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Endocrinology > Thyroid and Diabetic Testing Lecture Powerpoint > Flashcards

Thyroid and Diabetic Testing Lecture Powerpoint Flashcards

1
Q

Populations to screen for diabetes (6)

A
  • Asymptomatic adults age 45+
  • all individuals with risk factors (obese, family history)
  • minority
  • PCOS
  • low HDL, high triglycerides
  • recurrent yeast infections
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2
Q

HbA1C scale for diabetes

A

<5.7% healthy
5.7-6.4% prediabetic
>6.5% diagnostic** for diabetes

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3
Q

Fasting plasma glucose scale for diabetes

A
  • 70-100mg/dL normal
  • 100-126mg/dL prediabetes
  • > 126mg/dL diabetes
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4
Q

Screening guidelines for diabetes

A

-symptomatic presentation (polyuria, polydipsia, weight loss) AND casual plasma glucose >200mg/dL

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5
Q

Fasting plasma glucose follows a ___ hour fast

A

8

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6
Q

Some conditions that can lead to elevated fasting glucose (5)

A
  • Lab error
  • corticosteroids
  • excess glucagon
  • B blockers
  • caffeine or other drugs
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7
Q

Random glucose test

A

Done without fast, should never be >200mg/dL otherwise strongly indicative of diabetes (casual, indicates need for further testing)

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8
Q

Glucose Tolerance Test and what is it particularly useful in diagnosing?

A
  • Only performed in patients who have been on unrestricted diet/physical activity for 3 days before testing, involves administration of 50-100g oral glucose administered after 10 hour fast
  • Gestational diabetes
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9
Q

Goal of diabetic control is to limit…

A

….microvascular and macrovascular end organ damage

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10
Q

Common microvascular complications of diabetes (3) and common macrovascular ones (3)

A
  • eye (cataracts and glaucoma)
  • kidney (nephropathy)
  • neuropathy
  • brain (stroke)
  • heart (CAD)
  • extremities (peripheral vascular disease)
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11
Q

HbA1C testing

A

Measures 70% of glycosylated hemoglobin in blood which remains for the 120 day lifespan of the RBC (avg) (does not reflect acute increase or decrease) and therefore allows for highly accurate measure of blood glucose conc.

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12
Q

__% change in A1C reflects a change of about ___mg/dL in avg blood glucose

A

1, 30

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13
Q

Conditions that alter HbA1C (4)

A
  • Iron deficiency (increased)
  • sickle cell (decreased)
  • bleeding (decreased)
  • toxicity (increased)
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14
Q

Creatinine levels and diabetes

A

Increased suggest presence of diabetes, low is not common and not a concern unless pregnant when it should be lower (if not then cause for concern)

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15
Q

Microalbumin and microalbumin/creatinine ratio (and what should healthy value be?)

A
  • Microalbumin test is an early indicator of kidney failure (albumin produced in liver and should not be present in blood when kidneys functioning properly) requiring 24 hour urine collection
  • Microalbumin creatinine ratio is close to a 24 hour microalbumin test regarding accuracy without requiring 24 hour collection and is thus preferred (<30:1 ratio)
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16
Q

How often is microalbumin/creatinine ratio ordered in diabetic patients?

A

Annually

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17
Q

Magnesium levels in diabetic patients

A

-often decreased, low levels accentuate insulin resistance and exacerbate the cardiovascular risks

18
Q

When is an insulin levels ordered? (3)

A
  • evaluate PCOS
  • diagnose insulinoma
  • Determine cause of hypoglycemia (order alongside c peptide to monitor endogenous insulin levels)
19
Q

Conditions with elevated insulin levels (4)

A
  • cushing syndrome
  • drug causes such as corticosteroids, levodopa, contraceptives
  • obesity
  • early type 2 diabetes
20
Q

Conditions with decreased insulin levels (2)

A
  • type 1 diabetes and late stage type 2

- hypopituitarism

21
Q

Why order a c peptide level in suspected diabetic patient?

A

Monitor insulin production by the B cells of the pancreas to determine the cause of hypoglycemia - see if body producing enough of own insulin and are insulin resistant or not

22
Q

C peptide levels in type 1 vs type 2 diabetics

A

C peptide level will be zero in type 1 diabetics (not producing insulin), in type 2 if left uncontrolled over time will drop to zero

23
Q

Actions of thyroid hormone (6)

A
  • Increase body’s metabolic rate and O2 consumption
  • calorigenic effect increasing heat production
  • increase heart rate and contraction strength
  • increase respiratory rate
  • stimulate appetite and breakdown of carbs, fats, proteins
  • turn on and off various nuclear receptors
24
Q

What do the C cells (parafollicular cells) of the thyroid produce?

A

Calcitonin

25
Q

Why is T3 more metabolically active than T4?

A

T3 has a much shorter half life and composes the majority in the circulation while more T4 is stored in the gland itself (and thus takes longer to reach a steady state in artificial replacement as well)

26
Q

Synthroid and armour thyroid

A

Artificial T4 and T3 and T4 respectively (T3 alone not very useful because it has such a short half life requiring frequent dosing intervals)

27
Q

Reverse T3 definition

A

Minorly biologically active thyroid hormone present in elderly that should never be ordered for a patient as a supplement

28
Q

2 major plasma proteins that are responsible for transport of thyroid hormone

A
  • Thyroid binding globulin

- Albumin

29
Q

Only __ T3/4 can penetrate cellular membranes and exert biologic activity

A

Unbound

30
Q

Test of choice for pituitary and hypothalamic thyroid function tests and its normal range

A

TSH assay (most specific and sensitive), .1-5 uU/MI

31
Q

Primary hypothyroidism sees a ___ TSH, very low levels of TSH can suggest ___

A

elevated, hyperthyroidism

32
Q

A TSH over ___ requires treatment

A

10 uU/MI

33
Q

2 uses of serum thyroglobulin levels

A
  • follow thyroid cancer patients post thyroidectomy to consider recurrence
  • elevated if thyroid is source of hyperthyroidism, low if exogenous source (factitious vs exogenous sources)
34
Q

ELISA T3/T4 test

A

Offers direct measurement of free hormone highly sensitive and specific, reasonably inexpensive and unaffected by thyroxin binding globulin levels

35
Q

Causes of elevated serum T4 (4)

A
  • graves disease
  • toxic multinodular goiter
  • toxic adenoma
  • thyroiditis
36
Q

Causes of decreased serum T4 (3)

A
  • hypothyroidism
  • amiodarone
  • post partum transient toxicosis
37
Q

Hyperthyroidism + antithyroid antibodies suggests…

Hypothyroidism + antithyroid antibodies suggests…

A

….Graves disease

….hashimoto’s thyroiditis

38
Q

Radionuclide scanning thyroid imaging

A

-Use of an isotope of iodine to determine if a nodule is hyperactive or underactive based on how it takes up the iodine (almost all cancers and benign lesions are cold)

39
Q

Test of choice for thyroid nodule workup

A

Fine needle biopsy

40
Q

Thyroid ultrasonography

A

Used to determine dimensions of thyroid lobes or nodules to see if solid, cystic, or mixed, important for monitoring course

41
Q

C peptide

A

A protein released in equal amounts alongside insulin into the bloodstream allowing it to be a marker of insulin production (endogenous, not present with exogenous) and release in the body

42
Q

2 standard tests to get when assessing thyroid and one to order when findings are abnormal

A
  • TSH
  • Free T4
  • Free T3

Endocrinology (19 decks)

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