Answers:
A patient with medullary carcinoma and multiple mucosal neuromas presents to the ED with palpitations, diaphoresis and an impending feeling of doom. What is their likely diagnosis?
A) MEN1
B) MEN2a
C) MEN2b
D) FMTC
MC Questions:
An elderly patient with "apathetic hyperthyroidism" might present with symptoms such as...
A) weight loss, severe depression and slow afib
B) weight loss, heat intolerance, sweating
C) anxiety, insomnia, palpitations
D) hand tremor, increase stool freq,weight loss
A) MEN1
B) MEN2a
C) MEN2b
D) FMTC
-MEN1=pituitary, parathyroid and pancreatic tumors (3Ps),
-MEN2a = medullary CA, Pheo, Hyperparathyroidism
-MEN2b = medullary carcinoma, Pheo and multiple mucosal neuromas.
-FMTC = MEN2a with MTC as the only manifestation, must r/o pheo or primary hyperparathyroidism
What is the rule of 3rds with respect to medullary thyroid carcinoma?
Rule of 3rds: 1/3 sporadic, 1/3 MEN2, 1/3 familial w/o other associations.
An elderly patient with "apathetic hyperthyroidism" might present with symptoms such as...
A) weight loss, severe depression and slow afib
B) weight loss, heat intolerance, sweating
C) anxiety, insomnia, palpitations
D) hand tremor, increase stool freq,weight loss
Free Response Question:
What are the three symptoms that are unique to Graves' hyperthyroidism?
Quick Facts:
Thyroid Crisis: acute exacerbation of thyrotoxicosis.
-in pts with poorly controlled hyperthyroidism who undergo surgery/radioactive iodine/parturition or stressful illness.
-Symptoms = fever, flushing, sweating, tachycardia, a fib, CHF, agitation, delirium, coma, abdominal pain, n/v/d, jaundice.
-Treat Quickly!
-Propranolol 1-2mg IV, Methimazole 20mg/6h
-Giving oral saturated iodide one hour after giving methimazole can slow hormone release.
-Hydrocortisone (50g) given every 6 hrs while symptomatic
-Avoid aspirin as it displaces T3 from TBG.
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