Week 2 Diabetes & endocrine Flashcards

Question

hyperCa/parathyroidism management

Answer 1

* Endocrine referral * Surgical referral * Criteria: * Need to be symptomatic * Recurrent neprholithaissi * Osteoporosis * Fractures * Ca \> 1 mg per deciliter above normal limits * Medical management - if mild * Monitor labs and bone density * Ca, Vit D * Increase fluid intake * Weight bearing exercise * Ca Crisis * Sx’s: Ca increase 14 or higher * need aggressive IV NS restoration of volume status * Referral to ED * symptomatic hyperca with n/v

Answer 2

* Benign 10-15% intracranial masses * \< 1 cm = microadenoma * \> 1 cm = macroadenoma * majority are prolactinomas (secrete prolactin) 40-57% * 11% Growth hormone tumors * 2% ACTH secreting (cushings)

Answer 3

* highest ACTH release when waking up, lowest at night * overproduction of cortisol from adrenal * Most common: high doses of steroids for long periods of time causes suppression of pituitary ACTH production * steroids used \> 10-14 days for asthma management, derm, neoplasma = careful monitoring for suppression * Long term exogenous \> 15 mg/day → suppresses HPA axis * \< 3 weeks okay * Heavier steroid dose should be done in morning cus night suppresses the morning pulse significantly * take heavier steroid dose in morning

Answer 4

pituitary caused symptoms

Answer 5

* Elevated cortisol levels * *Central* obesity, hirsutism, purple striae * psychological , skin , short term memory, menstrual irregularities, h/a * Buffalo hump dorsocervical fat pad * Increased supraclavicular fat pad * Muscle wasting/weakness * Acne * Emotional liability/depression * Senile purprua on the hands/bruses * Most common cause: exogenous steroids * Long term prednisone * Women \>\> * 50-60 yrs * Acanthosis nigricans * Galactorrhea, irregular menses (decreased LH/fsh)

Answer 6

* Testing needs to be done in **ABSENCE** of acute illness * Dx: \> 100 mcg of cortisol in urine during 24 hr period * or single midnight (nadir) serum cortisol \>7.5 (100% specificity/96 sensitivity) * Initial testing, 1 of the following: * 24-hour urine-free cortisol 2 times * Late-night salivary cortisol 2 times * Low-dose dexamethasone suppression test * Take low dose at 10pm then blood draw/cortisol taken next day * Healthy person: cortisol is suppressed * Cushing: don’t see cortisol suppression * Refer to endocrinology even if abnormal test or not : * If initial testing is positive * If high clinical suspicion and testing is negative

Answer 7

* Cushing disease: * first line: Surgical resection via transsphenoidal surgery (pituitary tumor resection) * Daily ketoconazole admin (mitigates cortisol impact) * chemo, radiation

Answer 8

* Secreting excess prolactin hormone * Females 20-50 yrs * Oligomenorrhea * • Galactorrhea * • Vaginal dryness * • Hirsutism * Males * Erectile dysfunction * • Decreased body and facial * hair * • Gynecomastia * Both * Infertility * Loss of interest in sex * Low bone density * Headaches * Visual disturbance * Delayed puberty

Answer 9

* Thorough ophthalmic exam * Neuro exam - visual field defects * Tumors can impinge on optic apparatus * Hirsutism * Acne * Hair growth * Thyroid exam - goiter * Children * Puberty changes * Look for hypogonadism * gynecomastia and galactorrhea

Answer 10

* Prolactin hormone * If have sx’s, get level * If asx, consider repeating in morning * Prolactin levels correlate with size of adenoma * Bigger = higher prolactin * Blood urea nitrogen (BUN) and creatinine * HCG if child bearing age * r/o pregnancy * TSH/free T4 * r/o hypothyroidism * ALT/AST - liver dz or hepatitis * Get MRI to search for prolactinoma * Refer to endo * Refer ophthalmology (neuro-opth exam) * If have microadenoma and asx, don’t need treatment * If microadenoma and sx, treat * All macroadenoma → treat

Answer 11

* **Cabergoline** - dopamine agonist * Preferred; fewer SE; greater efficacy * **Bromocriptine** * Respond fast with meds * Monitor prolactin levels more freq in beginning and less freq ad time goes on * Repeat MRI to know it’s decreasing in size * After a few yrs, can get off meds if prolactin and MRI normal

