Endocrine Flashcards
DM Dx
- 2 fasting > 125
- Random glucose > 200 + sx
- 2 hr 75g glucose > 200
- Hb-A1c > 6.5%
DM Tx Goals (3)
- BP > 130/80
- LDL < 100
- HbA1c < 7%
DM Monitoring
- HbA1c q 3 months
- Daily glucose monitoring at home; before ea meal + before bed
- Microalbumin in urine annually - if present start on ACE immediately before progression to proteinuria
- BUN, Cr and lipid panel annually
- Annual retinal exam
- Foot exam at every visit
- Check BP at ea visit
- Daily ASA if > 30
- Pneumococcal vaccine
Dawn Phenomenon v Somogyi Effect
- Dawn Phenomenon - inc nocturnal GH secretion leading to morning hyperglycemia; if 3 AM glucose is hight; inc evening insulin dose
- Somogyi Effect - rebound inc glucose in response to overnight hypoglycemia; if 3 AM glucose is low; dec evening insulin dose
4 Major Types Thyroid Cx
- Papillary - LN spread; most common; least aggressive; associated w/ radiation
- Follicular - heme spread; need tissue sample to see if it extends beyond capsule
- **Hurthle cell type - more aggressive and radio iodine resistant so do surgery
- Medullary - C cells; calcitonin;
- Anaplastic - aggressive; elderly
Osteoporosis Risk Factors
- Alcohol and smoking
- Thin, low BMI
- White, Asian
- Dec estrogen (early menopause)
- Ca (1200 mg / day) or Vit D def (800 units)
- Family hx
- Meds - corticosteroids and heparin use
Radioactive T3 Uptake Test
- T3 can bind to TBG or to a given resin; look at amount of T3 that binds to resin and this tells you about amount of T4 and TBG)
- If hyperthyroid and have inc T4 then T4 takes up all the space on TBG so more radioactive T3 binds to the resin instead
- If there is just an inc in TBG (as in pregnancy, liver disease, OCP and ASA use) then there will be plenty of room for T3 to bind TBG and less T3 binds to resin
- Reported # is amount of radioactive T3 bound to resin
Free Thyroxine Index
- Can be calculated based on radioactive T3 uptake test
- (pt’s T3 uptake / normal T3 uptake) x total T4
- High FTI means actual hyperthyroidism (high uptake x high total T4)
- Normal FTI means just inc TBG (low uptake x high total T4)
Hyperthyroid Tx
1- Can give beta blocker for immediate control of adrenergic sx
2- Start on methimazole (unless pregnancy - PTU)
3- Taper beta blocker after 4-8 wks once methimazole starts to work
4 - Cont methimazole 1-2 yrs; measure thyroid stimulating IgG at 1 yr; if absent then stop methimazole
5- If relapse, then treat w/ methimazole 1 more yr or consider ablation
6- May consider thyroidectomy if pt prefers surgery to meds or allergic to meds- need thyroid hormone replacement and look for hypocalcemia from hypoparathyroidism
Side Effects of PTU and Methimazole
Agranulocytosis (monitor leuks)
Hepatotoxic, rashes, arthralgia
