Endocrinology

Question 1

When is IV insulin indicated in the treatment of steroid induced hyperglycemia?

Answer 1

When there is evidence of ketoacidosis.

Question 2

What is the threshold for treatment of steroid induced hypoglycemia without acidosis, and what is the treatment?

Answer 2

Serum glucose > 200, subcutaneous insulin.

Question 3

Elevated antithyroglobin and antithyroperoxidase is seen in what diseases?

Answer 3

Chronic autoimmune thyroiditis (Hashimoto disease), Graves disease, and also some individuals without any thyroid disease.

Question 4

How is the diagnosis of chronic autoimmune thyroiditis made?

Answer 4

1. Elevated antithyroglobin and antithyroperoxidase antibodies.
2. Biopsy

Question 5

What is the treatment of chronic autoimmune thyroiditis?

Answer 5

Monitor TSH and free T4 every 6 months.
Treat hypothyroidism with levothyroxine.

Question 6

A patient presents with lethargy, constipation, and elevated THG and TPO antibodies. Which thyroid diseases should be considered?

Answer 6

1.Chronic autoimmune thyroiditis.
2. Graves disease

Question 7

Is subacute thyroiditis associated with hypothyroidism or hyperthyroidism?

Answer 7

Yes.

Question 8

How is Grave’s disease diagnosed?

Answer 8

1. Elevated free T4, undetectable TSH.
2. Positive thyroid stimulating antibodies (TSI). Also possibly postive THG and TPO antibodies.

Question 9

What is the treatment for Grave’s disease

Answer 9

1. Beta blockers (unless Asthma or hypoglycemia).
2. Methimazole
3. Most require surgical or radioactive iodine ablation (followed by synthroid for the resultant hypothyroidism).

Question 10

You are treating a patient who presents with a rubbery thyroid nodule. What is the probability it is malignant?

Answer 10

25%

Question 11

You are treating a patient who presents with a rubbery thyroid nodule. What is the diagnostic test of choice?

Answer 11

Fine needle aspiration.

Question 12

You are called to the newborn nursery to assess a 25 hour old infant who is now jittery, tachycardic and has flushed skin. The infant was born at an estimated gestational age of 39 weeks to a G1P1 mother via vaginal delivery, with rupture of membranes 5 hours prior to delivery. Prenatal labs including assessment for infectious diseases were all normal. The mother takes levothyroxine. The baby’s blood sugar is 65. What thyroid related disorder should be considered?

Answer 12

Maternal Graves disease with associated neonatal thyrotoxicosis. Even after treatment of Graves disease with ablation (and subsequent synthroid treatment due to the resulting hypothyroidism), the mother can continue to produce TSI and pass these antibodies to the infant.

Treatment options include methimazole or iodine.