Answer 12

* blood sugar 250-300 * Ketones * Acidosis * Type 1 DM * juvenile/kids * pH \< 7.3 (acidotic) * Bicarb \< 15

Answer 13

* Blood sugar 600 * Hyperglycemia * Hyperosmolality * Dehydration * Alt mental status (brain swelling, coma, death) * Type 2 DM * Adults * pH \> 7.3 * Bicarb \> 15

Answer 14

If 1 is positive, need REPEAT test on different day OR a 2nd different test to confirm diagnosis using same sample or 2 separate test samples. Can be used to screen too. * Fasting plasma glucose ≥ 126 mg/dL * No food for 8 hrs * Oral glucose tolerance test (75g) with plasma glucose ≥ 200 mg/dL 2 hours post glucose load * HgbA_1c ≥ 6.5 * [_POC_](https://accessmedicine.mhmedical.com/drugs.aspx?GbosID=130633) A1c testing is NOT recommended to diagnose but can use it for screen * If elevated, f/u with primary care provider * Random glucose ≥ 200 mg/dL AND classic symptoms of hyperglycemia or hyperglycemic crisis (polyuria, polydipsia, or unexplained weight loss

Answer 15

having classic symptoms of hyperglycemia or hyperglycemic crisis AND a random glucose _\>_ 200 mg/dL * want PLASMA glucose to dx (serum glucose varies 10-20% while plasma varies 1-3% in testing)

Answer 16

anything with rapid blood cell turnover * anemia * hemoglobinopathies * recent blood loss/transfusion * erythropoietin therapy * hemolysis/hemodialysis

Answer 17

* **All** adults begin **45** yrs+ **regardless** of their weight or any other risk factors * test younger than 45 yrs old it overweight (BMI _\>_ 25) (Asian \>23 BMI) + other risk factors: * 1st degree relative with diabetes * Black, Hispanic/Latino, Indian, Alaska Native, Asian, Pacific Islander * Hx of gestational diabetes or giving birth to a baby weighing \> 9 lbs * Physical inactivity * BP ≥ 140/90 or on therapy for hypertension * HDL \< 35 mg/dL * Fasting triglycerides \> 250 mg/dL * PCOS * Previously A1c _\>_ 5.7%, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) on previous testing * Sx's of insulin resistance * acanthosis nigricans, non-alcoholic steatohepatitis, PCOS, and SGA * Hx CVD * on Atypical antipsychotics or glucocorticoids

Answer 18

* Overweight (BMI \> 85^th percentile for age and sex, weight for height greater than 85^th percentile, or weight \> 120% for height) **AND** who meet one or more of the following criteria * Maternal gestational DM * Family history of type 2 diabetes in first- or second-degree relatives * Native American, African America, Latino, American, Asian American, and Pacific Islander) * Signs of [_insulin_](https://accessmedicine.mhmedical.com/drugs.aspx?GbosID=427219) resistance or conditions associated with [_insulin_](https://accessmedicine.mhmedical.com/drugs.aspx?GbosID=427219) resistance (eg, acanthosis nigricans, hypertension, dyslipidemia, PCOS, or small-for-gestational-age birth weight)

Answer 19

* risk for developing DM2 is highest in the decade immediately following delivery. * 40-60% - decrease that risk by following diabetic diet / lifestyle changes, lose weight * **The greatest risk of developing diabetes in the first decade after having gestational diabetes**

Answer 20

fasting: blood sugar 100-125 oral: 140-199

Answer 21

* For NON pregnant, use the 2 hour 75g * \>200 is positive **AND** need symptoms of hyperglycemia (if no sx's, need another diagnostic test to confirm) * For pregnant women: * 1 hr 50g, if \>180, go to 3 hr * 3 hr 100g, if \>140 = positive

Answer 22

* Type 1 * autoimmune β-cell destruction, typically leading to absolute insulin deficiency. * Type 2 * multifactorial process, insulin insufficiency (the pancreas does release enough insulin), insulin resistance, unregulated gluconeogenesis in the liver (producing glucose in the face of hyperglycemia) * Gestational diabetes * Diabetes diagnosed during the 2nd or 3rd trimester of pregnancy that was not clearly present prior to gestation * Other: * Monogenic diabetes syndromes (neonatal diabetes and maturity-onset diabetes of the young [MODY]) * Diseases of the exocrine pancreas (cystic fibrosis) * Pancreatic insufficiency secondary to chronic/recurrent pancreatitis * Drug/chemical induced (use glucocorticoids and those treated for HIV/AIDS or after organ transplantation)

