NUR 533 EXAM WEEK 2 NEWEST COMPREHENSIVE STUDY GUIDE 2025

Hypothyroidism - -High TSH + low T4 = primary hypothyroidism High TSH + normal T4 = subclinical hypothyroidism Normal TSH + low T4 = secondary hypothyroidism or severe non-thyroidal illness Subclinical Hypothyroidism Management - -TSH level 5-10 with sx of hypothyroidism: 3 6 month trial of levothyroxine TSH level 5-10 without sx of hypothyroidism: shared decision making on whether to treat or not TSH 10: treat with levothyroxine therapy Levothyroxine (1st line therapy) - -Average dose is 1.6 mcg/kg/day Low dose in patients with CAD or older age Recheck TSH in 6-8 weeks and adjust as needed Must take vitamins 4 hours before or after taking levothyroxine Hypothyroidsim & Pregnancy - -1st Trimester TSH Goal Level: 0.5-2.5 2nd and 3rd Trimester TSH Goal Level: 3 Dose will need to be increased by 20-30% After delivery, the dose can be decreased to the pre-pregnancy dose and TSH needs to be checked 6 weeks later Subacute Thyroiditis - -Exquisitely tender, diffusely enlarged gland after a viral illness Tx includes NSAIDS to relieve discomfort Postpartum Thyroiditis - -Inflammation of the thyroid gland following childbirth Normally occurs 3 months after birth Painless NUR 533 NUR 533 Graves Disease - -An autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos May hear a bruit in the thyroid upon auscultation Work-up: supressed TSH, elevated free T3 and T4, elevated total T3, positive thyrotropin receptor antibody; order CBC, LFTs, and ESR Tx: methimazole, propythiouricil, radioactive iodine therapy, thyroidectomy, beta blockers Check TSH q2-8 weeks until normal Toxic Multinodular Goiter - -Hyperthyroidism caused by multiple thyroid nodules Thyroid Storm - -Increased temp, pulse, edema, irregular HR, and HTN Medical emergency Knowledge Check - -Beta blockers should be initiated for patients with Graves' disease to alleviate the alpha-adrenergic symptoms of the hyperthyroidism. Radioiodine therapy is used for patients with Graves' ophthalmopathy. Surgical resection is performed for pregnant women who cannot be managed with thioamides or for patients who refuse radioiodine therapy. Thioamide therapy is recommended for patients younger than 20 years old, pregnant women, those with a high likelihood of remission, and those with active Graves' Orbitopathy Thyroid Nodule - -1. Check TSH 2. Iodine uptake scan (high) 2(a). Thyroid US 3. Nodule 1 cm: fine needle aspiration Management of Benign Thyroid Nodules - -Repeat exam,US, and TSH in 12 months and if unchanged, repeat in 24 months Surgery if 4 cm or symptomatic Hyperparathyroidism - -Hypersecretion of the parathyroid glands, usually caused by a tumor which increases calcium levels If calcium level is increased, repeat it Bone density scan should be completed Cushing Disease - -Excessive anterior pituitary secretion of ACTH which produces excess cortisol NUR 533 NUR 533 Most common cause is due to exogenous steroids Dx (one of the following): 24-hour urine free cortisol two times, *late night salivary cortisol two times*, or low-dose dexamethasone suppression test Tx: surgery Pituitary Adenoma - -A slow-growing, benign tumor of the pituitary gland that may or may not cause excess hormone secretion Prolactin hormone is most commonly the hormone being secreted Pituitary Prolactinoma - -Excess secretion of prolactin hormone due to a tumor Sx: oligomenorrhea, amenorrhea, galactorrhea, vaginal dryness, hirsutism, ED, decreased body and facial hair (men), gynecomastia After prolactin level ishigh, perform an MRI Refer to endocrinology and ophthalmology Knowledge Check 2 - -Medical management of primary hyperparathyroidism involves close monitoring of serum calcium and creatinine and bone density screenings. Weight bearing exercises should be encouraged, and vitamin D and calcium intake should be adequate, not decreased. This patient does not meet criteria for parathyroidectomy because of age less than 50 years and serum calcium less than 1 mg/dL above the upper limit of normal. Knowledge Check 3 - -Cognitive impairment, left ventricular hypertrophy, and renal calculi all occur with hyperparathyroidism. Chvostek's sign and perioral paresthesias occur with hypoparathyroidism. Knowledge Check 4 - -Primary hyperparathyroidism is characterized by the inappropriate secretion of PTH in the setting of hypercalcemia. Appropriately high PTH with hypocalcemia characterizes hypoparathyroidism. An appropriately increased secretion of PTH with low or normal serum calcium is characteristic of secondary hyperparathyroidism. Prolonged inappropriate secretion of PTH in which hypercalcemia develops is tertiary hyperparathyroidism. DKA - -Sx: high blood sugar, acidosis (pH 7.3), ketones More seen in T1DM BS 200-300 range HHS - -Sx: high blood sugar, hyperosmolality (pH 7.3), AMS More seen in T2DM NUR 533 NUR 533 BS 600 Side Effects of DM Medications - -Metformin: pancreatitis, hepatic failure, worsening of HF, joint pain, hypoglycemia when given with glipizide or glimiperide GLP-1 Agonists (-tide): severe hypoglycemia when given with insulin, N/V, HA, anorexia Sulfonylureas (-ide): decreased eGFR, AKI, electrolyte imbalance DM Diagnosis - -Just one of the following need to be present: HbA1C 6.5- make sure they are not anemic Fasting BS or = 126 2-hour glucose or = 200 BS 200 with sx of hyperglycemia To test, use the 75 gm of glucose Plasma glucose is used, not serum glucose Routine Screening for DM in Adult - -At age 45 for all individuals BMI 25 at all times Routine Screening for DM in Children - -BMI 85th percentile for their age and sex Weight 100% of their ideal weight for their height T1DM Tests - -C-peptide Anti-GAD Anti-insulin antibody Screen for these autoimmune diseases if considering T1DM diagnosis: - -Thyroid Celiac Metformin is contraindicated in those with: - -GFR 30 T1DM and Children - -Monitor A1C q6m until meeting goals If not meeting goal, A1C q3m HBA1C Dx - -Children want: 7.5 Pregnant adult: want 7.0 Anti-platelet Therapy - -Do recommend aspirin therapy for those with DM and over 30 years of age Cholesterol Testing and DM - -Check q5y Metformin lowers A1C by: - -1-1.5% Dual Therapy - -Initial A1C or = 7.5 A1C 9 = insulin Which insulin does not have a peak? - -Lantus (insulin glargine) Microvascular Changes - -Retinopathy, neuropathy, nephropathy