Endocrine

Question 1

Once thyroid disease stable, how often/when should TSH be rechecked

Answer 1

yearly or when pregnant, worsening symptoms, or start medication that may affect interact (iron, Ca, estrogen)

Question 2

TSH <0.3 indicates what

Answer 2

hyperthyroid

Question 3

TSH >4 indicates what

Answer 3

hypothyroid

Question 4

TSH 0.3-4 indicates what

Answer 4

euthyroid

Question 5

free T3 or T4 correlates more with thyroid state

Answer 5

free T4

Question 6

T4 is difficult to test directly. What is used instead

Answer 6

TBG (thyroxine binding globulin)

Question 7

what may cause increased TBG

Answer 7

pregnancy
acute hepatitis
estrogen
methadone
heroin

Question 8

what may cause decreased TBG levels

Answer 8

acromegaly
nephrotic syndrome
cirrhosis
chronic steroid, androgen, ASA, NSAIDs

Question 9

when would you see autoantibodies to thyroglobulin or thyroid microsomes and what is the major antigen

Answer 9

in paitents with autoimmune thyroid disease
Thyroid peroxidase (TPO) is the major microsomal antigen

Question 10

Anti-TPO antibodies may be found in what diseases

Answer 10

hashimotos and graves

Question 11

what is another name for autoimmune hyperthyroidism

Answer 11

graves

Question 12

what antibodies are specific for graves disease

Answer 12

TSH receptor antibodies (TRAb)

Question 13

what is the purpose of imaging for thyroid disease

Answer 13

to assess cause of hyperthyroidism but not funcitonal status of thyoid

Question 14

what is pemberton sign

Answer 14

pt elevates both arms until the touch the sides of their head and results in flushing of face, cyanosis, and resp distress
indicates impingement of structures from nodule/goiter

Question 15

is serum calcitonin usually ordered to measure thyroid disease

Answer 15

no

Question 16

if TSH is suppressed, what is next step

Answer 16

order free T4 and TT2 and radionuclide scan

Question 17

if TSH is elevated, what is next step

Answer 17

check free T4, start levothyroxine and evaluate for nodules

Question 18

what instructions should patients be given after receiving radioiodine treatment

Answer 18

no kidding or sharing utensils for 5 days
no close constant with young children or pregnant women
no breast feeding
flush toilet twice

Question 19

what will TSH, T3 and T4 levels be in hyperthyroidism

Answer 19

TSH low
T3/T4 high

Question 20

what are the treatment options for Graves

Answer 20

beta blockers
Thioamides (methimazole and propylthiouracil)

Question 21

decreased TSH with normal T4 and T3 indicates what

Answer 21

subclinical hyperthryoidism

Question 22

elevated TSH and normal T4 indicates what

Answer 22

subclinical hypothyroidsim

Question 23

long term use of levothryoxine should be monitored for what potential side effects

Answer 23

bone loss/osteoporosis
electrolyte imbalances

Question 24

what is metabolic syndrom

Answer 24

truncal obesity
HTN
DLD
insulin resistance but not yet diabetic

Question 25

diagnosing metabolic syndrome includes any three of the following:

Answer 25

elevated waist circumferences (>40 in min and >35 in women) Elevated triglycerides reduced HDL HTN Elevated FPG (>100mg/dL)

Question 26

what are factors that increase risk of metabolic syndrome

Answer 26

family hx of DM, HTN, obesity current obesity, DM, HTN western diet sedentary lifestyle Medications (steroids, antidepressants, antipsychotics)

Question 27

a patient presents with a diffuse, hyperpigmented velvety thickening of the skin around the neck and axillae. What is this and what is it indicative of

Answer 27

Acanthosis nigricans suggestive of moderate to severe

Question 28

what results would consitute an impaired fasting glucose

Answer 28

levels of 5.5-7 after an 8-12 hour period of fasting

Question 29

what initial blood work should be ordered for suspected metabolic syndrome

Answer 29

HA1C FPG fasting lipids CRP LFT TSH Uric acid