What lab tests are used to diagnose hypothyroidism?
- Serum TSH used to screen and diagnose hypothyroidism (Even with small T3 and T4 changes there will be an abnormally high level of TSH)
What are normal/hypo/hyper levels of TSH?
- Hyperthyroid – under 0.3
- Normal – 0.3-6
- Hypothyroid – over 6
How long after initiation of treatment for hypothyroidism would you recheck labs?
Check TSH 6-8 weeks after initiating therapy and after any dosage change
What are the signs and symptoms of hypothyroidism?
- face is pale, puffy, and expressionless
- skin is cold and dry
- hair is brittle, and hair loss occurs.
- Heart rate and temperature are lowered.
- lethargy, fatigue, and intolerance to cold.
- Mentation may be impaired
- Thyroid enlargement
What are the signs and symptoms of and hyperthyroidism?
- Nervousness
- Insomnia
- rapid thought flow
- rapid speech
- Skeletal muscles may weaken and atrophy.
- Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and skin that is warm and moist.
- Appetite is increased, weight loss
How is a thyroid storm treated?
Using a combination of:
- antithyroid drugs
- corticosteroids
- beta-blockers
- iodine solution
- supportive measures are needed
Can be a result of not treating hypothyroidism during pregnancy.
What medication is used to treat symptoms of hyperthyroidism?
- Methimazole or propylthiouracil
These are antithyroid drugs which treat the symptoms but not the condition itself.
What medications reduce absorption of levothyroxine?
- Histamine 2 (H2) receptor blockers (cimetidine)
- Proton pump inhibitors (lansoprazole)
- Sucralfate (Carafate)
- Cholestyramine, Colestipol
- Aluminum-containing antacids (-Maalox, Mylanta),
- Calcium supplements (-Tums, Os-Cal)
- Iron supplements (ferrous sulfate),
- Magnesium salts
- Orlistat (Xenical)
What drugs accelerate metabolism of levothyroxine?
- phenytoin (Dilantin),
- carbamazepine (Tegretol, Carbatrol),
- rifampin (Rifadin),
- sertraline (Zoloft), and
- phenobarbital.
How do you confirm a diagnosis of diabetes?
- Fasting glucose ≥ 126
- Random glucose ≥200
- Oral glucose tolerance test ≥200
- HbA1c 6.5% or higher
What are the general goals for a1c when treating diabetics?
General goal: < 7%
Older Adult goal: < 8%
In what situations should insulin be used for treatment?
- For all T1D
- Gestational diabetes
- Newly diagnosed diabetics with an A1C greater than 10% and a fasting glucose over 300
How often should an A1C be checked after beginning treatment for diabetes?
Every three months until it is less or equal to 7%
Then every 6 months thereafter
Name three actions of insulin
- Promotes conservation of energy and buildup of energy stores (glycogen)
- Stimulates cellular uptake of glucose, amino acids, neucleotides and potassium.
- Promotes synthesis of complex organic molecules –> assembly of amino acids into proteins and fatty acids incorporated into triglycerides
What are contraindications for pioglitazone?
- Patients with severe HF
- Patient with bladder cancer or history of bladder cancer
GLP-1
Glucagon-like peptide-1 receptor agonists
TZD
Thiazolidinediones
DPP4-I
Dipeptidyl peptidase 4 Inhibitors
SGLT2i
Sodium-glucose Cotransporter 2 Inhibitors
Which drug class should be considered for diabetes prior to insulin?
Biguanides
Mechanism of action for GLP-1
Glucogon like peptide (non insulin injectable)
Augments the effects of the incretin hormone GLP-1 by:
- activating receptors for GLP-1 to slow gastric emptying
- stimulate release of insulin
- inhibit postprandial release of glucagon
- suppress appetite.
Thereby reducing glucose levels and inducing weight loss.
Mechanism of Action for TZD
Thiazolidinediones
Reduce glucose levels by decreasing insulin resistance
Activation of a PPAR receptor which turns on insulin-responsive genes resulting in:
- increased cellular uptake of glucose by the skeletal muscle and adipose cells
(Enhances response to insulin, therefore insulin needs to be present for the drug to work)
MOA for DPP-4i
Dipeptidyl peptidase 4 Inhibitors
Enhances the action of incretin hormones to:
- stimulate release of insulin
- suppress release of glucagon
- keep blood glucose levels from climbing too high
Sulfonylureas
Stimulating the release of insulin from pancreatic islets (not for DM1) by binding with and blocking ATP sensitive potassium channels int eh cell membrane. The membrane then depolarizes permitting a Ca influx causing a release of insulin.
