Bcacp Endocrine Exam Questions With Answers

Bcacp Endocrine Exam Questions With Answers Typical levothyroxine (t4) maintenance dose - ANSWER- 1.6 mcg/kg/day Best test to screen for thyroid disease - ANSWER- TSH T4 requirements during pregnancy - ANSWER- Increase 40-50% Clinical Presentation of hypothyroidism - ANSWER- Extreme fatigue, weight gain, depression, cold intolerance, dry skin, hair loss, constipation, irregular/heavy menses, decreased concentration, bradycardia, hypothermia, diastolic HTN, hoarseness, hyperlipidemia Diagnosis of hypothyroidism physical exam - ANSWER- Increased diastolic blood pressure, decreased heart rate, thyroid palpitation Diagnosis of hypothyroidism lab values - ANSWER- TSH greater than 5mIU/mL with symptoms (or 10 without), low TT4, low FT4, low TT3 Normal lab values for thyroid function tests - ANSWER- TSH 0.4-4 mIU/L TT4 5-12mcg/dL FT4 0.7-1.9 ng/dL TT3 80-180 ng/dL Screening - ANSWER- Everyone older than 35 should be screened every five years Treatment of hypothyroid - ANSWER- levothyroxine (t4) Monitoring TSH levels - ANSWER- Recheck 6-8 weeks after dose change, every 3-6 months during first year, annually thereafter Hypothyroidism at risk populations - ANSWER- Pregnant women, infants, patients with thyroid cancer, patients with cardiac disease, patients with osteopenia, elderly Hypothyroidism pregnancy - ANSWER- Treat mildly elevated TSH (normal 0.4-3) Increase T4 replacement dose by 30% at first sign Monitor monthly Typically 40-50% increase during pregnancy Hypothyroidism infants - ANSWER- Replace T4 with dosage of 10-15mcg/kg/day Can crush and mix with formula or breastmilk Hypothyroidism with thyroid cancer - ANSWER- Target TSH 0.1-0.2 Hypothyroidism with preexisting cardiac disease - ANSWER- Start with low dose 12.5mcg and increase in 12.5mcg increments ever 6-8 weeks T4 drug interactions (decrease absorption) - ANSWER- Cholestyramine, calcium, ferrous sulfate, sucralfate, aluminum hydroxide, magnesium, zinc, MTV T4 drug interactions (increase in metabolism) - ANSWER- Rifampin, phenytoin, phenobarbital, sertraline T4 drug interactions (pharmacodynamic) - ANSWER- Warfarin-decreased drug activity in hypothyroidism (need higher dose) Digoxin-increases drug activity in hypothyroidism (need lower dose) Other thyroid preparations - ANSWER- Desiccated thyroid hormone Triiodothyronine (cytomel, triostat) Synthetic T4/T3 (liotrix) Desiccated Thyroid (Armour Thyroid) - ANSWER- Variable amount of iodine Potential for allergic reaction Potential of thyrotoxicosis-contains T3 Triiodothyronine (T3) - ANSWER- Greater potential for cardiac effects Short half life Must monitor T3 25mcg equivalent to 60-100 mcg T4 Hyperthyroidism - ANSWER- excessive activity of the thyroid gland Hyperthyroidism clinical presentation - ANSWER- Heat intolerance, tremor, palpitation, systolic HTN, nervousness, frequent bowel movement, less frequent/lighter menses, fatigue and muscle weakness, goiter, weight loss, insomnia Hyperthyroidism lab values - ANSWER- Low TSH High TT4 High FT4 High TT3 Hyperthyroidism treatment - ANSWER- Radioactive Iodine If Not Pregnant* PTU (Prevents T4 to T3 Conversion) - High Risk of Hepatotoxicity Methimazole and Carbimazole Thioamides-PTU mechanism of action - ANSWER- Inhibits the peripheral conversion of T4-T3 Delayed effect(weeks) Dosed 300-600mg/day Thioamides adverse effects - ANSWER- agranulocytosis vasculitis Also: rash, arthralgia, hepatotoxicity, vasculitis, lupus thioamides (methimazole) - ANSWER- 30-60 mg/day Less hepatotoxic Do not use in first trimester/lactating/thyroid storm Iodides MOA - ANSWER- Block thyroid hormone release Inhibit the peripheral conversion of T4 to T3 *Decrease gland size/vascularity* Rapid onset (2-7 days) Iodides adverse effects - ANSWER- 1. Hypersensitivity reactions 2. Dose-related toxicity ("iodism") -Metallic taste, burning mouth and throat, sore teeth and gums, head cold symptoms, stomach upset, diarrhea 3. Salivary gland swellin