Answer 23

* The presence of any of these support dx of type 1 DM: * islet cells autoantibodies (ICAs) * insulin autoantibodies (IAAs) * autoantibodies to glutamic acid decarboxylase 65 (GAD65) * tyrosine phosphatases IA-2 transmembrane proteins * zinc transporter (ZnT8) * 70% to 80% of patients with type 1 DM have anti-GAD antibodies * adding a check for ICA can increase the sensitivity of detection of type 1 DM to \>90%. * Insulin Autoantibodies (IAA) in 100% of young patients but NOT in older patients. * Anti-GAD antibodies are more likely to be present in young adults with type 1 diabetes than they are in children.

Answer 24

* Thyroid disease * Celiac disease * Hashimoto thyroiditis, Graves disease, Addison disease, autoimmune hepatitis, dermatomyositis, myasthenia gravis, vitiligo, and pernicious anemia.

Answer 25

* Metformin is SAFE to use if _\>_ 30 GFR so DON”T use it if less than 30

Answer 26

* Goal 10%, results with 5% * Start seeing effects with 5% body weight loss * Maintain at 7% * 30 mins day exercise * Unless contraindicated, children with prediabetes and diabetes should be encouraged to engage in physical activity at least an hour a day (play an hour a day)

Answer 27

if BMI \> 35 AND with comorbidity or with BMI > 40

Answer 28

think ABC's! * A1c * Every 6 months if stable * Every 3 months if not at goal * A1c goal: \< 7%. * A1c goal for children and adolescents with diabetes: \< 7.5% * Point-of-care testing of the A1c may allow for more timely decision on adjustments of therapy, when available. * Aspirin/antiplatelet agents * Aspirin 75 to 162 mg/day * Secondary prevention in those with diabetes and a history of CVD * Primary prevention in men and women 50 years old and older with type 1 or 2 diabetes or who have additional CV risk factors * no benefit if under 30 yrs * NO Aspirin if \< 21 years old (Reye syndrome) * Clopidogrel (75 mg/day) ok instead of aspirin * Blood pressure * Measured at every visit * Goals are: * Adults: SBP \< 140 / \< 90 * Children and adolescents: \< 130 / \< 80 OR \< 90th percentile for age, sex, and height * Start meds if lifestyle mods (DASH diet, weight loss, and exercise) don't lower BP * ACE inhibitors, ARBs, CCB, or diuretics are recommended. * NO ACE, ARBs, and spironolactone in pregnancy. * It is also recommended that at least one antihypertensive agent be given at night. * Cholesterol * If LDL \> 190 (doesn’t matter about ASCVD #), it’s very high → start on statin * Get lipid profile (total cholesterol, LDL, HDL, and triglycerides) at the time of diagnosis, and at least q 5 years thereafter in patients under the age of 40 years. * a calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) of \> 20% and the patient’s age is what primarily drives the decision to treat with statin therapy or not * Screening for neuropathy * Diabetic foot exam annually for DM 2, and w/in 5 years for DM 1 * if have insensate feet, foot deformities, or ulcers = screen every visit * The foot examination: inspection, foot pulses, and testing for loss of protective sensation: * light-touch perception with 10-g monofilament and at least one of the following: temperature, vibration using 128 Hz tuning fork, pinprick sensation, and ankle reflexes. * Cardiovascular neuropathy * resting tachycardia and/or orthostatic hypotension. Electrophysiologic testing is rarely needed. * Screening for diabetic gastroparesis * get history history. * If suspicious, get a gastric emptying * Screening for retinopathy * Dilated retinal exam done at the time of diagnosis in all persons with type 2 diabetes and in those older than age 10 with type 1 diabetes for 5 or more years * If there is no retinopathy present after serial annual exams, the recommended screening intervals may increase to no longer than every 2 years. * Screening for nephropathy * Serum creatinine at least YEARLY to get GFR * Urine albumin excretion YEARLY in all persons with type 2 diabetes and in those with type 1 diabetes who have had the diagnosis for 5 or more years. * This is done via spot urine-to-creatinine ratio * Get UA, CMP * Persistent albuminuria is a marker for CVD. * Immunizations * Pneumoccocal * Age 2 to 64 years old with diabetes= get PPSV23 vaccine. * if \< 65 yrs old when vaccine is given, repeat after age 65 with at least 5 years between doses. * If \> 65, one vaccine is sufficient--unless there is also a history of nephrotic syndrome, chronic renal disease, or other immunocompromised states, such as post-transplantation. * if _\>_ 65 years or older and who have not previously received PCV13 should receive a dose of PCV13 first, followed 6 to 12 months later by a dose of PPSV23. * Flu vaccine yearly when \> 6 months with diabetes * Hepatitis B vaccine 19 yrs and older * Tobacco use assessment

