Endocrinology Flashcards
1
Q
How is baseline GH associated with hypothyroidism compared to NTI?
A
Increased in hypothyroidism compared to NTI
2
Q
What does GH do when TRH is administered to a dog with hypothyroidism and a dog with NTI
A
increases in hypothyroid dogs and not NTI dogs
3
Q
How does TSH change after administration of TRH in dogs with hypothyroidism and dogs with NTI dogs
A
TSH does not increase after TRH in hypothyroid dogs
TSH increases in NTI dogs
4
Q
what is the difference in efficacy between enteric coated micropellets and non coated pancreatic enzyme supplementation?
A
no difference in formulations
5
Q
How is IGF-1 different 2-4 weeks after starting inuslin?
A
higher after starting insulin (300 vs 670)
6
Q
what can be used to predict diabetic remission in cats?
A
Increase in IGF-1
increased TC and IGFBP-3 in cats who went into remission
7
Q
How are retinol, 25OHD, and alpha-tocopherol impacted by EPI? How are levels impacted by enzyme supplementation?
A
retinol and alpha-tocopherol lower in dogs with EPI
If weight loss, lower 25ODH
Remain low in the face of enzyme supplementation
8
Q
How does adjusting i-131 dose based on thyroid:salivary gland size ratio impact outcome compared to fixed dosing?
A
no difference in outcome
variable dose: 61% euthyroid, 30% hypothyroid, 9% persistently hyperthyroid
fixed dose: 58%, 26%, and 16%
9
Q
What is the most common form of spontaneous hypothyroidism in cats?
A
Goitrous hypothyroidism associated with thyroid hyperplasia
10
Q
A
11
Q
how does treating hypothyroidism impact azotemia in cats with spontanous hypothyroidism?
A
High serum creatinine normalized
12
Q
Prognosis of cats hospitalized with acute pancreatitis (aka how many survived to discharge)
A
77.7% survived to discharge
13
Q
Negative prognostic indicators for pancreatitis
A
longer to evaluation, pleural effusion, lethargy, hypoglycemia, ionized hypocalcemia, azotemia, parenteral nutrition and persistent anorexia in hospital
14
Q
How many cats hospitalized with acute pancreatitis had ultrasonographic changes?
A
85%, majority (81.3%) pancreatomegaly
15
Q
Difference between low dose and high dose cosyntropin?
A
no difference between 1 ug/kg compared to 5 ug/kg
16
Q
How does TSH administration impact dose of radioactive iodine?
A
does not lower i-131 dose, even at high TSH doses
17
Q
Sensitivity of post stimulation cortisol of 24.8 to diagnose HAC (all cause)? Does basal cortisol change test interpretation?
A
All cause HAC: Sn 86% and sp 94%
Basal cortisol is redundant
18
Q
Sensitivity of post stimulation cortisol of 24.8 to diagnose PDH?
A
100% sp, 81% sn
19
Q
How do serotonin and prolactin concentrations differ at 6 weeks and 6 months post thyroid hormone supplementation?
A
no difference in either hormone
20
Q
How does C-BARQ change with levothyroxine supplementation in hypothyroid dogs?
A
Increased in C-BARQ scores at 6 weeks, no change at 6 months
21
Q
How many dogs (all dogs and dex-resistant) have concurrent pituitary and adrenal lesions?
A
5% pituitary and adrenal lesions in all dogs
10% pituitary and adrenal lesions in dex-resistant dogs
22
Q
What is heterogenous contrast enhancement on CT of the pancreas associated with?
A
longer hosplization, more likely to have PVT, higher SpecCPL
23
Q
what are risk factors for short term death in dogs with pancreatitis?
A
Presence of SIRS, coagulation disorders, increased creatinine, ionized hypocalcemia
24
Q
After bilateral thyroidectomy, how many cats were hypothyroid and how many cats had recurrent hypothyroidism?
A
49% hypothyroid
22% persistent hyperthyroidism
25
Of all euthyroid and hypothyroid cats post bilateral thyroidectomy, how many remained hypothyroid, euthyroid, and developed recurrent hyperthyroidism?
17% remained hypothyroid
83% euthyroid
44% developed recurrent hyperthyroidism
26
In cats with hyperthyroidism, what is higher, SDMA or creatinine?
SDMA increases more relative to creatinine
27
In cats with hyperthyroidism, how does SDMA and creatinine correlate with GFR?
