Endo Flashcards
(32 cards)
Metabolic syndrome
What is the major risk factor?
Other risk factors?
OBESITY major risk factor
- overlaps with DM*
- age
- ethnicity: Indigenous, African, Hispanic, Asian, Pacific Islander
- sedentary lifestyle
- poor diet (high carb)
- poverty
- hx of HTN, dyslipidemia, impaired fasting glucose, PCOS, GDM, gout, OSA
- Meds: atypical antipyschotics (esp clozapine)
- family hx of DM
Metabolic syndrome increases risk for ____ and ______
What are some other obesity-related co-morbidities?
CVD
DM
- NASH
- Liver cancer
- CKD
- PCOS
- gout
Metabolic syndrome
Diagnostic criteria:
3 or more of the following:
WTHFB
- waist circumference
- high TG (1.7+ or above)
- low HDL-C (<1.0 men <1.3 women or treated)
- high FPG (5.6+ or treated)
- high BP (130+/85+ or treated)
Metabolic syndrome
Diagnostic investigations
Labs: CBC, fasting glucose, A1C, eGFR/Cr, lipids, Lp(a), TSH, LFTs, urate
Sleep study if symptoms of OSA
Framingham Risk Calculator to determine 10-year CV risk
Metabolic syndrome
What is the first line treatment?
Aggressive lifestyle interventions
- weight management
- physical activity
This will help with hyperglycemia and CV risk factors
Metabolic syndrome
Weight loss: aim for ______ % loss, goal BMI _____
5-10% of initial weight
BMI <25
Metabolic syndrome
4 different diets to have shown improvement in weight and glycemic control
- mediterranean
- DASH (Na <2300 mg/day)
- low glycemic index
- high fibre (30+ g/day)
OBESITY
Candidates for bariatric surgery:
BMI >40
or
BMI >35 plus risk factors
BMI
- underweight:
- healthy
- overweight
- obese
under: <18.5
healthy: 18.5-24.9
overweight: 25.0-29.9
obese: 30.0+
Obesity is defined as:
BMI:
in kids:
BMI 30.0+
in kids: 95% on WHO growth chart
Obesity
What categories of medications are risk factors for obesity?
- antidepressants
- antihistamines
- anti-pyschotics
- antidiabetics (insulin, SU)
- anticonvulsants
- hormones (estrogen, progesterone)
- beta/alpha blockers
- glucocorticoid steroids
Obesity
-linked to what types of cancer?
-colon, endometrial, lung, liver
Obesity
Exercise recommendations
- adults
- kids
150 min mod intensity/week
weight training 2x/week
Kids: 60 min + mod exercise/day
155-180 min/week
ORLISTAT for obesity
- route?
- % weight loss at one year?
- net weight loss at 4 years
common side effects?
ORLISTAT
- po
- 3% at 1 year
- 2.8 kg at 4 years
side effects:
- loose oily stools
- flatus
LIRAGLUTIDE for obesity
- route?
- drug class?
- % weight loss at one year?
- net weight loss at 3 years
common side effects?
contraindications?
LIRAGLUTIDE aka Victoza
- sc
- GLP-1
- 5.4% at 1 year
- 4.2% at 3 years
- significant reduction in risk of developing T2DM
side effects:
-n/v/d/constipation
Contraindicated:
- hx pancreatitis
- personal or FHx of medullary thyroid cancer
- pregnancy
NALTREXONE-BUPROPION for Obesity
- route?
- % weight loss at 1 year?
- effect on pre-DM?
- effect on HTN?
common side effects?
Contraindications?
CONTRAVE
- po
4. 8% weight loss in 1 year - impact on pre-DM not studied
- INCREASE in BP
side effects:
- nausea, constipation, diarrhea, dry mouth
- headache, dizziness
Contraindications:
- uncontrolled HTN
- any opioid use
- hx or risk for seziures
- severe liver/renal failure
- pregnancy
- MAOI
Hypothyroidism signs and symptoms
- Neuropsychiatric:
- Neuromuscular:
- Physical appearance/Voice:
- Cardiovascular:
- Thyroid Gland:
- Thermoregulation:
- Gastrointestinal:
- Pituitary Function:
- Neuropsychiatric: depression, decreased mental function
- Neuromuscular: Physical tiredness, paresthesia, hypokinesis, hyporeflexia
- Physical appearance/Voice: weight gain, coarse, dry skin, periorbital edema, non-pitting edema, hoarseness
- Cardiovascular: Bradycardia, Isolated diastolic hypertension
- Thyroid Gland: Goiter
- Thermoregulation: diminished sweating, Cold intolerance
- Gastrointestinal: Constipation
- Pituitary Function: Menorrhagia
Hyperthyroidism signs and symptoms
- Neuropsychiatric:
- Neuromuscular:
- Physical appearance/voice:
- Cardiovascular:
- Thyroid Gland:
- Thermoregulation:
- Ophthalmologic:
- Gastrointestinal:
- Pituitary function:
- Neuropsychiatric: Anxiety, irritability, restlessness, Fatigue, increase appetite, decrease attention span
- Neuromuscular: Tremors, proximal muscle weakness, hyperreflexia
- Physical appearance/voice: Weight loss, hair loss
- Cardiovascular: Palpitations, tachycardia, A-fib, Isolated systolic hypertension
- Thyroid Gland: Goiter
- Thermoregulation: Increase sweating, heat intolerance
- Ophthalmologic: Blurred or double vision, dry eyes, conjunctivitis, proptosis or dysconjugated gaze.
- Gastrointestinal: Increase frequency of stools
- Pituitary function: Amenorrhea/oligomenorrhea
When is anti-TPO measured?
- not generally checked
- may help determine if autoimmune thyroiditis if pt has goitre or mildly elevated TSH
What are the risk factors for thyroid disease?
- sex and age?
- personal or family hx?
- hx of?
- meds?
- diet?
- genetics?
men 60+
women 50+
personal/family hx thyroid disease
hx of autoimmune, neck irradiation, thyroidectomy or radioactive iodine ablation
meds: lithium and amiodarone
diet: iodine excess/deficieicny
- Turner, Down syndrome
Hypothyroidism and TSH
- when to check after starting/changing dose?
- when to check TSH if normalized on treatment?
- when to check if on lithium and amiodarone?
- 6 weeks after starting or changing dose
- check annually unless new indication
- if on Li/amiodarone: check q3-6 months
Thyroid
TSH is high, fT4 low
diagnosis of ____________
HYPOthyroidism
Thyroid
TSH high, fT4 normal
diagnosis of _________
subclinical hypothyroidism
*usually asymptomatic
*treat if TSH >10 mU/L for subclinical
Thyroid
TSH low, fT4 high
diagnosis of _________
HYPERthyroidism
- overcorrected on synthroid
- Grave’s
- painless/postpartum thyroiditis
- toxic multinodular goitre
