-
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
- infertility
- depression
- fatigue
- 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?
- elderly
- 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.
a-fib
-
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)?
WBC
-
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?
- malignant
- adenoma - noncancerous
-
GH is released in response to what?
- sleep
- exercise
- hypoclycemic state
-
What may be the only sign of hypothyroidism in children?
short stature
-
A _________ is done to r/o Turner's syndrome in girls.
karyotype
-
Growth hormone deficiency can be caused by _______ failure.
chronic renal
-
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?
- PCOS
- 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
- idiopathic
-
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.
- idiopathic
- CNS disorders
- hypothyroidism
- HCG-secreting tumor
-
If you see precocious puberty in a boy, what should be on the top of the list of DDs?
CNS TUMOR!
-
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?
- none
- 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
- thyroid
-
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
- gonadotropin
- 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.
hyperpigmentation
-
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?
pheochromocytoma
-
What will you see to dx pre diabetes?
- A1c 5.7 - 6.4%
- Fasting glucose 100-125
- 2-hour glucose tolerance 140-199mg/dL
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