Answer 29

persistent albuminuria for \>30 mg (abnormal)

Answer 30

* **celiac disease and hypothyroidism.** * don't recommend screening for these because it's ‘rare’: primary adrenal insufficiency, autoimmune hepatitis, autoimmune gastritis, dermatomyositis, and myasthenia gravis are more common in individuals with type 1 diabetes

Answer 31

* Biguanides – metformin (Glucophage and others) * Glucagon-like peptide-1 (GLP-1) receptor agonists – albiglutide (Tanzeum), dulaglutide (Trulicity), exenatide (Byetta, Bydureon), liraglutide (Victoza), lixisenatide (Lyxumia ), and semaglutide (Ozempic) * Amylin agonist - pramlintide (Symlin) * Dipeptidyl peptidase-4 (DPP-4) inhibitors – alogliptin (Nesina), linagliptin (Tradjenta), sitagliptin (Januvia), and saxagliptin (Onglyza) * Sodium/glucose cotransporter 2 (SGLT2) inhibitors (aka gliflozins) – canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro) * Pramlintide (Symlin)

Answer 32

mono therapy * **Metformin** * **GLP1-RA** * **SGLT-2** * DPP4 * thiazolidinediones TZD * alpha glucosidase inhibitors (AGIs) * sulfonylureas if pt is “high risk" for ASCVD, have stage 3 CKD, HF use: * GLP1 or SGLT-2 inhibitor if goal not at 3 months, try dual therapy

Answer 33

* Lactic acidosis * Decompensated congestive heart failure (CHF) * Severely impaired renal function (\< 30 GFR) * Liver failure, heavy alcohol use, or in patients undergoing major surgery. * Warn patients to stop drug whenever a study requiring iodinated contrast is needed and not restarted until 48 hours later if the renal function permits.

Answer 34

* 1-1.5% * most therapies for diabetes would result in a 0.5% to 1.5% reduction. * The most *effective* therapeutic classes (with an expected 1%-1.5% A1c reduction): * Biguanides (metformin) * GLP-1 receptor agonists * Does not cause hypoglycemia & weight loss. * But a/s wit vitamin B12 deficiency. * get “periodic” testing of B12 esp if pt has anemia or symptoms of peripheral neuropathy.

Answer 35

* SGLT2 inhibitors (Empagliflozin, Canagliflozin , and Dapagliflozin) * GLP-1 receptor antagonists Liraglutide * Although SGLT2 inhibitors have some proven efficacy for primary and secondary prevention of cardiovascular endpoints, their cadioprotective effects are most pronounced in patients with underlying CV disease. * Liraglutide has been show more beneficial than other GLP-1 in reducing CV endpoints (CV death, non-fatal MI, or stroke).

Answer 36

* lifestyle modifications, metformin, AND [would need dual therapy]: * GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, TZDs, colesevelam (a bile-acid sequestrant that lowers LDL and improves glycemic control), bromocriptine-QR (Cycloset), alpha-glucosidase inhibitors, sulfonylureas, non-sulfonylurea secretagogues (aka the “glinides” or meglitinides), amylinomimetic agents (amylin agonist), and insulin are all treatment optiåons that can accompany metformin

Answer 37

* The GLP-1 receptor agonists, pramlintide (Similin), and most insulins

Answer 38

start with insulin (w/ or w/o other agents), esp if have sx's of diabetes if not at goal at 3 months (\< 7%), triple therapy or tx with insulin may be needed

Answer 39

reduces A1c 1-1.5% in the liver to reduce gluconeogenesis; in the skeletal muscles to decrease insulin resistance

Answer 40

* reduce 1-1.5% a1c * in pancreas, stimulates insulin secretion & prevent beta-cell apoptosis

Answer 41

* 1-1.5% * Enhance insulin secretion from the pancreas by interacting with the ATP-sensitive potassium channels in the beta cell membranes

Answer 42

1-1.5% reduced * Increases insulin sensitivity of skeletal muscle, adipose tissue, and the liver

Answer 43

Enhance insulin secretion from the pancreas by interacting with the ATP-sensitive potassium channels in the beta cell membranes (structurally different than the sulfonylureas)

Answer 44

0. 5-1% A1c reduction * Inhibits the SGLT2 membrane protein in the proximal tubule, which results in decreased renal glucose reabsorption and increased urinary glucose excretion.

