistance training weekly Signup and view all the answers

What treatment option is considered appropriate given the patient's FRAX score?

No treatment, recommend non-pharm therapy Signup and view all the answers

What is one of the recommended criteria for individuals to be screened for osteoporosis?

50-64 years with a history of a previous osteoporosis-related fracture Signup and view all the answers

At what age should women be screened for osteoporosis if they have one clinical risk factor?

65 years Signup and view all the answers

What may potentially underestimate the risk when using FRAX or CAROC tools?

Recency of fractures Signup and view all the answers

What is the first-line treatment for a patient with a new vertebral fracture and clinical risk factors for osteoporosis?

Alendronate 70mg po q weekly Signup and view all the answers

In light of the patient's vitamin D deficiency, what would be the most appropriate daily supplementation?

2000 IU of Vitamin D Signup and view all the answers

Which of the following is NOT a recommended non-pharmacological therapy for a patient with osteoporosis?

Low-impact aerobic exercises only Signup and view all the answers

What condition might indicate the use of Calcitonin as a second-line agent?

Intolerance to bisphosphonates Signup and view all the answers

What is the significance of eGFR 48 in this case?

Suggests the need for dose adjustment of certain medications Signup and view all the answers

What is the primary concern with using Denosumab in this patient?

High risk of hypocalcemia without correcting vitamin D deficiency Signup and view all the answers

Which statement accurately describes the recommended calcium intake for this patient?

At least 1000 mg of dietary calcium is needed daily Signup and view all the answers

How does the FRAX result affect treatment decisions?

A 10-year risk of 16% highlights the need for pharmacological treatment Signup and view all the answers

Study Notes

Endocrinology Lecture Notes - December 1st, 2024

The lecture was on endocrinology topics, including hypercalcemia, MEN syndromes, hyperthyroidism, hypothyroidism, thyroid disease in pregnancy, osteoporosis & metabolic bone disease, diabetes, lipid guidelines, adrenal & pituitary, care for transgender patients, thyroid nodules & cancer, and obesity guidelines.
The lecture also covered endocrinology 101, emphasizing the critical interpretation of lab values for hormone patterns rather than just normal ranges, especially in assessing labs.
A section focused on hypercalcemia, reviewing the 2022 Hyperparathyroidism Guidelines from the Fifth International Workshop and a Canadian/international consensus on primary hyperparathyroidism.
Hyperparathyroidism (PHPT) surgical management was detailed; distinguishing between symptomatic and asymptomatic PHPT, where the latter warrants a "Stay The Fudge Away U Stupid Calcium" approach, emphasizing when surgical intervention is necessary.
Conditions like tertiary hyperparathyroidism and magnesium deficiency-related PTH resistance were also covered.
A table summarizing different lab patterns in calcium problems was provided (including Primary/Tertiary HyperPTH, Pseudohypoparathyroidism, FHH, Lithium, Thiazides, Vitamin D excess, PTHrp, Osteolysis, Vitamin D deficiency).
The lecture provided details on calcium physiology: parathyroid-mediated processes involve opposite directions for serum calcium and phosphate; vitamin D-mediated actions involve the same direction.
Calcium physiology Pearls 3&4 covered instances where serum calcium, phosphate, and PTH are all high (suggesting kidney impairment), and how magnesium deficiency can reduce PTH secretion, potentially causing hypomagnesemia in suspected hypoparathyroidism..
Discussing the medical management of PHPT if surgery is not possible. Correcting Vitamin D deficiency, maintaining a calcium-consistent diet, and utilizing bisphosphonates or denosumab, and/or cinacalcet were recommended.
A review of secondary and tertiary hyperparathyroidism, and the indications for surgery in these cases, including refractory cases despite vitamin D analogs/calcimimetics and symptomatic hypercalcemia/calciphylaxis/progressive bone disease.
Another section distinguished familial hypocalciuric hypercalcemia (FHH) from primary hyperparathyroidism (PHPT) based on urine calcium:creatinine ratio.
Hypoparathyroidism guidelines from 2022 were covered; diagnosis (involving low/undetectable PTH with hypocalcemia measured on separate occasions) and management were emphasized, emphasizing conventional therapy with oral calcium and active vitamin D.
A section outlined the hypoparathyroid differential, both acquired (related to hypomagnesemia, hypermagnesemia, post-surgical, radiation, infiltrative disease, autoimmune polyglandular syndrome type 1) and congenital forms (e.g., pseudohypoparathyroidism or DiGeorge syndrome).
Included multiple-choice questions (MCQs) concerning conditions like hypercalcemia and treatment options (especially for an 85yoF patient and potential medical management).
The outline included various topics essential for understanding endocrine disorders, such as Hyperthyroidism/Thyrotoxicosis, their management strategies, complications (like thyroid eye disease, TED, and thyroid storm) and related considerations in pregnancy.
The lecture had multiple 'Pearls' – one emphasizes the importance of evaluating hormone patterns in lab tests, not only normal values. Another focuses on interpreting high RAIU (radioactive iodine uptake) test results. One additional Pearl covers that a big gland (goiter) usually indicates thyroid stimulation and that painful gland usually indicates inflammation (thyroiditis). A fourth explains the need for Beta-blocker use and duration in hyperthyroid patients. A fifth pearl outlines the medical management options for Graves' disease pregnancies.
The presentations touched on hyperthyroidism, including management strategies for Graves' Disease (including medical management with use of MMZ, special care related to pregnancy , and potential surgery).
The lecture included various components of thyroid storm, including its definition (tachycardia, confusion, hyperthermia). Treatment (ABCs, beta blockers, PTU, iodine, glucocorticoids) and complications were discussed.
Covered Hypothyroidism: resources, screening, subclinical hypothyroidism, and conditions like myxedema coma, and the treatment options.
Detailed information was provided on thyroid disorders in pregnancy, including strategies for managing subclinical hypothyroidism or pre-existing hypothyroidism in pregnant individuals, and Graves's disease/gestational thyrotoxicosis.
The presentation covered the clinical risk factors, who needs to be screened. Screening recommendations and when to start treatment for moderate risk and high risk for osteoporosis was stressed.
Also discussed atypical femoral fractures, osteoporosis of the jaw, cases of inadequate response, pharmacotherapy, and treatment summary.
The lecture included information on how to differentiate cases of gestational transient thyrotoxicosis from persistent thyroid pathology.
A comprehensive summary of the management of primary and secondary hyperparathyroidism, outlining the differences and situations where each might be appropriate.
Information on the management and workup for Graves' orbitopathy was also provided (emphasizing the role of imaging and the potential for treatment with glucocorticoids, or when surgery is warranted).
Details on multiple endocrine neoplasms (MEN) and their components (including MEN 1 (PPP), MEN 2A (PMP), and MEN 2B (MMP)) and the importance of considering these syndromes in presentations of single conditions.
Information on diagnosing diabetes, including types 1 and 2, as well as gestational diabetes (GDM), and management strategies (including when to use insulin, what medication is the better choice, and when to consider a referral).
This presentation includes presentations describing how to diagnose and manage DKA (diabetic ketoacidosis), including the importance of monitoring potassium levels, proper volume replacement and insulin therapy.
Lastly, the slides discussed the importance of screening for autoimmune thyroid disease in T1DM patients.
The lecture included additional information on Type 2 Diabetes management, specific presentations related to treatment targets, confounders (like altered erythropoiesis), and strategies for managing patients who are not at target, using data from various sources, such as the CDA 2024 guidelines.

