Endocrinology
Missed Concepts
- Workup of thyroid nodule almost always ends with FNA, the one exception is a patient without suspicious US findings or cancer risk factors, a low TSH, and a hot nodule on 123-Iodine scan (toxic adenoma). For these patients go straight to treatment (Methimazole pretreatment to achieve euthyroid > RF ablation vs. surgery)
- Hashimoto thyroiditis can be associated with other autoimmune conditions such as atrophic gastritis (pernicious anemia).
- During vitamin B12 repletion, you should monitor serum potassium, which can drop as new RBCs are formed.
- Young, normal weight patient, without family history of diabetes presents with symptomatic DKA? T1DM
- Total T3 and T4 in pregnancy can be 1.5x normal range and still be physiologic. TSH is suppressed. There is no role for measuring free T4 in pregnancy
- Hyperglycemia and catabolic symptoms (weight loss, urinary frequency) are indications for insulin.
- One complication of SGLT2 inhibitors is euglycemic DKA with BG < 250, but still with an elevated AG and low pH.
Hypercalcemia
- H&P:
- Dx: Best initial test is PTH
- Tx: