What labs are used to diagnose thyroid problems? –
Free and total T3
Free and total T4
TSH
Anti-TPO
Hypothyroidism labs - increased TSH, decreased
... [Show More] T3 &T4
hyperthyroidism labs - decreased TSH and increased T3 &T4
When to recheck labs after starting levothyroxine? - 6-8 weeks or after dose
change, then 12 months once stabilized
S/S hypothyroidism - pale, puffy, and expressionless face, cold and dry skin, brittle
hair/hair loss, low heart rate and body temperature, lethargy, fatigue, cold
intolerance, mental status changes, thyroid enlargement
Think "hypo low and slow"
S/S hyperthyroidism - strong and rapid heart rate, dysrhythmias, angina,
nervousness, insomnia, rapid thought flow and speech, muscle weakness/atrophy,
increased metabolic rate (increased heat production, increased body temperature,
heat intolerance), warm/moist skin, increased appetite, weight loss despite
increased caloric intake
think "hyper as in fast"
result of not treating hypothyroidism during pregnancy - permanent
neuropsychological deficits in the child. First trimester: fetus unable to produce
their own thyroid hormones. Fetal thyroid gland is fully functional in the second
trimester.
Medication to treat SYMPTOMS of hyperthyroidism - beta blocker (decrease HR)
non-radioactive iodineHow to take levothyroxine with food? - take on an empty stomach in the morning,
30-60 minutes before breakfast
Supplement/drug interactions with levothyroxine - antacids, iron, calcium
Confirm diabetes diagnosis prior to treatment - fasting plasma glucose greater than
or equal to 126, A random plasma glucose of greater than or equal to 200 plus
symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose
of greater than or equal to 200, or a hemoglobin A1c, a 6.5 or higher (on two
occasions)
A1c general goal - <7%
Older adult A1c goal - <8%
When should insulin be considered? - For patients with an A1c >10%, a fasting
blood glucose >300 or are markedly symptomatic
At what interval should A1c be rechecked? - 2-4 times a year (every 3 months)
until A1c drops to 7% and at least every 6 months there after
action of insulin - regulation of glucose metabolism. Insulin promotes glucose and
amino acid uptake into muscle and adipose tissues, and other tissues except brain
and liver. It also has an anabolic role in stimulating glycogen, fatty acid, and
protein synthesis
First, it stimulates cellular transport (uptake) of glucose, amino acids, nucleotides,
and potassium. Second, insulin promotes synthesis of complex organic molecules.
Under the influence of insulin and other factors, glucose is converted into
glycogen, amino acids are assembled into proteins, and fatty acids are incorporated
into triglycerides
Pioglitazone (TZD) contraindications - do not give to patients with heart failure or
history of bladder cancer
GLP-1 - glucagon-like peptide-1 receptor agonist
ending in -glutide/tide
ex. semaglutide [Show Less]