Answer 45

Slows degradation of GLP-1 and glucose-dependent insulinotropic peptides (GIPs)

Answer 46

bile acid sequestrant Colesevelam (Welchol) and Bromocriptine

Answer 47

* metallic taste, nausea, diarrhea, abdominal pain, lactic acidosis (rare – but potentially fatal); B12 deficiency * Doesn’t cause hypoglycemia

Answer 48

nausea, vomiting, diarrhea; renal impairmentan acute renal failure associated with dehydration caused by GI toxicity; injection-site reactions; risk of acute pancreatitis; thyroid C-cell hyperplasia; possible risk of thyroid C-cell carcinoma

Answer 49

* genital mycotic infections; Fournier’s gangrene; volume depletion; decreased eGFR; acute kidney injury; hypotension; fractures; hyperkalemia; hypermagnesemia, hyperphosphatemia; euglycemic diabetic ketoacidosis

Answer 50

pancreatitis, hypersensitivity reactions, hypoglycemia if used in conjunction with sulfonylureas; fatal hepatic failure; possible worsening of heart failure; possible and severe joint pain

Answer 51

* if a1c \< 8%, total daily dosing 0.1-0.2 units per kg of body weight * if a1 \> 8%, total daily dosing 0.2-0.3 units per kg * start with Basal (long acting) insulin * STOP/reduce sulfonurleas therapy when starting basal insulin

Answer 52

* Onset 5-15 mins * Peak 30-90 mins * Duration 4-6 hrs

Answer 53

* Onset 30-60 mins * Peak 2-3 hrs * Duration 8-10 hrs

Answer 54

* Onset 2-4 hrs * Peak 4-10 hrs * Duration 12-18 hrs

Answer 55

* Onset 2 to 4 hours, no peak, Duration 20 to 24 hours * Detemir (Levemir) -- Onset 2 to 4 hours, Peak 3 to 9 hours, Duration 6 to 24 hours * Degludec (Tresiba) – Onset 1 hour, Peak 9 hours, Duration greater than 42 hours *

Answer 56

* NEPHROPATHY: Annual screening for albuminuria with a random spot urine sample for albumin/creatinine ratio after child is 10 years old or older and has had diabetes for at least 5 years. (normal spot ACR _\<_ 30 mg/dg) * RETINOPATHY: Annual comprehensive and dilated eye exam after age 10 and when child has had T1DM for at least 3 to 5 years, then annually after * NEUROPATHY: Annual compressive foot exam starting at age 10 *or* after puberty has started (whichever is earlier) after diabetes duration of 5 years. * HYPERTENSION: Cuff blood pressure at time of diagnosis and every office visit thereafter. Elevated blood pressure should be confirmed on **3** separate days with DM 1 * DYSLIPIDEMIA: Fasting lipid panel starting at age 10. If LDL cholesterol is less than 100 mg/dL, then repeat every 3 to 5 years. If abnormal, monitor yearly. Initial therapy should consist of optimizing glucose control and medical nutrition therapy using a Step 2 American Heart Association (AHA) diet. Statin therapy is recommended after making lifestyle changes if LDL cholesterol is greater than 160 mg/dL, or greater than 130 mg/dL with 1 or more cardiovascular risk factors. Remember that statins are contraindicated in pregnancy, so consider birth control in adolescents who require statin therapy. * THYROID DISEASE: Screen for thyroid disease with thyroid stimulating hormone (TSH) soon after diagnosis and improvement in glucose control. Also, consider testing for antithyroid peroxidase and antithyroglobulin antibodies soon after the diagnosis. If TSH is normal, repeat every 1 to 2 years, or sooner if patient has symptoms of hypothyroidism, thyromegaly, abnormal growth rate, or unexplained glucose variation. * CELIAC DISEASE: Screen for celiac disease with either tissue transglutaminase or deamidated gliadin antibodies, along with serum immunoglobulin A (IgA) level, soon after diagnosis. Recommendations for screening also include if the patient has a first-degree family member with celiac disease, growth failure, weight loss or failure to gain weight, gastrointestinal (GI) symptoms (diarrhea, flatulence, abdominal pain, or other concerns for malabsorption), or recurrent unexplained hypoglycemia or worsening of glycemic control.