GFR and SDMA have low correlation and is not significant, creatinine has moderate correlation with GFR and is significant
28
In a cat with elevated SDMA prior to i-131 treatment, would you expect this cat to become azotemic following treatment?
no, all cats with elevated SDMA prior to i-131 were not azotemia following treatment
29
What ultrasonographic abnormalities of the gastric wall may be associated with pancreatitis?
Loss of wall layering
Intermediate hyperechoic echogenicity of thick submucosal layer
Focal thickening adjacent to diseased pancreas
30
What starting dose of DOCP is sufficient?
1.5 mg/kg, 28-30 day interval
31
how is age associated with DOCP dose?
younger dogs need higher DOCP dosing, none needed 2.2 mg/kg
32
What is the median dose of DOCP needed?
1.1 mg/kg
33
How does insulin lispro differ when compared to regular insulin when managing cats with DKA?
median time to glucose <250 is faster with lispro compared to regular insulin
0.09 u/kg/hr lispro safe and effective
34
OR of having CKD in diabetic cats?
4.47
35
What breeds of dogs in the USA are at risk for diabetes?
Samoyed
Miniature schnauzer
Miniature poodle
Pug
Toy poodle
Australian terrier breed
36
What is the heritability of DM in american eskimo dogs? What is the most of inheritance?
0.62 (high heritability, low precision)
Polygenic, no evidence of single gene/large effect
37
What ECG changes are expect in a dog with hypothyroidism? How does treating dogs with hypothyroidism affect these changes?
Hypothyroid: Bradycardia, decreased P and R wave amplitude
Treatment: improved HR, p wave amplitude, fractional shortening, decreased LV end diastolic volume, normalized systolic diameter
38
What parameters can be used to predict ionized calcium from total calcium? Sensitivity and specificity of model for hypercalcemia?
tCa, chloride, albumin, cholesterol, creatinine, BUN, body condition score, GGT, age, and potassium
Sn 30.4% Sp 99.8%
39
How are melatonin, serotonin, and dopamine different in dogs with SARDS vs PDH?
no difference
40
What urine marker is increased in dogs with PDH compared to SARDS
Urine MT6s: creatinine ratio
[Urine 6-sulfatoxymelatonin (MT6s) concentrations represent accumulated amounts of systemic melatonin over several hours and are therefore less affected by fluctuations in circulating concentrations]
41
How does trilostane impact QoL based on survery?
Dogs had better QoL, questions related to owner impact more important than patient demeanor
42
In non-hyperphosphatemic dogs, what tCa concentration can be used to predict hypercalcemia and what is the PPV, and sn?
12.0 cut off
PPV 93%
Sn 52%
43
Prevalence of ionized hypercalcemia is more in hyperphosphatemic or non-hyperphosphatemic?
non-hyperphosphatemic
also had lower prevalence of ionized-hypocalcemia
44
What factors affect CGM accuracy in dogs with DKA?
NO effect of metabolic variables, BSC, and time wearing sensor
analytic accuracy not achieved, however clinical accuracy 100% and 99.6%
45
How does idexx TT4 compared with immulite TT4
Dogs: lower levels good agreement, higher levels impact idexx sampling
Immulite underestimates TT4
Cat: no effect on clinical decision until TT4 over 10
46
How do diabetic cat erythrocytes compare to control cats?
higher membrane carbonyls
lower cytoplasmic TBAR and thiols. No change in treatment and remission
47
what is the significance of diabetic erythrocyte change in cats?
DM is associated with increased protein oxidation and reduced antioxidant defences
48
What is the complication rate of adrenal FNAs? what were they?
8% (4/50). 3 hemorrhage, 1 death from ARDS
No hypertensive crises
49
What is the strength of correlation between specCPL and AUS findings of pancreatitis?
AUS is weakly correlated with specCPL
50
What pancreatic ultrasonographic changes are correlated with clinical diagnosis of pancreatitis?
pancreatic size, echogenicity, mesenteric echogenicity (moderate correlation)
51
Sensitivity and specificity of ultrasound for pancreatitis when one pancreatic change required vs three changes?
One change: sn 89%, sp 43%
Three changes: sn 43%, sp 92%
52
How many dogs with clinical pancreatitis had hypertriglycemia and hypercholesterolemia?
What is the OR for each for pancreatitis compared to normal dogs?
18% hypertriglyceridemia (OR 2.6)
24% hypercholesterolemia (OR 16)
53
How do lipoprotein profiles differ in dogs with pancreatitis compared to healthy dogs?
