Endocrine Flashcards
What is the time interval between changing thyroid medications and re-checking labs to evaluate effectiveness?
8 weeks
What two betablockers are effective in treating thyroid toxicosis?
Propranolol & Nadolol
Methimazole and PTU can cause damage to what organ?
Liver (Liver failure)
How is it best to take levothyroxine?
Empty stomach with a glass of water
What is the percent risk that a thyroid nodule is malignant?
5%
Thyroxine is abbreviated as?
T4
How do you dose thyroid medication in a patient who is overweight?
Dose them at their ideal body weight
Menorrhagia is caused by hypo or hyper thyroid?
Hypothyroidism
Amiodarone and Interferon can cause which endocrine dysfunction?
Hypothyroidism
A normal DTR value is what?
2+
What is the goal TSH for a patient receiving treatment for hypothyroidism?
0.5-2
A patient on levothyroxine treatment for hypothyroidism returns with a TSH of <0.5. What do I do?
Decrease the dose by 12.5-25ug/d
A patient on levothyroxine returns with a TSH of >4. What do I do?
Increase the dose by 12.5-25ug/d
Diabetes and Hypothyroidism often go hand in hand because they are both considered what type of disorders?
autoimmune
A Normal TSH ranges between what values?
0.4-4
Free T4 ranges between what?
10-27
TPO should be below what?
35
When should we treat subclinical hypothyroidism?
Infertility, considering pregnancy, pregnancy. those who are symptomatic, with a goiter, or TPO antibodies
If a patient present with a thyroid nodule what should be done?
Draw a TSH and order an ultrasound
What are symptoms of type 1 diabetes?
The polys, weight loss, ketonuria
To diagnose diabetes a fasting sugar must be above?
126
To diagnose diabetes a random sugar must be above?
200
Diabetics have an A1C of > what?
6.5
If a patient is meeting their goals how often do you check an A1C?
2 X yearly
If a patient is not meeting their goals how often do you check the A1C?
Every 3 months
In regards to insulin when is it likely to see a hypoglycemic episode?
During the insulin’s peak
What is the goal for fasting sugars in a a person with diabetes?
<100
What is the goal for 1-2 post prandial sugars in a a person with diabetes?
<140-180
In a person with diabetes what is the goal for A1C?
7
What is the goal for a person with diabetes who is an older adult?
8
What eGFR requires us to STOP metformin
<30
Metformin in a patient with a eGFR of less than 30 can cause an increased risk of what?
Lactic Acidosis
What is an example of a popular TZD?
Pioglitazone
What population should NOT take TZDs?
Those with heart failure, on nitrates, or those who are also on insulin. It causes increased fluid load and subsequent weight gain.
In TZD an insulin sensitizer, insulin releaser, or insulin secreater?
Insulin Sensitizer
Sulfonylureas work by doing what?
Releasing insulin
Glipizide is what category?
Sulfonyurea
Do sulfonylureas cause weight gain?
yes
Are sulfonylureas expensive?
no
DPP-4 Inhibitors do what? (secrete, excrete, or sensitize)
They “smart” release
Are DPP-4s expensive? Do they have many side effects?
Yes! No.
DPP-4s end in the suffix?
“Gliptan”
GLP-1s do what?
Smart releasing
Which diabetes drugs promote weight loss?
GLP-1s & SGLT2s
Which diabetic drug class delays gastric emptying and should be avoided in patients with gastroparesis?
GLP-1. Also avoid these drugs in people with neuropathy as they likely have damage to the nerves in the gut as well.
GLP-1s are good for people with what disorders?
CKD, ASCVD
GLP-1s should not be prescribed yo those with a history of what acute abdominal disease?
pancreatitis
SGLTs does what to glucose?
Off loads it via the kidneys
At what eGFR would it be inappropriate to prescribe an SGLT2?
eGFR<30
Are SGLTs expensive?
You bet!
SGLT2s are good drugs for those with what conditions?
ASCVD, HF, CKD
Gastroparesis is a symptom of what class of diabetic drugs?
GLP-1s
If the pancreatic beta cells are dead which two classes of diabetes drugs will no longer be effective?
Sulfonyurea & DPP-4
What normal physiologic response causes a high 4-8am glucose?
Dawn Phenomenon. Suspect this phenomenon if the 2-3am blood glucose is normal or high.
Rebound hyperglycemia due to overtreatment of bedtime insulin is called what?
Somogyi effect. To fix eat a snack before bed or limit NPH insulin. Suspect this if blood glucose is low at 2-3am.
The surge of what hormone leads to ovulation?
LH
PTH affects what mineral?
Calcium
The most common form of grave’s disease is caused by what?
Autoimmune process. Look for other autoimmune d/o such as RA, pernicious anemia, and osteoporosis.
Is Grave’s disease hyper or hypo thyroidism?
HYPERthyroid
Amenorrhea, pre-tibial myxedema (orange peel appearance) and lid lag are physical signs of what?
Grave’s disease
Calcium and Vitamin D are given in hyper or hypothyroidism?
Hyper
Treating a pregnant woman for hyperthyroidism requires treatment with which medication?
PTU
PTU can cause what side effects?
Liver failure, skin rash, granulocytopenia/aplastic anemia, and thrombocytopenia
Thyroid Storm requires hospitalization and presents with what symptoms?
Fever, abdominal pain, altered level of consciousness
Can a 24 hour radioactive iodine test be done in a pregnant or breast feeding woman?
Nope
What are three lab markers of autoimmune thyroid disease?
TRab, TSI, TPO
Hypothyroid does what to cholesterol?
Increases it.
Which drugs can lead to thyroid disease?
Amiodarone, Lithium, High dose iodine, interferon alfa, & dopamine
Cold are spots are indicative of what on a thyroid?
Cancer
Which diabetes drug causes photosensitivity?
Sulfonylureas
In women HDL needs to be higher than what?
50
In males HDL needs to be higher than what?
40
Peak postprandial sugars should be less than what?
180
TZDs should be avoided among what three populations?
HF III/IV, bladder cancer, liver disease
Decreasing transfat will do what to the LDL and HDL?
lower and raise!
What is the 15-15 rule in hypoglycemia?
give 15g and check again in 15 minutes
the “ides” are what class of diabetes drugs?
sulfonylureas
Metformin prevents absorption of what?
B12
pH of < 7.2 indicates what?
Lactic acidosis
A patient on metformin is scheduled for a dye study what should I counsel?
Hold metformin the day of the procedure and for 48 hours later
All insulins can cause what two things?
Hypoglycemia and weight gain
Rapid acting insulin peaks in how many minutes?
30
Short acting insulin peaks in how many hours?
1-5
Intermediate insulin peaks in how many hours
6-14
SGLT-2 can cause what three things?
Weightloss, DKA, and increased risk of foot or leg amputation
DPP-4 s protect what organ?
Kidneys
Can I combine GLP-1s and DPP-4s?
No ma’am
If you’re at risk for DM type II how much weightloss is recommended?
7%
