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What are the lab values seen in someone
with thyroid binding globulin deficiency?
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Low total T4, normal free T4, normal TSH.
The patient is clinically euthyroid because
the metabolically active free T4 is at a
normal level.
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What are the signs/symproms of
Hashimoto's thyroiditis?
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Symptoms of hypothyroidism- weakness,
lethargy, cold intolerance, constipation,
dry skin, obesity.
Signs: GOITER, growth retardation,
abnormal puberty, pale dry skin,
myopathy, muscular hypertrophy.
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What antibodies are associated with the development of Hashimoto's thyroiditis?
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Microsomal antibodies (antibodies to thyroid peroxidase) & sometimes antithyroglobulin antibodies
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What occurs microscopically in patients with Hashimoto's thyroiditis?
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Lymphocytic proliferation of the gland.
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What antibodies are associated with the development of Graves Disease?
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IgG antibody termed thyroid stimulating immunoglobulin
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What is the treatment course for Graves disease in children?
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Propranolol for acute symptom management.
Prophylthiouracil or methimazole are antithyroid treatment medications (45% only need this medication and the condition resolves).
Radioactive ablation- increases antibody production transiently.
Surgical excision (must be done if the condition doesn't resolve in 3 yrs)- risks include recurrent laryngeal nerve damage or hypoparathyroidism.
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What is the mechanism and clinical presentation of pseudohypoparathyroidism?
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-Genetic resistance to the effects of PTH.
-Presents with cherubic appearance in a 5-10 yoa child with brachydactyly, short stature, and developmental delay.
-Labs: decreased calcium, increased phosphorus, significantly increased PTH.
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How do you treat pseudohypoparathyroidism?
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-Treat with calcium supplementation and Vitamin D supplementation.
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What is adrenoleukodystrophy?
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- X-linked disorder causing CNS demyelination and progressive neurologic impairment (cortical blindness, deafness, quadriparesis, and death)
-Defect in the peroxisome leading to increased levels of very long chain fatty acids which leads to demyelination and cortical destruction.
-Adrenal failure can be the only manifestation of the disorder.
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What are the signs and symptoms of Cushing's syndrome?
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- Elevated serum cortisol and increased ACTH from ectopic production.
-Increased weight with POOR linear growth, hypertension, premature growth of body hair, central weight gain, proximal muscle weakness, violaceous striae
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What lab values are abnormal in someone with Cushing's syndrome?
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- Elevated urine cortisol, serum androgens, and decreased renin.
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How do you calculate the serum osmolality?
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2Na + BUN/2.8 + Gluc/18 (mainly dependent on Na)
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How do you calculate the anion gap?
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Anion gap = Na - (Choride + Bicarbonate)
Normal 8-12 meq/L
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How do you calculate the sodium deficity when correcting hyponatremic dehydration?
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(Desired sodium - measured sodium) x weight x 0.6 = sodium deficit
sodium deficit + maintenance sodium (3 meq/kg/day) = replacement over 24 hours
ONLY use 3% NS if rapid correction is needed.
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What are the typical causes of a non-anion gap acidosis?
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Normal anion gap acidosis:
USED CARP
Ureterostomy
Small bowel fistula
Extra chloride
Diarrhea
Carbonic anydrase inhibitors
Adrenal insufficiency
Renal tubular acidosis
Pancreatic fistula
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