Endo CE 4

Question 1

PPG >200, already on 40 units of basal - next step

Answer 1

ADA recommends adding about 4 units of rapid acting insulin to the biggest meal of the day

Question 2

serum thyroid markers
3

Answer 2

TSH
T4
T3

Question 3

TSH is produced where

Answer 3

by anterior pituitary gland

Question 4

what is the most sensitive measure of thyroid disease

Answer 4

TSH

Question 5

TSH is a ___

Answer 5

messenger

Question 6

T4 =

Answer 6

thyroxine

Question 7

T4 can be of what two things

Answer 7

bound or free

Question 8

Bound T4

Answer 8

is attached to proteins and becomes too large to enter cells and be effective

Question 9

Free T4

Answer 9

is not attached to proteins and can enter cells to affect metabolism

Question 10

Total T4 =

Answer 10

Free T4 + Bound T4w

Question 11

Which T4 do you measures and why

Answer 11

free T4 as bound T4 cannot enter cells so it won’t have any impact

Question 12

T3 =

Answer 12

triiodothyronine

Question 13

T3 can be what to things

Answer 13

bound or free

Question 14

most T3 circulates as what

Answer 14

bound T3 - serves as a reserve, and has no impact on metabolism

Question 15

which T3 do you measure

Answer 15

total T3 measurements are more reliable than free T3

Question 16

which is more active, T3 or T4

Answer 16

T3 is 5 x more active than T4

Question 17

TSH is normal - plan

Answer 17

no further testing

Question 18

TSH is elevated - plan

Answer 18

add free T4 - we’re thinking about hypothyroid

Question 19

TSH is decreased - plan

Answer 19

add free T4 and T3 - we’re thinking about hyperthyroidism

Question 20

primary hypothyroidism - TSH, T4, T3

Answer 20

tsh - elevated
t4 - low
t3 - usually normal

Question 21

subclinical hypothyroidism - TSH, T4, T3

Answer 21

TSH - elevated
T4 - normal
T3 - normal

Question 22

primary hyperthyroidism- TSH, T4, T3

Answer 22

TSH - low
T4 - usually elevated
T3 - normal or elevated

Question 23

for primary hypothyroidism - what is usually going on

Answer 23

97% of the time, T4 is not being produced enough

Question 24

primary hypothyroidism is caused by

Answer 24

reduction in the amount of circulating free thyroid hormone

Question 25

most common cause of hypothyroidism

Answer 25

Hashimoto’s thyroiditis (autoimmune)

Question 26

primary hypothyroidism means pathology is where

Answer 26

in the thyroid gland

Question 27

secondary hypothyroidism mean pathology is where

Answer 27

outside the thyroid gland

Question 28

subclinical hypothyroidism - TSH 10 or more

Answer 28

treat to prevent progression to primary hypothyroidism

Question 29

subclinical hypothyroidism - TSH 4.5 to <10

Answer 29

no benefit from treatment; monitor for 6-12 months unless patient comes more symptomatic

Question 30

primary hypothyroid - replacement factoids
3

Answer 30

1. l-thyroxine (synthetic T4) PO daily, in AM, on empty stomach
2. based on ideal body weight
3. absorption in empty stomach is best