Pancreatitis: higher LDL, lower TG rich lipoproteins and HDL compared to healthy
54
When compared to histopathology, what is the sn of specCPL in dogs with moderate or severe AP?
90%
55
What percent of dogs with pancreatic neoplasia have elevated specCPL?
83%
56
MST of dogs with insulinoma post op? How does this vary with stage?
MST 372 days,
Stage I: 652 days
Stage II or III: 320 days
57
How many dogs have post-operative hyperglycemia after surgical management of insulinoma?
33% post-op hyperglycemia
19% total population persistent DM
No risk factors identified
58
How does pancreatitis influence ADMA (asymmetric dimethylarginine)?
Higher in acute pancreatitis and associated with mortality
59
What pancreatic lipase diagnostic has the highest repeatability and which one the lowest?
Spec cPL highest
Vcheck lower repeatability
60
How does in house pancreatic lipase different from Spec cPL assay?
In house assays are lower
61
Is there a difference in subclinical bacteriuria in cats with hyperthyroidism vs euthyroidism?
no difference (4.3% vs 4.6%)
female increased risk (OR 6.9)
62
what is the prevalence of hypoadrenocorticism in dogs with chronic GI disease per JVIM 2020 (Hauck)
4%
63
Is a fPL more likely to be falsely positive or falsely negative?
Positive indicates pancreatitis is probable
Negative test cannot rule out pancreatitis
64
How long does it take for trilostane to suppress cortisol and how long does this last?
1 hour, lasts 8 hours
65
what markers are not helpful to determine dose of trilostane?
USG, UCCR, and ACTHst
66
What percent of dogs with pancreatitis associated EHBO survived? what proportion of survivors survived with medical management alone?
79% survived, 94% survived with medical management alone
no difference in outcome for median bile duct dilation
67
In dogs with acute pancreatitis, how many days to see peak of hyperbilirubinemia, how many days to see decline of hyperbilirubinemia?
8 days peak
15 days to see decline
68
Mortality rate of pancreatitis per JVIM 2020 (Kuzi)
19%
69
Inflammatory markers of pancreatitis
CRP, IL-6, TNF-alpha increased
Antithrombin lower
70
What treatment can be considered for dogs with MPS-I?
Pentosan polyphosphate
71
What mutation is seen in Golden Retrievers with MPS-I
Homozygous deletion of 287 bp resulting in full deletion of exon 10 of the IDUA gene
72
How does non-critical illness impact TT4 after TSH stimulation test in RAI and euthyroid cats?
no impact of non-critical illness
73
What diagnostic tests can be used to assess for iatrogenic hypothyroidism in RIA treated cats?
fT4 and TSH (canine assay)
74
What thyroid function tests are associated with decreased survival in cats with NTI?
Cats who died had lower T4 and TSH and T3
No difference in fT4
75
How is glycemic variability implicated in diabetic remission?
cats with lower GV are more likely to achieve remission
76
What medication can be used to decrease glycemic variability?
GLP-1 agonist (exenatide)
77
In what percent of dogs was a nadir detected using a CGM vs alpha track?
79% CGM, 41% alpha track
CGM allows for more accurate identification of nadir and hypoglycemic episodes
78
What variables are used in a model to accurately predict hypercortisolism in dogs?
sex, age, breed, polydipsia, vomiting, potbelly/hepatomegaly, alopecia, pruritus, alkaline phosphatase, and urine specific gravity.
79
What percent of dogs with increased lipase have pancreatitis?
32%
80
What are predictors to develop high lipase?
hemodialysis, increased bilirubin, increased creatinine, decreased HCT
81
What disease processes is are associated with high lipase?
renal disease, endocrine disease, immune mediated disease, and upper airway obstruction
82
What is hyperlipasemia associated with prognostically?
longer hospitalization and higher mortality
83
How does prednisone impact DGGR (1,2-O-dilauryl-rac-glycero glutaric acid-(6’-methylresorufin))
increase over a period of 7 days but does not increase over RR
84
How many dogs with PDH need antihypertensive therapy?
60%
BP is not associated with disease control
85
In cats with hypophysectomy, how many died post ops and how many were alive at 4 week?
85.3% alive
15% post op deaths
86
What marker can be used to predict DM remission in cats undergoing hypophysectomy?
