Endocrine Labs Flashcards
Normal TSH, with multiple endocrine-like symptoms. Order what…
T4 for clarification
Weeks it takes for the TSH to equilibrate
4-6 weeks
Total T4 is not commonly used. It is less accurate because the protein bound portion can be affected by
pregnancy, medications and this is not measuring the protein bound hormone, but the globulin
Free T3 can be good for
Cases of Hyperthyroidism, as levels of it tend to change more dramatically than T4 levels in hyperthyroidism. but this is more rare
TSH comes back low
Order FT4 and FT3 to confirm. prob end up referring
TSH comes back high
Order FT4 to confirm
TSH high, T4 low
Hypo. levo. monitor with periodic TSH
TSH high, T4 normal
“subclinical hypothyroidism” (Tx if symptomatic or TSH >10 or planning pregnancy)
TSH high, T4 high
refer
DM2 screening repeats
Repeat the same test ordered originally
General rule of sp/sn of DM tests
good Specificity, but poor sensitivity (when positive=def have DM, when negative=may still have DM)
FBG level for DM dx
> /= to 126 on TWO separate tests
IGT levels
impaired glucose tolerance = 101-125
A1c dx of DM
> /= 6.5% on TWO separate tests
A1c high risk values and dx
5.7% - 6.4% IGT
Changes in RBCs could affect
results of A1c
2hOGTT steps
(Two-hour) Oral Glucose Tolerance Test.
Must fast for 8hrs ` pt first drinks 75g Glucose Solution/load ` waits 2hrs ` blood drawn. (F8,75G, 2hrs, Blood)
OGTT dx values
same as any other blood glucose.
- > /=200 DM
- levels 140 - 199 are diagnostic for impaired glucose tolerance IGT
- Under 140 is NORMAL
Monitoring tests for DM pt’s
Complete Urinalysis
Lipid Panel
CMP(liver fnx)
A1c (biannually in stable pt’s, quarterly in unstable pt’s)
Goal A1c for DM?
<7%
Protein portion of lipoprotein?
apolipoprotein
Normal life of LDL, and abnormal life?
attach to receptors and “used up”. but if oxidized it can not attach and cause all sorts of shenanigans like atherosclerosis
Main transporter of triglycerides and cholesterol is? life of them?
VLDLs. from the liver into the plasma. degrade to become LDL. which last longer in the blood. (test of choice is LDL due to this)
HDL fnx?
Significant transporters of cholesterol from the peripheral tissues and arteries to the liver “good”
80/15
Triglycerides in the plasma are a combo of VLDLs (80%) and LDLs (15%)
plasma triglyceride level is used to calculate
LDL level
Components of Lipid Panel
Total Cholesterol HDL-C LDL Triglycerides Total Cholesterol-to-HDL ratio
Total cholesterol Normal levels
140-199mg/dL
HDL Normal levels
Men: 35-65mg/dL
Women: 35-80mg/dL
LDL normal levels
optimal is <100mg/dL but individualized based on rf
Triglycerides normal levels
<150mg/dL
TC-to-HDL ratio
higher the ratio the greater the risk for developing atherosclerosis (optimal is <3.5)
other optional ratio besides tc-to-hdl (do not use this)
LDL/HDL ratio, optimal <4.5 DO NOT USE THIS
RF list for Statin therapy
dyslipidemia as detected by screening labs(LDL>130 or HDL <40)
DM
HTN
Smoker
One method for Statin plan
tx until LDL goal is reached then maintain that dose.
other labs for CVD eval
Apolipoprotein A and B. lower the ratio, the higher the risk bc it mimics A/B ~ LDL/HDL
Exercise and LDL
changes make-up of LDLs found in plasma by reducing the portion of LDLs that are oxidized
