Endocrinology Flashcards
What medications can cause hypothyroidism?
-Amiodarone
-Lithium
-Immune Checkpoint Inhibitors
-Tyrosine Kinase Inhibitors
What are symptoms of hypothyroidism?
-Extreme fatigue
-Weight gain
-Cold intolerance
-Dry skin, loss of hair
-Bradycardia
-HTN
-Depression
-Goiter
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)
When is treatment for hypothyroidism usually started?
TSH > 5
What is the preferred initial treatment for hypothyroidism?
Levothyroxine (T4)
What initial dose of levothyroxine is appropriate for most patients?
1.6 mcg/kg/day
Which patient populations may benefit from an initial levothyroxine dose of 12.5 mcg?
-Elderly
-Severe hypothyroidism
-History of CAD
-Arrhythmias
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
Which medications may decrease levothyroxine absorption?
-Calcium
-PPIs
-Ferrous sulfate
-Aluminum hydroxide
-Magnesium
**Take 1-2 hours before or 4-6 hours after
What is the conversion of desiccated thyroid hormone to levothyroxine?
1 grain (65 mg) = 60-100 mcg of T4
What lab results would be expected in subclinical hypothyroidism?
-High TSH
-Normal T3/T4
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)
What dose of levothyroxine is recommended for subclinical hypothyroidism?
25-75 mcg
Which patients should not receive treatment for subclinical hypothyroidism?
> 60 years old
What are symptoms of hyperthyroidism?
-Heat intolerance or increased sweating
-Tremor
-Palpitations or tachycardia
-Nervousness/anxiety
-Weight loss despite increased appetite
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)
What non-medication treatment options are available for hyperthyroidism?
-Radioactive iodine
*Contraindicated in pregnant or nursing mothers
-Thyroidectomy
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
What are severe side effects of methimazole and propylthiouracil?
-Agranulocytosis
-Hepatitis
-Vasculitis
Which class of medications may provide symptom relief of hyperthyroidism symptoms?
Non-selective beta blockers (propranolol & nadolol)
Which medications are recommended in PCOS if patients are infertile?
-Clomiphene
-Metformin
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
