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Thyriod problems

Thyriod problems. What about a low t3 in thyroid replacement?. Replace with Armor Replace with cytomel Ignor it. Answer. T3 therapy— overwhelming evidence that T3 supplementation or partial replacement not beneficial

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Thyriod problems

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  1. Thyriod problems

  2. What about a low t3 in thyroid replacement? • Replace with Armor • Replace with cytomel • Ignor it

  3. Answer • T3 therapy— overwhelming evidence that T3 supplementation or partial replacement not beneficial • neurocognitive function and psychologic well-being may not return to normal with levothyroxine • creates risk for hyperthyroidism and long-term effects • subgroup of 16% with D-iodinase gene polymorphism may improve with appropriate T3 supplementation • thyroid desiccated (eg, Armour Thyroid, S- Thyrar, Thyroid Strong) and liotrix (T4 and T3; Thyrolar) contain higher ratio of T3 (associated with increased risk for hyperthyroidism) • drugs that interfere with levothyroxine—proton-pump inhibitors,

  4. Should you check for Antithyroid Antibodies and anti TPO antibodies in Hypothyroid Patients? • A. True • B. False

  5. Answer • B. False • antithyroglobulin and antithyroid peroxidase (anti-TPO)—testing generally not recommended for diagnosis of hypothyroidism because >90% due to Hashimoto disease • testing may be useful prognostically; in subclinical thyroid disease, antibodies may be predictive of likelihood of development of overt thyroid disease

  6. if TSH low, you should check ?

  7. Answer • check free T4 and free T3

  8. Traditional Chinese Medicine for Treatment of H1N1 Influenza • In a relatively young and healthy population, a combination of 12 herbs was as effective as oseltamivir. • A traditional Chinese medicine (TCM) containing 12 herbs (including Ephedra, which is banned in the U.S. and Canada) has been proposed as an alternative to oseltamivir for treating patients with H1N1 influenza. Researchers in China randomized 410 people (mean age, 19) with documented H1N1 infections to no treatment, oseltamivir, TCM, or oseltamivir plus TCM. The study was not blinded, and exclusion criteria included presence of a new infiltrate or substantial chronic illness. • The median time to fever resolution was 26 hours in the control arm; it was significantly shorter in each of the active treatment groups (oseltamivir, –34%; TCM, –37%; combination, –47%). Resolution of cough, sore throat, rhinorrhea, headache, and fatigue did not differ among treatment groups, and no significant differences were noted in complication rates. • Comment: In this nonblinded trial, a traditional Chinese medicine was as effective as oseltamivir in shortening fever duration among relatively healthy patients with H1N1 influenza. The precise mechanism is unknown but could be related to modulation of T cell subpopulations, as well as inhibitory effects on the influenza virus itself. Although the findings are interesting, people enrolled in this trial were young and relatively healthy; treatment with an antiviral likely was unnecessary. Whether this TCM is effective in people at higher risk is unclear.

  9. Follow-Up Chest X-Rays After Pneumonia? • Follow-up imaging probably can be limited to older patients. • Older guidelines recommended routine follow-up chest x-rays at about 6 weeks after episodes of community-acquired pneumonia, presumably to screen for malignancy after an acute infiltrate has cleared. More recent U.S. guidelines don't address this issue (Clin Infect Dis 2007; 44(Suppl 2):S27), and a recent U.K. guideline recommends this practice only for patients with persistent symptoms or those "at higher risk of underlying malignancy (especially smokers and those aged >50 years)" (Thorax 2009; 64(Suppl 3):iii1). • In this population-based cohort study, Canadian researchers identified all 3398 patients without known cancer who received inpatient or outpatient treatment for pneumonia between 2000 and 2002 in metropolitan Edmonton. The incidence of newly diagnosed lung cancer was 1.1% at 90 days and 1.7% at 1 year. Only 40% of patients had follow-up chest x-rays performed within 90 days. All but 1 of the 57 patients in whom cancer was diagnosed within 1 year were 50 or older; thus, the authors conclude that routine follow-up chest x-rays should be restricted to people in that age group. • Comment: Because less than half the patients underwent follow-up chest x-rays and, because this study was not a randomized comparison of imaging versus no imaging, the benefit of routine radiography after pneumonia remains unclear. However, the low 1-year incidence of lung cancer provides reassurance that a selective approach — limiting follow-up chest x-rays to middle-aged and older adults — is reasonable. Obviously, patients of any age who remain symptomatic also should undergo follow-up imaging. (Read the case history of a pneumonia patient, and decide if you would order a follow-up x-ray.)