4 week post-op IGF-1 lower in cats achieving Dm remission
87
How is diabetes control impacted post hypophysectomy? (Fenn 2021)
71% of surviving cats went into diabetic remission, 12% recurrence after median of 248 days
88
What % of cats undergoing hypophysectomy had improved control of DM?
95% of surviving cats
89
MST of cats undergoing hypophysectomy? (Fenn 2021)
853 days (just over 2 years)
90
How is diabetes control impacted post hypophysectomy? (von Bokhorts 2021)
92% diabetic remission
IGF 1 normalized in 23/24 cats
91
MST of cats undergoing hypophysectomy? (von Bokhorts 2021)
1347 days (just under 4 years)
92
In diabetic dogs with CGM, what time periods was associated with higher BGs?
1-6am
93
What insulin pens are the most accurate when delivering low doses of insulin?
JuniorSTAR and Vetpen 0.5-8U
especially if dose is 0.5 or 1U
94
how does dose accuracy compared with insulin pens vs syringes?
pens underestimate, syringes over estimate
Degree of which syringes over estimate is more than pens underestimate
95
What markers of calcium homeostasis are higher in dogs with hypercortisolism? What values are lower?
Higher: phosphorus, Fractional excretion of calcium, serum, serum PTH
Lower: 25OHD, FGF23
Suggests urine loss of calcium
96
How does IGF-1 differ in healthy cats with weight gain/loss?
no correlation with body weight in cats
97
When is a CGM least accurate in diabetic cats?
during periods of rapid BG change
Lag between IG and BG
98
In cats with TT4 over 40 nmol/L (3.1 ug/dL) at time of discharge after treatment with i-131, how many became euththyroid?
40%
99
what cut off of TT4 at time of discharge can be used to predict candidates for immediate retreatment with i-131
>150 nmol/L (11.65 ug/dL)
100
How many cats who failed RAI treatment were treated successfully again with RAI?
86%
101
what is the variation in activity of RAI before administration?
88.4-103.3% of prescribed dose
102
What is the variation compared to prescribed dose of RAI after administration?
79.1%-100.2%
103
What percentage of cats with CGMs had sensor failure and what was median time of sensor activity?
80%
7 days
Good agreement of BGs and IGs
104
how is TLI associated with DM?
No associated with TLI in dogs with diabetes
105
What does of DOCP is shown to be equivalent to 2.2 mg/kg? (JVIM, Vincent 2021)
1.1 mg/kg q30 days
106
What percentage of Korean compounded trilostane packets had acceptable strength of trilostane?
40.9%
107
How many dogs given fenofibrate had reduction in triglycerides? What else did fenofibrate reduce?
100%, 90% had decrease in cholesterol
ALP also was decreased
108
Reported adverse effects of fenofibrate
quieter demeanor and firm stools in 1 dog
(note in JFMS cats number 1 side effect = diarrhea)
109
When transitioning cats from glargine to ultra long acting once a week insulin, what changed? what adverse effects were noted?
no change in body weight, clinical signs, fructosamine, and mean IG concentration (aka equivalent to glargine at controlling DM)
No adverse reactions
110
What insulins are associated with lower day to day variability?
Degludec and Toujeo compared to vetsulin
111
what percent of subclinical and overt hypothyroid cats developed azotemia in Pederson 2021?
71.9% overt
39.6 subclinical
112
What dosing scheme was proposed in Pederson 2021? What was the median dose?
80% of composite dose from T4/T3, thyroid volume, TcTU uptake
1.9 mCi
113
In cats with hyperaldosteronism, what other hormones are increased?
Progesterone and corticosterone
32% of cats with aldosterone >3000 had progesterone over 10
114
How is cortisol correlated with hyperaldosteronism?
Lower in cats with aldo over 3000, higher with aldo under 500
115
Are cats with aldosterone and progesterone secreting adrenal tumors more likely to have bilateral or unilateral tumor?
100% of cats had unilateral tumors with contralateral adrenal atrophy
116
Percentage of cats with aldosterone and progesterone secreting tumors who have DM? What was the remission rate of these cats?
100% had DM, 3 cats had high corticosterone
Remission in 3/10 cats with surgery, none with medical management
117
How many cats with aldosterone and progesterone secreting adrenal tumors developed hypoadrenocorticism following adrenalectomy?
3/4 (75%)
118
Prognosis following surgery for aldosterone and progesterone secreting adrenal tumors vs medical management
Surgery: 2/4 >1 year
Medical management: 2/4 >1 year
119
What markers can be considered for detecting under control vs well control of hypercortisolism in context of clinical picture?
