Endocrinology Flashcards by Connor Hummel

What medications can cause hypothyroidism?

-Amiodarone
-Lithium
-Immune Checkpoint Inhibitors
-Tyrosine Kinase Inhibitors

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What are symptoms of hypothyroidism?

-Extreme fatigue
-Weight gain
-Cold intolerance
-Dry skin, loss of hair
-Bradycardia
-HTN
-Depression
-Goiter

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What labs are used to diagnosis hypothyroidism?

-TSH > 5 w/ symptoms or > 10 without symptoms or positive antithyroid antibodies
(normal TSH 0.4-4)

-Low total T4
(normal T4 5-12)

-Low total T3
(normal T3 80-180)

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When is treatment for hypothyroidism usually started?

TSH > 5

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What is the preferred initial treatment for hypothyroidism?

Levothyroxine (T4)

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What initial dose of levothyroxine is appropriate for most patients?

1.6 mcg/kg/day

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Which patient populations may benefit from an initial levothyroxine dose of 12.5 mcg?

-Elderly
-Severe hypothyroidism
-History of CAD
-Arrhythmias

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How often do TSH levels need to be checked while taking levothyroxine?

-Every 6-8 weeks after each dose change
-Every 3-6 months during first year of diagnosis
-Annually thereafter

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Which medications may decrease levothyroxine absorption?

-Calcium
-PPIs
-Ferrous sulfate
-Aluminum hydroxide
-Magnesium

**Take 1-2 hours before or 4-6 hours after

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What is the conversion of desiccated thyroid hormone to levothyroxine?

1 grain (65 mg) = 60-100 mcg of T4

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What lab results would be expected in subclinical hypothyroidism?

-High TSH
-Normal T3/T4

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When are patients with subclinical hypothyroidism supposed to receive treatment?

-TSH 10 or more
-TSH 5-9 (personalized on basis of symptoms, age, quality of life, risk factors, co-morbidities)

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What dose of levothyroxine is recommended for subclinical hypothyroidism?

25-75 mcg

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Which patients should not receive treatment for subclinical hypothyroidism?

> 60 years old

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What are symptoms of hyperthyroidism?

-Heat intolerance or increased sweating
-Tremor
-Palpitations or tachycardia
-Nervousness/anxiety
-Weight loss despite increased appetite

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What labs are used to diagnosis hyperthyroidism?

-Low TSH
(normal TSH 0.4-4)

-High total T4
(normal T4 5-12)

-High total T3
(normal T3 80-180)

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What non-medication treatment options are available for hyperthyroidism?

-Radioactive iodine
*Contraindicated in pregnant or nursing mothers

-Thyroidectomy

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What medication treatment options are available for hyperthyroidism?

-Methimazole
*Less hepatotoxicity
*Not recommended in first trimester or if breastfeeding

-Propylthiouracil
*Recommended during first trimester and if breastfeeding
*More hepatotoxicity

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What are severe side effects of methimazole and propylthiouracil?

-Agranulocytosis
-Hepatitis
-Vasculitis

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Which class of medications may provide symptom relief of hyperthyroidism symptoms?

Non-selective beta blockers (propranolol & nadolol)

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Which medications are recommended in PCOS if patients are infertile?

-Clomiphene
-Metformin

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Which medications are recommended for insulin resistance associated with PCOS?

-Metformin*
-Pioglitazone
-GLP-1 agonists

Which medications are recommended for menstrual irregularities associated with PCOS?

-Oral contraceptives
-Metformin

What medications can cause hyperprolactinemia?

-Dopamine antagonists (antipsychotics, TCAs, metoclopramide)
-SSRIs
-Verapamil
-GnRH analogs

What is the recommended treatment for hyperprolactinemia?

-Bromocriptine *Recommended for fertility and during pregnancy *CI: ischemic heart disease, PVD, uncontrolled HTN -Cabergoline *Better GI tolerance *CI: ischemic heart disease, PVD, uncontrolled HTN

What medications can cause weight gain?

-Insulin -TZDs -SUs -Atypical antipsychotics -TCAs -SSRIs -Lithium -VPA -Glucocorticoids -Oral contraceptives

What is the goal amount of weight lost with treatment?

5-10% decrease in body weight over 6 months

When is pharmacological treatment for obesity indicated?

BMI 30 or more OR BMI 27 or more PLUS co-morbidities (T2DM, HTN, OSA, etc.) *Medications should only be recommended if patients do not meet goals with lifestyle changes

When should a weight loss medication be deemed ineffective and discontinued?

If < 5% weight loss in 3 months

How long should phentermine be used for?

3 months

What are contraindications to phentermine therapy?

-HF -CV disease -Arrythmias -Stroke -Glaucoma -Anxiety

What are side effects of orlistat?

-GI effects (bloating, cramping, oily spotting) -Fat-soluble vitamin deficiency

What are contraindications to orlistat therapy?

-Chronic malabsorption therapy -Cholestasis -Hepatotoxicity

How much weight should a patient lose during the first 12 weeks of Qsymia therapy?

at least 3% of body weight (if not, discontinue therapy)

How much weight should a patient lose during the 12 weeks of highest Qsymia dose?

at least 5% of body weight (if not, taper off therapy)

What are contraindications to Qsymia therapy?

-Pregnancy -Severe depression -Recent stroke or CV event -Nephrolithiasis *REMS program available

What are contraindications to Contrave therapy?

-Seizure disorder -Anorexia -Bulimia

How much weight should a patient lose during the first 12 weeks of Contrave therapy?

at least 5% of body weight (if not, discontinue therapy)

How much weight should a patient lose during the first 16 weeks of Saxenda therapy?

at least 4% of body weight (if not, discontinue therapy)

What are side effects of Qsymia?

-Paresthesia -Dysgeusia -Insomnia -Dry mouth

When should bariatric surgery be considered?

BMI 40 or more OR BMI 35 or more w/ comorbidities (DM, OSA, CV disease, joint disease)

What deficiencies are typically associated with Roux-en-Y gastric bypass surgery?

-Iron -B12 -Folate -Calcium

What are symptoms of primary adrenal deficiency (Addison disease)?

-Weakness/fatigue -Anorexia -Salt craving -Hypotension -Weight loss -Dehydration

What is the treatment of primary adrenal deficiency?

-Hydrocortisone -Cortisone -Prednisolone -Fludrocortisone

How should corticosteroid dosing be adjusted during sick-days/times of stress for primary adrenal deficiency?

Double or triple dose

What are symptoms of Cushing Syndrome?

-Central obesity w/ moon/round face + buffalo hump -HTN -Striae -Myopathy -Osteopenia or osteoporosis

What are symptoms of hyperaldosteronism?

-Fatigue -Muscle cramping -Paresthesia -Polyuria/polydipsia -HTN -Hypo-K

What is the treatment for hyperaldosteronism?

-Spironolactone -Eplerenone

What are symptoms of male hypogonadism?

-Decrease libido -ED -Loss of body hair -Loss of energy

What is the treatment for male hypogonadism?

-Testosterone

What are side effects of testosterone?

-Increase in BP (oral and SQ) -Edema -Acne -Gynecomastia -Polycythemia -Hair loss

What are contraindications to testosterone?

-History of breast or prostate cancer -Untreated BPH -Untreated OSA -Uncontrolled HF -Pregnancy/breastfeeding