  10. Choose the correct statement about normal thyrotropin (TSH) levels. A) Genetically predetermined B) <2.0 μIU/mL in most young to middle-aged euthyroid individuals C) Increased in smokers D) Lower limit is 0.8 to 1.0 μIU/mL

  11. Answer • A) Genetically predetermined

  12. Hyperthyroidism is caused by _______ in 80% of cases. A) Toxic multinodular goiter B) Graves disease C) Smoking D) Iatrogenic cause

  13. Answer • B) Graves disease

  14. Compared to methimazole, propylthiouracil: A) Must be dosed less frequently B) Has a faster onset C) Is more effective D) May be more likely to lead to failure of radioiodine therapy

  15. Answer •  D) May be more likely to lead to failure of radioiodine therapy

  16. Antithyroid drugs cause remission of toxic multinodular goiters in 50% of patients. A) True B) False

  17. Answer •  B) False

  18. Thyroid surgery is usually indicated for which of the following? A) Smaller nonobstructive goiters B) Toxic nodules in patients >65 yr of age C) Pregnant patients or those with drug intolerance  D) All "hot" nodules

  19. Answer • C) Pregnant patients or those with drug intolerance 

  20. Hypothyroidism is caused by _______ in >90% of cases. A) Hashimoto disease B) Iatrogenic cause C) Iodine deficiency D) Thyroid agenesis

  21. Answer • A) Hashimoto disease

  22. Choose the correct statement about the treatment of hypothyroidism. A) Levothyroxine should be taken with food B) T3 supplementation shown to be highly beneficial C) Proton-pump inhibitors and H2-blockers interfere with levothyroxine D) Levothyroxine has no effect on neurocognitive function or psychologic well-being

  23. Answer •  C) Proton-pump inhibitors and H2-blockers interfere with levothyroxine

  24. Which of the following patients with postpartum thyroiditis are least likely to develop chronic thyroid disease? A) Women who develop only hyperthyroid phase B) Women who develop only hypothyroid phase C) Women who develop hyperthyroidism after transient hypothyroidism D) Women with hypothyroidism and postpartum depression

  25. Answer • A) Women who develop only hyperthyroid phase

  26. Compared to postpartum thyroiditis, Graves disease:  A) Is more common B) Presents with milder symptoms C) Is associated with larger goiters D) Is not associated with ophthalmopathy

  27. Answer • C) Is associated with larger goiters

  28. In pregnant women, which of the following is more likely to occur in hyperthyroidism than in hypothyroidism? A) Abruption B) Heart failure C) Stillbirth D) Low birth weight

  29. Answer • B) Heart failure

  30. Which of the following is diagnostic for diabetes mellitus (DM)? A) Fasting plasma glucose (FPG) of 110 mg/dL B) 2-hr postprandial glucose (on oral glucose tolerance test [OGTT]) of l65 mg/dL C) Hemoglobin (Hb)A1c ≥6.5% D) Any of the above

  31. Answer • C) Hemoglobin (Hb)A1c ≥6.5%

  32. The strongest acquired risk factor for developing type 2 DM (T2DM) is: A) Obesity B) High-fat, low-fiber diet C) Physical inactivity D) Excessive alcohol consumption

  33. Answer •  A) Obesity

  34. Every person who develops insulin resistance (IR) will eventually progress to IGT or overt DM. A) True B) False

  35. Answer •  B) False

  36. In a meta-analysis of several clinical trials involving >100,000 patients randomized to different therapies, all the following classes of drugs were associated with a lower risk for developing T2DM, except: A) Calcium channel blockers B) Angiotensin-converting enzyme inhibitors (ACEIs)  C) Diuretics D) Angiotensin-receptor blockers (ARBs)

  37. Answer • C) Diuretics

  38. If a patient's HbA1c is not at target goal with a basal insulin dose of _______U/kg per day, then insulin therapy needs to be intensified and prandial coverage should be considered. A) 0.1 to 0.2 U/kg B) 0.2 to 0.3 U/kg C) 0.3 to 0.5 U/kg  D) 0.4 to 0.6 U/kg

  39. Answer •  D) 0.4 to 0.6 U/kg

  40. In the Treating to Target in Type 2 Diabetes study, the 3-yr cumulative rates for hypoglycemia and weight gain were lowest in patients with T2DM whose insulin therapy was initiated with: A) Basal insulin B) Prandial insulin C) Premix insulin

  41. Answer • A) Basal insulin

  42. In the STEP-Wise study, the greatest reduction(s) in HbA1cwere achieved with addition of the ______ bolus(es) of prandial insulin. A) First B) Third C) First and second D) Second and third

  43. Answer •  C) First and second

  44. Which of the following is a mechanism of anemia in patients with chronic kidney disease (CKD)? A) Decreased production of erythropoietin B) Inflammation C) Hemolysis D) All the above

  45. Answer • D) All the above

  46. Before the introduction of erythropoiesis-stimulating agents (ESAs) for treating renal anemia, patients on dialysis required an average of 26 U blood/year. Currently, about ________ of dialysis patients with CKD and ________ of non-dialysis-dependent CKD patients still receive transfusions. A) 33%; 15% B) 25%; 10% C) 13%; 8% D) 5%; 2%

  47. Answer •  B) 25%; 10%

  48. Results of a landmark study on the effects of normal vs low hemoglobin (Hb) values in patients with cardiac disease receiving hemodialysis and epoetin clearly show that normalization of Hb _______ in dialysis patients with cardiac disease. A) Is harmful B) Is beneficial C) Has no effect on outcomes

  49. Answer •  A) Is harmful

  50. Thyroid hormones • levorotatory thyroxine (T4)—produced by thyroid • half-life 1 wk • triiodothyronine (T3)—produced by peripheral tissues • half-life 1 day • more potent than T4

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