Archer USMLE step 3 Endocrinology lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html

1. ENDOCRINOLOGY Archer Online USMLE Reviews www.ccsworkshop.com All rights reserved Archer Slides are intended for use with Archer USMLE step 3 video lectures. Hence, most slides are very brief summaries of the concepts which will be addressed in a detailed way with focus on High-yield concepts in the Video lectures. These slides are only SAMPLES

2. Thyroid Disorders Thyrotoxicosis Subacute Thyroiditis Thyroid Function Tests Hashimatos Thyroiditis Hypothyroidism Thyrotoxic periodic paralysis Thyroid Nodule and Approach Thyroid Cancer

7. TFTs – Further Approach Obtain Total and Free T4 levels, ONCE TSH comes abnormal

15. Thyrotoxicosis Important topics: Graves disease Subacute thyroiditis Post partum thyroiditis Amiodarone induced

17. Classification of Thyrotoxicosis based on RAIU Scan High RAIU Low RAIU Graves' disease Subacute thyroiditis Toxic multinodular goiter* Painless thyroiditis (includes postpartum thyroiditis) Toxic adenoma* Chronic thyroiditis with transient thyrotoxicosis HCG-mediated (choriocarcinoma) Iatrogenic/surreptitious thyroid hormone TSH-secreting pituitary tumor Metastatic functional follicular thyroid cancer (after thyroidectomy) Amiodarone-induced thyroiditis Struma ovarii (uptake in pelvis)

20. Treatment for Thyrotoxicosis Due to Overproduction of Thyroid Hormone Modality Advantages Disadvantages Antithyroid drug therapy Least invasive Least costly Lower risk of permanent hypothyroidism Potential beneficial immunomodulatory effects Adverse drug effects Low permanent remission rate (approximately 33%-50%) Radioiodine Moderately fast reduction in thyroid hormone levels Less invasive than surgery Permanent hypothyroidism likely Requires delay in pregnancy (6-12 months) and breastfeeding May precipitate new or worsened ophthalmopathy Slight risk of thyroid storm after treatment ( in severe Hyperthyroidism, use pre-treatment) Thyroidectomy Rapid reduction in thyroid hormone levels Allows concurrent removal of suspicious nodules (if present) Allows reduction in size of large goiters Most invasive Most costly Permanent scar Permanent hypothyroidism likely Potential injury to parathyroids and recurrent laryngeal nerve

33. Euthyroid Sick Syndrome

50. Thyroid Nodule Approach

54. Guidelines ( Source: NEJM)

57. Pheochromocytoma

74. INSULINOMA - Whipples Triad – the symptoms of hypoglycemia - C-peptide level.

77. Glucagonoma Necrotizing migratory erythema Octreotide scan

79. Polycystic Ovary Disease

84. Adrenal Incidentalomas

89. KEY POINT SOMGYI EFFECT Nightmares are a clue and signifies a drop in blood glucose to low levels Next step  reduce the dose of pre-dinner insulin