Endo Flashcards
How calculate total daily insulin requirement?
Cr >1.5 + age>65 + glucose<180 –> 0.3u/kg
Otherwise –> 0.5u/kg
how much of total daily insulin administer as basal and bolus?
50% basal + 50% bolus
how much of total daily insulin administer as mixed insulin?
2/3 in AM + 1/3 in PM
glucose check –> goal level?
100-150
DM –> dx?
- fasting glucose >126
- random glucose >200
- 2hr glucose >200
- A1c >6.5%
DM –> glycemic goal?
A1c <7%
HLA-DR3 and HLA-DR4 are associated with what 2 conditions?
- juvenile DM1
- autoimmune hepatitis
autoimmune hepatitis is associated with what antibody?
anti-smooth muscle Ab
72M –> insomnia, fatigue, irregular pulse –> dx?
Afib from hyperthyroid
pheochromocytoma –> rule of 10s
10% extra-renal 10% familial 10% bilateral 10% malignant 10% in children
what is alopecia areata
autoimmune –> patchy hair loss
TSH: low
T4: high
US: diffuse enlargement of thyroid
Radioactive iodine uptake scan: diffusely decreased uptake
condition?
autoimmune thyroiditis (acute hyperthyroid phase):
- Hashimoto’s thyroiditis
- DeQuervain’s granulomatosis thyroiditis (subacute painful thyroiditis)
- silent autoimmune thyroiditis (subacute painless thyroiditis)
silent autoimmune thyroiditis (subacute painless thyroiditis) –> risk factors (3)
- spontaneously
- post-infection
- postpartum
Hashimoto’s thyroiditis –> Ab
- thyroglobulin Ab
- thyroid peroxidase Ab (TPO)
differentiate: Hashimoto’s vs De Quervain’s granulomatous thyroiditis
Hashimoto:
- painless
- lymphocytic infiltrate
De Quervain’s:
- painful
- granulomatous response
TSH: low
T4: high
US: diffuse enlargement of thyroid
Radioactive iodine uptake scan: diffusely increased uptake
condition?
Graves disease
TSH: low
T4: high
US: normal
Radioactive iodine uptake scan: diffusely decreased uptake
condition?
- exogenous ingestion of T4
- stroma ovarii
TSH: low
T4: high
US: irreg heterogenous nodules
Radioactive iodine uptake scan: focal areas of increased uptake
condition?
- toxic multinodular goiter
- toxic adenoma
Graves disease –> pathophys
autoimmune –> TSH receptor Ab –> increase thyroglobuin production
how differentiate bw exogenous ingestion of T4
vs stroma ovarii
sestamibi scan
thyroid storm –> tx
- cool IVF, cool blankets
1) propranolol –> decrease autonomic ssx
2) PTU or methimazole
3) steroid: prevent T4 convert to more active T3
active thyroid nodules –> trt w surgery or radioactive iodine ablation?
radioactive iodine ablation
TSH elevated –> but no hypothyroid ssx –> dx
subclinical hypothyroid
subclinical hypothyroid –> when treat?
- TSH >10
- get ssx
myxedema coma –> tx
- warm IVF, warm blanket
- T4/T3
- IV hydrocortisone
Graves dz –> tx
PTU or methimazole
Graves dz –> patient has already developed exophthalmos and pretibial myxedema –> tx
surgery + steroids
exogenous intake of T4 –> thyroglobulin is low or high? why?
thyroglobulin low
Thyroglobulin is only elevated with T4 if T4 came from thyroid