Additional Topics

Covered the care of transgender patients, offering guidance on reproductive endocrinology, obesity, and thyroid nodules.
The lecture included indications, steps and complications of hormone replacement therapy for menopause.
Also discussed conditions like amenorrhea and their respective causes, including primary causes like anatomic obstruction, chromosomal abnormalities, and secondary causes including hypothalamic dysfunction (functional hypothalamic amenorrhea /FHA), pituitary issues (e.g., prolactinoma), thyroid disorders, or ovarian problems (e.g., PCOS, POI).
A summary slide for Cushing's syndrome explained the etiology of the condition including pituitary adenomas and ectopic ACTH sources as well as how to differentiate them.
A separate slide covered the use of inferior petrosal sinus sampling (IPSS) as a diagnostic tool.
A comprehensive discussion of adrenal incidentaloma was given, emphasizing the evaluation for malignant characteristics, functional properties, and managing mild autonomous cortisol secretion (MACS) instances.
An essential understanding of hyperprolactinemia was provided, including possible etiologies (medications, hypothalamic dysfunction), and diagnostic steps (including the "hook effect" ).
Acromegaly was also covered.
Diabetes insipidus, and diagnosis, was provided, including the need to rule out other causes (OR fluid) before determining it's DI..
The role of screening for, and management of lipids, including statin therapy indications and appropriate use of secondary medication choices (such as ezetimibe and evolocumab, and icosapent ethyl) was highlighted.
Presented an overview of potential treatment for those patients with poor lipid control despite starting with a statin were presented.

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Description

Test your knowledge on hyperthyroidism and its complications, including myxedema coma. This quiz covers common indicators, treatment options, and clinical manifestations of these thyroid conditions. Perfect for medical students and healthcare professionals alike.