Hypothyroid- Eti, Sx
- Hasimoto, low pituitary
- Fatigue, weakness, constipation, depression,
- Hyporelexia
- Brittle nails, hair
Hypothyroid- Dx, Tx
- Elevated TSH, low T4 = primary hypothyroid
- High T4 = secondary
- Levothyroxine
Hyperthyroid- sx
- Heat intolerance, tachy, diarrhea, wt loss, tremors
- Low TSH, high T4 = primary
Graves- Sx
Exophthalmos, lid lag
- Pretibial myxedema- pink to brown plaques on skin
- Bruits
- Tx: Radioactive iodine followed by hormone replacement
Toxic multinodular goiter/ adenoma-
Clinical hyperthyroid w/o eye findings
- Laryngeal compression
- Beta blockers for thyrotoxicosis
Thyroid nodules- Sx
- Difficulty swallowing, breathing, hoarness, jaw pain
- Benign: smooth, sharply outline, discrete
- Malignent- Rapid growth, no mvmt with swallowing
Thyroid nodules- Dx
FNA with biopsy
- Radioactive iodine uptake, US
Thyroid nodules-Tx
Thyroidectomy, observation with US
Metabolic syndrome- Dx criteria
- 3+ of following
- Waist circumference > 40, >35
- High triglycerides
- Low HDLs
- High fasting glucose
- HTN
DM 1- Patho, epi
- Pancreatic beta cell destruction, autoimmune or idiopathic
- children, onset
DM 1- Sx
- Polyuria, dipsia, wt loss, polyphagia
- DKA
DM 2- Patho, epi
- Insulin resistance, impairment of secretion
- Weight, decreased phys activity
- Fat peeps
DM 2- Sx
- Obesity, ketonuria,
- Often silent, incidental finding- neuropathy, retinopathy
DM Dx
- Fasting CBG > 126 x 2 occasions
- A1c > 6.5%
- Oral GTT > 200
DM Screening
Q 3 years
- > 45
- BP > 135/80
- BMI > 25 with risks- phys inactive, relative, >9lb baby, cholesterol
Biguanides; Metformin- MOA
- 1st line
- Decreases hepatic glucose production
- decreased oral glucose absorption
Biguanides; Metformin- AE
- GI
- Lactic acidosis
- Macrocytic anemia
Sulfonylureas; glipizide, glyburide, glimepiride- MOA
- Insulin secretagogue
- Stimulates insulin release
Sulfonyluras; glipizide, glyburide, glimepiride- AE
Hypoglycemia
- GI upset
- Disulfram rxn, wt gain
Meglintinides- Repaglinidine- MOA, AE
- Stimulates beta cell insulin secretion
- Hypoglycemia
Alpha- glucosidase inhibitors- acarbose, miglitol- MOA
- Delays glucose absorption
- Hepatitis, GI
Thiazolidinediones ; pioglitazone, rosiglitazone- MOA
Increased insulin sensitivity
- Fluid retention
DPP-4 inhibitors- Januvia
- Increases GLP-1, increased insulin secretion, decreased glucagon
- Pancreatitis
GLP-1 agonists; victoza, byetta
- Increases GLP-1, increased insulin secretion, decreased glucagon
- Hypoglycemia, gastroparesis
