What is Pemberton's sign?
- used to assess with goiter
- elevate both arms til reach sides of head
- Note flushing, cyanosis, respiratory distress d/ t impingement of thoracic inlet
What labs would point to subclinical hypothyroidism.
- elevated TSH
- normal thyroid hormone levels
When should you treat subclinical hypothyroidism.
- if TSH > 10
- menstrual cycle irregularities
Why should you consider treating subclinical hypothyroidism if TSH > 10?
- it improves CO, lipids
- reduces atherosclerosis
- prevents goiter
With secondary hypothyroidism (pituitary), you will see ______ T4 and _____ TSH.
When might you see hypothyroidism postpartum?
2-6 mos post delivery
What is the goal of hypothyroidism therapy?
to replace thyroxine to mimic normal, physiologic levels and alleviate signs, symptoms, and biochemical abnormalities
With Levothyroxine, what pts should you start out at a lower dose?
- high risk for CV dz
How often should you evaluate TSH?
q 6-8 weeks until normalized
New onset of ________ is often caused by hyperthyroidism.
If T4 is elevated, what test should follow?
24 hour radio iodine uptake to r/o Grave's
If you suspect hyperthyroidism and T4 is "normal", then what?
Get a T3 level too
If T4 is low (suspect hyperthyroidism) with decreased TSH, what should you do?
MRI to r/o hypothalamic-pituitary dz
Two drugs given to control excess thyroid hormone, and which is best in pregnancy?
Why should you send a pt to the ER who is taking hyperthyroid drugs and gets a sore throat?
risk for agranulocytosis!
What levels should always be checked prior to starting a pt on a hyperthyroidism drug (Tapazole, PTU)?
Subacute thyroiditis typically develops after ___ or ________. s/s?
- URI, viral syndrome
- severe pain radiating to ear
- low grade temp
- thyroid tender to palpation
- s/s of hypErthyroidism (no exophthalmus!)
What usually happens with Subacute thyroiditis over what time frame?
- s/s of hyperthyroidism
- may become hypothyroid, then return to normal
- 2-6 mos
Tx for Subacute thyroiditis?
Increased risk for thyroid nodules at what age and gender?
"Cold" thyroid nodules (no increase in uptake, abnormal or hypo functioning) indicates? "Hot" or hyperfunctioning nodules are usually what?
- adenoma - noncancerous
GH is released in response to what?
- hypoclycemic state
What may be the only sign of hypothyroidism in children?
A _________ is done to r/o Turner's syndrome in girls.
Growth hormone deficiency can be caused by _______ failure.
First sign of puberty in a boy.
increased testicular volume
Premature thelarche is due to ?
estrogens or increased response of breasts
What is adrenarche?
onset of pubic hair
Kids with premature adrenarche are at increased risk of what?
- other metabolic syndromes
Precocious puberty is before age ______ in girls and _____ in boys.
Premature adrenarche can be due to what?
- mild form of congenital adrenal hyperplasia
- exposure to topical testosterone
- adrenal tumors
With constitutional growth delay, growth is normal for the first ________ of life; decelerates to near or less than 3rd%, then resumes normal rate by ________ of life.
Causes of central precocious puberty.
- CNS disorders
- HCG-secreting tumor
If you see precocious puberty in a boy, what should be on the top of the list of DDs?
Refer to endocrinology if a child has a bone age ____ of their chronological age.
2 years ahead
What labs are needed for premature thelarche? For premature adrenarche?
- 24-hr urine; bloodwork to r/o congenital hyperplasia
What labs/diagnostics for isolated menarche?
- Free T4, TSH
- pelvic ultrasound
True precocious puberty workup.
- bone age
- LH, FSH
- estradiol, testosterone
What should you do if LH and FSH are high with precocious puberty workup?
MRI to r/o CNS tumor
What should you do if LH and FSH are low with precocious puberty workup?
- indicates more peripheral than central
- SEND TO ENDOCRINOLOGY!
Delayed puberty occurs when a boy is _______ or older or a girl is ______ or older.
Most common cause of delayed puberty.
consitutional growth delay
Most common cause of ambiguous genitalia.
congenital adrenal hyperplasia
Surgical intervention may be needed for hyperparathyroidism if what?
- recurrent stones
- bone disease
- Ca++ > 12.5
_________ is a symptom of primary Addison's dz.
What is pheochromocytoma?
catecholamine producing tumor
The primary symptoms of pheochromocytoma.
- labile HTN with
- ha, tachycardia, & diaphoresis
HTN that is difficult to control could be?
What will you see to dx pre diabetes?
- A1c 5.7 - 6.4%
- Fasting glucose 100-125
- 2-hour glucose tolerance 140-199mg/dL