A 30 year-old female patient who complains of fatigue has a screening TSH performed. Her TSH value is 8 mU/L. What should be done next? - ANSWER Repeat
... [Show More] the TSH and add T4
TSH values rise and fall continuously. Consequently, TSH levels are repeated and an average is usually calculated. A diagnosis of hypothyroidism can be made after a second abnormal TSH unless the initial value is very elevated and the patient is symptomatic. When an elevated TSH is discovered, it should be repeated and a serum free T4 can be measured. Depending on these results, a diagnosis of thyroid disease can be made.
A patient who has been treated for hypothyroidism presents for her annual exam. Her TSH is 14.1 (normal = 0.4- 3.8). She complains of weight gain and fatigue. How should the NP proceed? - ANSWER Ask if she is taking her medication
Her TSH is elevated. This is usually caused by insufficient supplementation in a patient with hypothyroidism. If the TSH was within normal range following her last annual exam, something has changed. The first point that must be established is whether the patient is still taking her medication. If she is still taking her medication, determining when she is taking it is very important. It should be taken on an empty stomach for absorption. These two important facts must be established BEFORE increasing her current dose. The TSH is usually repeated when an abnormal value is measured, but this patient has symptoms of an abnormal TSH.
What is the AM fasting glucose goal for a 75 year-old patient who has diabetes? - ANSWER 90-130mg/dL
Considering the patient's age, with few coexisting conditions, the ADA 2016 Standards of Care recommend a target fasting glucose goal of 90-130 mg/dL. For those with complex/intermediate (multiple coexisting conditions) health status, target is 90-150mg/dL and very complex (end stage chronic illness or mod-severe cognitive impairment) is 100-180 mg/dL.
A female patient has the following characteristics. Which one represents a risk factor for Type II diabetes? - ANSWER History of gestational diabetes
History of gestational diabetes conveys an 83% chance of developing Type II diabetes (within 17 years of delivery). Hyperlipidemia by itself is not a risk factor for diabetes, though it is commonly seen in conjunction with diabetes. Infrequent, regular exercise increases the risk of increased BMI, but by itself is not a risk factor for Type II diabetes. A family history of Type II diabetes increases the risk of developing it, but this is not true of Type I diabetes. [Show Less]