Haptoglobin (increase is associated with poor control), less degree ALT and GGT
120
are CGMs reliable for hypoglyemia?
no, for BGs less than 100, only 39.1% of CGM readings were within 15 mg/dL of reference BG
121
What hemostatic changes are expected in hyperthyroid cats? Are they more hypercoagulable?
Higher fibrinogen, higher AT activity, and vWF:Ag concentration (may suggest endothelial dysfunction) however NOT more likely to be hypercoagulable
Hemostatic changes resolved after i-131
122
What percent of cats with EPI had pancreatitis with little to no ultrasonographic changes?
39%
123
Most common clinical sign of EPI in cats? Most common concurrent disease?
weight loss (15/22 cats, 68%)
CE is most common concurrent disease
124
Ultrasonographic findings in cats with EPI?
Thin pancreatic parenchyma, pancreatic duct dilation or diffuse SI dilatation with echogenic contents
125
Is there a difference in orally administered I 123 compared to SC I 123 in euthyroid cats?
No difference in administration route on paired % thyroidal RAIU
126
What is a more reliable indication of chronic stress in cats, hair cortisol or nail cortisol?
Nail cortisol, hair cortisol is too varaible
127
Sensitivity and specificity of endogenous ACTH to differentiate between PDH and and AT
sn 90.62%, sp 87.5%
128
Sensitivity and specificity of post CRH stimulation ACTH to differentiate between PDH and and AT
Sn 100%, sp 66.67%
129
How is CRHT impacted by adrenal tumor size or pituitary tumor size?
no correlation
130
Incidence of hyponatremia and hypernatremia in dogs post hypophysectomy? Incidence of hyperkalemia? How long did sodium take to normalize?
46.5% hypernatremia
6.3% hyponatremia
No instances of hyperkalemia
24-48 hours, does not influence post op outcome
131
Risk factors associated with persistent DI in dogs post hypophysectomy
longer surgery times, enlarged pituitary glands
132
In Pederson 2021, how many cats remained hyperthyroid and how many cats developed hypothyroidism post I-131?
5-10% cats hyperthyroid, 20-50% developed hypothyroidism
133
Risk factors for developing hypothyroidism post I-131
older (OR 1.1), female (OR 2.04), detectable TSH (4.19), bilateral thyroid nodules (1.57), homogenous distributions of Tc99m uptake, higher I131 uptake, milder severity score
134
Risk factors for persistent hyperthyroidism post I-131
younger (OR 0.81), higher severity score, lower I-131 uptake
135
What disease processes are cavitary effusions rich in VLDL and LDL associated with?
CKD, acquired PSS, PLE
Lower in protein
136
What can be measured in cavitary effusion that might suggest pancreatitis?
Transudate rich in triglycerides
137
What disease processes are cavitary effusions rich in dense lipoproteins associated with?
heart disease, caudal vena cava syndrome, intracavitary neoplasia
protein higher
138
What metabolites are associated with pancreatitis in cats (when fPLI is used to diagnose pancreatitis)
Selected sphingolipids (2 cerebrosides (HexCer(d18:1/24:0) and HexCer(d18:1/24:1)) and 1 sphingomyelin (SM C18:0)
139
What cut off of UCCR can be used to diagnose hypoadrenocorticism with what sn and sp?
<1.4
100% sn
97.3% sp
140
How does serum calprotectin change in schnauzers treated for idiopathic hyperlipidemia with ULFD?
increased calprotectin after resolution of hypertriglyceridemia
Lower in dogs with untreated disease
clinical implication unknown
141
How is hyperlipidemia associated with insulin resistance in miniature schnauzers?
Insulin concentrations are higher in miniature schnauzers with hyperlipidemia, insulin decreases after treatment with ULFD
142
How does ultra long acting insulin compare to intermediate acting insulin in dogs treated for 8 week? what were adverse effects?
No change in body weight, clinical signs, fructosamine concentration, or mean interstitial glucose concentrations
No adverse events
143
What clinical features/biochemical features are diagnostic for congenital hypothyroidism in cats?
Disproportionate dwarfism, high TSH, low to low normal TT4
144
What mutation may be associated with congenital hypothyroidism in cats?
recessive c.430G>A (p.(Gly144Arg)) thyroid peroxidase variant
145
What percent of cats with persistent ionized hypercalcemia were azotemic?