Answer 57

* Insulin injection * Insulin pump * Wireless insulin pump ("Pod" style) * Continuous glucose monitor (CGM) * "Artificial pancreas"

Answer 58

* \>95% of NB's have no or little clinical manifestations at birth * if present, lethargy, hypotonia, hoarse cry, feeding problems, constipation, macroglossia, open posterior fontanelle, umbilical hernia, dry skin, hypothermia, and prolonged jaundice. * Goiter is uncommon * only in infants with genetic defects in thyroid hormone synthesis

Answer 59

* TH essential for growth and neurological development in childhood. * Longer the condition goes undetected, the lower the IQ. * For newborn screening, use TSH testing then (T4) testing if TSH levels high * other places do both TSH and T4 levels * repeat screening at 2 weeks in case of delayed onset of hypothyroidism. * TSH screening alone will **not** identify infants with central hypothyroidism, while infants with subclinical hypothyroidism can only be detected by TSH testing. * don't exclude hypothyroidism in Newborn screening if have high index of suspicion

Answer 60

* start Synthroid (levo) asap * initial dosing neonates 10-15 mcg/kg/day * tablets \>\> suspensions * better for dosing * crush into breast milk, formula, water * do not give with Ca, soy, iron supp

Answer 61

* Hashimoto thyroiditis (also called chronic lymphocytic thyroiditis) * early to mid-puberty * autoimmune condition that may occur by itself or in association with other autoimmune diseases such as type 1 diabetes mellitus, Addison disease, juvenile idiopathic arthritis, or systemic lupus erythematosus. * increased prevalence in individuals with Down syndrome and Turner syndrome

Answer 62

* decline in linear growth, weight gain (usually minimal), fatigue, constipation, cold intolerance, poor school performance, bradycardia, dry skin, proximal muscle weakness, delayed relaxation phase of deep tendon reflexes, irregular menstrual periods, and delayed puberty. Rarely, acquired childhood hypothyroidism presents with precocious puberty. * thyroid gland is usually enlarged and **firm with pebbly texture, or goiter.** * atrophic thyroid glands (rather than a goiter) → final stage of thyroid failure in Hashimoto thyroiditis.

Answer 63

* Thyroid function tests (TSH and free T4) and thyroid antibodies (thyroid peroxidase antibody and thyroglobulin antibody) [will be high] * Initial findings of hypothyroidism may be elevated serum TSH concentrations and normal free T4 concentrations (subclinical hypothyroidism). As thyroid failure progresses, serum free T4 concentrations fall (overt hypothyroidism).

Answer 64

Levothyroxine goal: normalization of serum TSH values (no need to monitor thyroid antibodies)

Answer 65

Most children with congenital hypothyroidism do not have clinical manifestations of hypothyroidism due to the presence of maternal thyroid hormones or a small amount of thyroid tissue in the infant. If present, signs and symptoms of congenital hypothyroidism may include lethargy, hypotonia, hoarse cry, feeding problems, constipation, macroglossia, open posterior fontanelle, umbilical hernia, dry skin, hypothermia, and prolonged jaundice

Answer 66

Approximately 85% of cases of congenital hypothyroidism are due to thyroid dysgenesis, which includes agenesis, hypoplasia, and ectopy. Approximately 10% to 15% of cases of congenital hypothyroidism are due to inborn errors of thyroxine synthesis which are inherited in autosomal recessive pattern. Hashimoto thyroiditis is the most common cause of acquired hypothyroidism. Central hypothyroidism is due to disruption in the hypothalamus or pituitary leading to decreased TSH levels, and is a rare cause of congenital hypothyroidism.

Answer 67

C Elevated TSH and normal free T₄ Subclinical hypothyroidism is characterized by elevated TSH and normal free T₄. Overt hypothyroidism is characterized by elevated TSH and low free T₄. Low TSH and normal free T₄ is characteristic of subclinical hyperthyroidism. Low TSH and high free T₄ is characteristic of overt hyperthyroidism.

