Module 9 Flashcards
What are the main presenting symptoms of DM Type I
Usually present after a brief period of PROFOUND symptoms polyuria, polydipsia, polyphagia, wt loss, blurred vision, fatigue.
What are the main presenting symptoms of DM Type II if any?
May have no symptoms or subtle symptoms. Symptoms include polyuria, polydipsia, polyphagia, blurred vision, fatigue, and slow healing wounds, and frequent infections
What lab tests would you order in DM type 1 and DM type II?
Diabetes I
C-peptide level
Insulin level
1A autoantibodies
Diabetes II
Serum glucose or random fasting
Oral glucose tolerance test
HbA1c
What may cause a non-toxic simple goiter
iodine deficiency, Grave’s disease, neoplasia, or thyroiditis
In non-toxic simple goiters what would the lab tests show?
low or normal free T4 and a high or normal TSH level
What could you use to assess the size and number of nodules?
Ultrasound
How do you measure nontoxic simple goiters?
surgical or radioiodine to reduce thyroid volume
What is a thyroid nodule?
Distinct lesion within the thyroid that is radiologically different from the rest of the thyroid. Include both solid and cysts.
What might cause a thyroid nodule?
adenomas, cysts, carcinomas, multinodular goiters, Hashimoto thyroiditis, and subacute thyroiditis
How do you manage a thyroid nodule or suspicious lesion?
If TSH elevated then start levothyroxine
If suspicious lesions pt is referred for surgery
For solitary lesions pt is referred for lobectomy
What is the most common cause of hyperthyroidism?
Graves disease
What are the symptoms of hyperthyroidism?
Dry eyes, SOB, diffuse goiter (in Graves), wt loss, hyper-defecation, amenorrhea, tremor, heat intolerance, anxiety pruritis
What is the best screening for hyperthyroidism?
TSH is the best screening for primary hyperthyroidism. Levels will be low or undetectable.
What is the most common presenting symptom of Hypothyroid?
Fatigue
What are some other symptoms of hypothyroid?
increased sensitivity to cold, wt gain, hoarseness, puffiness of face, irregular menstrual cycles, dry and brittle hair, depression, numbness and tingling, constipation.
What do subclinical levels of hypothyroid show on lab work?
elevated TSH and normal free T4
What do more advanced levels of hypothyroid show on lab work?
TSH elevated and LOW T4 and T3 levels
What is the most serious condition that can occur in hypothyroid?
myxedema coma with slowed mentation and visible symptoms
How often do you assess the thyroid levels of someone on levothyroxine?
annually or biannual screening
What types of people are greater risk of subclinical hypothyroidism?
Pts with autoimmune diseases such as diabetes type 1
When do you start screening for DM type II?
Begin screening at age 45 and 40-70 for those who are overweight and or have ONE or MORE of risk factors: physical inactivity, family hx of diabetes, hx of gestational diabetes, HTN, dyslipidemia, POS, hx of cardiovascular disease
*if neg then repeat every 3 years or if a change in risk
Recognize the criteria for diagnosis of metabolic syndrome (this is an exact L.O.)
Insulin resistance with hyperinsulemia
HTN
abd obesity
dyslipidemia
hypertriglyceridemia
low HDL
high LDL.
Contrast the signs and symptoms of hyper and hypothyroidism (I have a pic in my L.O.)
Hypothyroidism:
Hair loss Goiter slow HR fatigue cold sensitivity constipation memory issues depression joint/ muscle aches irregular menstrual cycles
Hyperthyroidism:
hair loss bulging eyes goiter heart palpitations tremors heat intolerance diarrhea wt loss sleep disturbances muscles weakness anxiety/nervousness sweating
WHat are some history questions you would ask for type II diabetic at their annual visit?
DO you have increased thirst and urination (may be the first symptoms but some are asymptomatic initially).
May have hyperglycemia as one of the symptoms.
May have no symptoms or subtle symptoms.
Symptoms include polyuria, polydipsia, polyphagia, blurred vision, fatigue, and slow healing wounds, and frequent infections
What would you assess for on physical exam for type II diabetic at their annual visit?
Assess for dehydration, weight loss, precipitating causes ie: infection, illness, stress.
1) evaluate glucose control (poor control leads to end organ complications)
2) assess the presence or progression of end organ damage
3) assess associated diseases (CAD risk factors or other autoimmune diseases)
What investigations would you order for a type II diabetic at their annual visit?
Urine glucose Urine and blood ketones Fasting or serum glucose Oral glucose tolerance test HbA1C Self-monitoring blood glucose
What are the non-pharm and pharm managment approaches to the type II diabetic?
Management:
Non-Pharm: diet and lifestyle changes
Glucose monitoring
Pharm:
1st choice metformin
Metformin + another agent (if HgA1c not reached after 3 mo)
Metformin + 2 other agents (if HgA1c not reached after those 3 mo)
Metformin + more complex insulin regime + or – other noninsulin agent
When would you refer a type II diabetic?
Poorly controlled
Yearly ophthalmology visits
Cardiologist for secondary prevention of CAD
Consultation with dieticians
Exercise physiologist
Social work to manage emotional, financial, etc
What are the endocrine disorders in which a specialist needs to be involved?
Acromegaly- endocrinologist
Addison’s disease
Cushing’s syndrome
Pheochromocytoma
Hirsutism- enhanced androgen-dependent sensitivity to increased levels of circulating androgens
Hyperkalemia-levels lower than 3 or higher than 6
May be caused from hyperaldosteronism, renal failure, Addison’s disease, acidosis, sickle cell anemia rhabdomyolysis, MEDS: (ie: NSAIDS, ACE inhibitors, trimethoprim-sulfamethoxazole
Hyponatremia- referral for levels >125mEq/L
Hypertriglyceridemia and elevated liver and pancreatic enzymes, chest pain, resp issues, or rhabdo need to go to ED stat
Parathyroid disorders
Thyroid disorders- Large goiters, thyroid nodules, thyroid storm, thyrotoxic crisis, rapid A fib, SEVERE primary hypothyroidism and central hypothyroidism
How would you address the spiritual and emotional well-being of patients with endocrine disorders?
Pts with type II diabetes are more likely to be depressed further impacting their healthy lifestyle choices. SSRI’s are better choices as THEY DO NOT CAUSE hyperglycemia.
Encouraged to share with their family and seek support from friends and family.