75%
146
What is a potential adverse effect of alendronate when treating hypercalcemia in cat?
Severe hypophosphatemia
147
What is the effect of alendronate on hypercalcemia in cats?
shorter time to reach 15% decrease in ionized calcium concentration, though not significant after adjustment for age and initial iCa
148
How does I-131 affect muscle mass?
restores muscle mass in >85% of cats
2/3 of cats with hyperthyroidism have abnormally low muscle mass
149
How many false positives were there in Addison's machine learning
4/12 false positive (clinically acceptable)
No false negatives
150
What variable can be used to predict glucocorticoid-deficient hypoadrenocorticism?
No single variable can predict glucocorticoid-deficient hypoadrenocorticism
151
What percent of diabetic cats achieved remission in a recent large retrospective? what is associated with remission?
29% received remission
Commercially avaiable low carb wet diet that was higher in fat
152
How is oxidative stress associated with acute pancreatitis?
increased markers of oxidative stress in dogs with AP, not associated with outcome
153
What is hypercalcemia in cats most commonly associated with?
AKI 13%
Malignancy 10.1%
Idiopathic 10.1%
CKD/diet associated 8.4%
154
What percent of cats could no cause of hypercalcemia be determined?
47.1%
155
What percentage of cats hypercalcemia had urolithiasis with AKI, iatrogenic, CKD/renal diet associated/idiopathic?
83.3% AKI
72.7% iatrogenic
61.1% CKD/diet
50% idiopathic
156
What are miR-216a and miR-375 associated with?
positive association with CRP
157
what miRNA may serve as a biomarker for acute pancreatitis?
miR-375
158
What is the prevalence of systemic hypertension of dogs with HAC (Jose 2020)
>150 82%, >180 46%
159
Sn and Sp of platelet count of at least 438,000 to predict systemic hypertension in a dog with HAC?
100% sp
61.1% sn
160
What biochemical changes would you expect to see in a hypertensive dog with HAC?
Platelets over 438,000
Lower potassium levels (3.1-5.4)
UPC over 0.5
161
How does concurrent diabetes mellitus impact risk for SH in dogs with HAC?
lower risk
162
What breed of cat is predisposed to hypoadrenocorticism?
British short hair
163
What is the median dose of DOCP and prednisolone in cats with hypoadrenocorticism?
2.2 mg/kg q28d (1.3-3.0 mg/kg)
Pred 0.3 mg/kg/day (0.08-0.5 mg/kg/day)
164
How long does it take for lipase activity to decrease in dogs with acute pancreatitis?
2 days
165
What may be an early marker of AP on ultrasound in dogs?
mesenteric echogenicity
Correlated with lipase and PLI, ultrasonographic diagnosis of AP did not correlate
166
TT4, fT4, and TSH in cats with spontaneous hypothyroidism
low fT4 and TT4
High TSH
167
How long should you wait after anesthesia or surgery to test thyroid function?
14 days
168
How long after discontinuing a sulfonamide before testing thyroid function?
4 weeks, in some cases may need 12 to 22 weeks for clinical hypothyroidism to resolve
169
How do sulfonamides impact thyroid function?
Inhibit thyroid peroxidase
will see low TT4, fT4, and increased TSH
170
Which NSAID has the biggest impact on thyroid function? How long should you wait after stopping an NSAID to test thyroid function?
Aspirin
Wait 7-14 days
171
How does phenobarbital impact thyroid function?
Acclerates clearance of T4 via peripheral deiodination to T4 and subsequent hepatobiliary clearance and fecal excretion
Will see decreased TT4, fT4, TSH will be increased or unchanged. TT3 is unchanged
Takes 1 month to see changes
172
How long should you wait to test thyroid function after stopping phenobarbital?
6 weeks
173
How long should you wait after stopping steroids before testing thyroid function?
1 week
174
How does both anti-inflammatory and immunosuppressive steroids impact thyroid function?
anti-inflammatory: after 3-5 weeks inhibits iodothyronine deiodinases. decreases TT3 only
immunosuppressive: Decrease in TT4, TT3, and fT4, no change in TSH
Topical also will decrease TT4 and TT3
175
How does clomipramine impact thyroid function? (tricyclic antidepressant)
Decreases TT4, fT4, and rT3 though not below reference range
MOA:
1. Inhibits thyroid hormone synthesis
2. enhances 5′-deiodinase activity
3. Interferes with the HPT axis
176