Answer 68

* Graves disease is the most common cause of hyperthyroidism in children and adults. * autoimmune condition in which antibodies bind and activate the thyrotropin (aka TSH) receptor. Graves disease accounts for more than 95% of childhood and adolescent cases of hyperthyroidism, with a peak incidence of 11 to 15 years of age (female predominance). * In adults, Graves disease accounts for 50% to 80% of cases of hyperthyroidism, with a peak incidence between 40 and 60 years of age (again female predominance), although it can occur at any age. * may occur in conjunction with other autoimmune diseases, including type 1 diabetes mellitus, hypoparathyroidism, Addison disease, myasthenia gravis, vitiligo, and pernicious anemia.

Answer 69

* Hyperfunctioning thyroid nodules, thyrotoxic phase of autoimmune Hashimoto thyroiditis (so-called Hashitoxicosis, caused by release of preformed thyroid hormone from the inflamed thyroid gland), and factitious hyperthyroidism from exogenous thyroid hormone.

Answer 70

* Weight loss, heat intolerance, difficulty sleeping, tremor, increased frequency of defecation, irritability, and menstrual irregularity. * Tachycardia, palpitations, and widened pulse pressure. * Atrial fibrillation common if \> 50 yrs * Children * behavioral disturbances, decreased attention span, difficulty concentrating, emotional lability, and hyperactivity. * upper percentiles for height. Rare findings include localized dermopathy (pretibial myxedema) and thyroid acropachy (clubbing). * tremors, a shortened relaxation phase in deep tendon reflexes, fatigue, and proximal muscle weakness. * Graves ophthalmopathy * Proptosis, periorbital edema, & inflammation * Gynecomastia, reduced libido, and erectile dysfunction.

Answer 71

* low/undetectable TSH, elevated T₄ * T3 may also be elevated, and some individuals may have low TSH, normal free T₄, and elevated T₃. Thyrotropin receptor antibodies **(TRAbs) are present in 95% of affected patients.** * Thyroid peroxidase and antithyroglobulin antibodies may be positive * Thyroid stimulating immunoglobulins (TSI) may also be positive but this test has less sensitivity and a negative result does **not** exclude Graves disease.

Answer 72

* 24-hour radioiodine uptake: * measure uptake at 4 and 24 hours * high: graves, toxic nodular goiter * low: inflamed/destructed gland (thyroiditis), iodine exposure * 24-hour radioiodine scan: * do same time uptake * differentiates from Graves disease, toxic adenoma, and toxic multinodular goiter. * Graves disease, * generally diffuse and homogenous * focal in a toxic adenoma and heterogeneous with multiple areas of focal increased and suppressed uptake in toxic multinodular goiter. * Pertechnetate thyroid scan: * Provides an image of the thyroid and can distinguish between Graves disease, toxic adenoma, and toxic multinodular goiter. * only 20 minutes to perform; but no numerical measurement of uptake and cannot be used to dose radioiodine therapy.

Answer 73

ECG to determine atrial fibrillation is present

Answer 74

get a bone-density test should be obtained.

Answer 75

* CT or MRI of the neck should be obtained

Answer 76

* **antithyroid medication** * reduce thyroid hormone production and block its effect peripherally. * methimazole (for 2nd/3rd trimester) and propylthiouracil( for 1st trimester): inhibit thyroid hormone production. * methamizole SE pruritic papular or urticarial rash, granulocytopenia or agranulocytosis (which typically is accompanied by fever, sore throat, mouth sores, and other systemic symptoms consistent with infection) and hepatitis. * BB for cardiovascular findings. * **radioiodine ablation of the thyroid gland** * orally administered iodine-131 concentrates in the thyroid gland and induces cell death. * **surgical thyroidectomy** * surgery if fail initial medical therapy, relapse after cessation of antithyroid drugs, have significant drug reactions, have large goiters, or severe ophthalmopathy. * complications: hypoparathyroidism and recurrent laryngeal nerve damage. As with RAI, permanent hypothyroidism is the goal of therapy. *

Answer 77

**C Low TSH and normal free T₄** Low TSH and normal free T₄ is characteristic of subclinical hyperthyroidism. Low TSH and high free T₄ is characteristic of overt hyperthyroidism. Subclinical hypothyroidism is characterized by elevated TSH and normal free T₄. Overt hypothyroidism is characterized by elevated TSH and low free T₄.

Answer 78

**Increased uptake with diffuse homogenous appearance on scan**

Week 2 Diabetes & endocrine Flashcards

(102 cards)