Exam 2 Flashcards
What are the initial lab tests that are ordered to evaluate thyroid function?
TSH, Free T4, T3 (add this for hyperthyroidism)
Name the two hormones produced by the thyroid gland
Triiodothyroine- T3 and thyroxine -T4
What primary hormones are produced by the pituitary gland?
Thyroid-stimulating hormone (TSH) and ACTH
What is the purpose of TSH?
TSH tells your thyroid how much thyroid hormone it needs to make; if thyroid hormone levels are too low, the pituitary produces more TSH
What is an expected TSH/T3/T4 levels for a patient with Grave’s disease?
-TSH: low
-T3/T4: high
What are expected TSH/T3/T4 levels for a patient with Hashimoto’s?
-TSH: high
-T3/T4: low
What are the expected TSH/T3/T4 levels for patients with central or secondary hypothyroidism?
-TSH: low
-T3/T4: low
What is the test that assesses the functional status of the thyroid to differentiate between Grave’s/subacute thyroidits, and toxic nodular goiters?
A 24-hour radioactive iodine uptake (RAIU) test which identifies areas of increased and decreased thyroid function (hot and cold spots)
What is the difference between anti-thyroid medication and an ablative dose of radioactive iodine to treat Graves’ disease?
Anti-thyroid medication work by inhibiting thyroid hormone synthesis ; often not used alone but in prep for surgery or at initiation of radioactive iodine; ablative radioactive iodine is curative whereas the anti-thyroid medication generally is not
What is the treatment of choice for hyperthyroidism in middle-aged and older adults?
Radioactive iodine
When is use of radioactive iodine contraindicated?
pregnancy and breastfeeding; women should not become pregnant until at least 4 months after therapy
How long will the patient require thyroid replacement therapy after ablative radioactive treatment for hyperthyroidism?
for the rest of their life
According to the American Association of Clinical Endocrinologists, what is the usual dose of levothyroxine per day for full replacement?
1.6 mcg/kg per day
How would you alter the dose for initiating synthetic thyroid replacement with an older patient with hx of cardiac issues?
These patients should begin with 1/2 the expected full replacement dose or 25-50 mcg per day
How would you increase synthetic thyroid replacement in those the older patient or those with cardiac issues?
Increase the dose gradually by 25 mcg/day once every 4 to 6 weeks
What would make you suspicious of thyroid cancer (clinical presentation)?
-Lump or nodule in the neck that is PAINLESS
-Tightness/full feeling in neck
-Difficulty breathing, swallowing, hoarse voice, hemoptysis, swollen lymph nodes
-Sudden hoarseness with hemoptysis
What is the difference between Cushing syndrome and Cushing disease?
Cushing’s syndrome is caused by cortisol hypersecretion from multiple different causes, whereas Cushing’s disease is the hypersecretion of ACTH caused by a pituitary adenoma
What is the clinical presentation of Cushing disease?
-S: Gradual development of weight gain, back pain, headaches, skin changes, muscle weakness, menstrual irregularities/hirsutism (women), decreased libido and impotence (men)
-O: central obesity, “moon face”, “buffalo hump”, atrophy of epidermis, easy bruising, fungal infections, acne, stretch marks
What is Addison’s disease?
-also known as primary adrenal insufficency; failure of adrenal glands to produce hormones because of a problem in the gland
What is the clinical presentation of Addison’s disease?
-S: fatigue, weakness, anorexia, weight loss, nausea, abdominal pain, diarrhea,
-O: hyperpigmentation, hypoglycemia, hypotension
Diagnostic tests for Addison’s
-Plasma cortisol level (0800 draw less than 3mcg/dL = + for Addison’s)
-ACTH level >200 pg/mL
What is the difference between DMI and DMII?
DMI is a metabolic disorder causing severe insulin deficiency, beta cell destruction, and is often caused by autoimmune destruction to beta cells of the pancreas; often triggered by an infection or toxic insult and must have insulin replacement
DMII results from abnormal secretion of insulin, resistance to the action of insulin in target tissues, and inadequate response at the insulin receptor; has a stronger genetic association than type I
Is there a difference in the clinical presentation of DMI and DMII?
Generally no, the symptoms are the same and result from hyperglycemia; however ketoacidosis primary only effects type I diabetics
What is the goal of treatment for DM1?
Initial goal: normalize the elevated blood glucose level
-Plasma glucose levels of 80-130
-Peak postprandial glucose level of less than 180
-A1C below 7%