Endocrinology

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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.
  • Prolactin-secreting pituitary adenomas, including large ones, are first treated with oral dopamine antagonists, whereas other pituitary adenomas are treated with surgery if large enough.

Hypercalcemia

  • H&P:
  • Dx: Best initial test is PTH
  • Tx: