Endocrine Flashcards
Once thyroid disease stable, how often/when should TSH be rechecked
yearly or when pregnant, worsening symptoms, or start medication that may affect interact (iron, Ca, estrogen)
TSH <0.3 indicates what
hyperthyroid
TSH >4 indicates what
hypothyroid
TSH 0.3-4 indicates what
euthyroid
free T3 or T4 correlates more with thyroid state
free T4
T4 is difficult to test directly. What is used instead
TBG (thyroxine binding globulin)
what may cause increased TBG
pregnancy
acute hepatitis
estrogen
methadone
heroin
what may cause decreased TBG levels
acromegaly
nephrotic syndrome
cirrhosis
chronic steroid, androgen, ASA, NSAIDs
when would you see autoantibodies to thyroglobulin or thyroid microsomes and what is the major antigen
in paitents with autoimmune thyroid disease
Thyroid peroxidase (TPO) is the major microsomal antigen
Anti-TPO antibodies may be found in what diseases
hashimotos and graves
what is another name for autoimmune hyperthyroidism
graves
what antibodies are specific for graves disease
TSH receptor antibodies (TRAb)
what is the purpose of imaging for thyroid disease
to assess cause of hyperthyroidism but not funcitonal status of thyoid
what is pemberton sign
pt elevates both arms until the touch the sides of their head and results in flushing of face, cyanosis, and resp distress
indicates impingement of structures from nodule/goiter
is serum calcitonin usually ordered to measure thyroid disease
no
if TSH is suppressed, what is next step
order free T4 and TT2 and radionuclide scan
if TSH is elevated, what is next step
check free T4, start levothyroxine and evaluate for nodules
what instructions should patients be given after receiving radioiodine treatment
no kidding or sharing utensils for 5 days
no close constant with young children or pregnant women
no breast feeding
flush toilet twice
what will TSH, T3 and T4 levels be in hyperthyroidism
TSH low
T3/T4 high
what are the treatment options for Graves
beta blockers
Thioamides (methimazole and propylthiouracil)
decreased TSH with normal T4 and T3 indicates what
subclinical hyperthryoidism
elevated TSH and normal T4 indicates what
subclinical hypothyroidsim
long term use of levothryoxine should be monitored for what potential side effects
bone loss/osteoporosis
electrolyte imbalances
what is metabolic syndrom
truncal obesity
HTN
DLD
insulin resistance but not yet diabetic
diagnosing metabolic syndrome includes any three of the following:
elevated waist circumferences (>40 in min and >35 in women)
Elevated triglycerides
reduced HDL
HTN
Elevated FPG (>100mg/dL)
what are factors that increase risk of metabolic syndrome
family hx of DM, HTN, obesity
current obesity, DM, HTN
western diet
sedentary lifestyle
Medications (steroids, antidepressants, antipsychotics)
a patient presents with a diffuse, hyperpigmented velvety thickening of the skin around the neck and axillae. What is this and what is it indicative of
Acanthosis nigricans
suggestive of moderate to severe
what results would consitute an impaired fasting glucose
levels of 5.5-7 after an 8-12 hour period of fasting
what initial blood work should be ordered for suspected metabolic syndrome
HA1C
FPG
fasting lipids
CRP
LFT
TSH
Uric acid
