Thyroid: Start, stop or recheck?
Exam Findings
Diabetic Medications
2 Diabetic 2 Medications
Exam Findings 2: Electric Boogaloo
100
A 42-year-old woman presents for a routine check-up. She feels well and denies weight gain, fatigue, or cold intolerance.
Labs show: TSH: 6.2, T4: 1.7.
Subclinical hypothyroidism
(Recheck in 6 months)
100
This exam finding is due to excess exposure to this hormone. 
Cortisol
100
This is the best medicine to prescribe to a type 2 diabetic patient whose disease has progressed to a catabolic state.
Insulin
100
SGLT-2 Inhibitors should be held for this many days before surgery.
3 days
100
This finding is common in type two diabetes.
Acanthosis nigricans
200
A 55-year-old man presents for a well check. He has hyperlipidemia and a strong family history of cardiovascular disease.
Labs show: TSH: 10.5, T4: 1.0
Subclinical hypothyroidism
(Start Levothyroxine)
200
This exam finding is caused by a tumor on this anatomical structure.
Pituitary gland
200
This is the goal dose for all diabetics on metformin.
2 g daily
200
When diabetes, hypertension, and proteinuria are present, adding an ACE/ARB with this blood pressure treatment goal is indicated
130/80
200
This is the treatment of choice for a goiter that is compressing nearby structures.
Surgical removal
300
30 year old woman presents with anxiety and racing heart for 2 weeks. She has lost 5 pounds and has a heart rate of 110.
Labs show: TSH: <0.01, T4 2.6, Anti-TPO positive, TR ab negative
Imaging: Radioactive iodine uptake low
Hashimoto's thyroiditis
Recheck
300
Low uterine exposure to this nutrient causes "Cretinism," which is irreversible.
Iodine
300
This medicine class should be stopped for all patients on insulin - because it is no longer effective.
Sulfonylureas
300
Vitamin B12 deficiency regularly happens as a side effect of this diabetic medication.
Metformin
300
An excess of this pituitary hormone can lead to the coarse facial features noted in this patient's picture.
Growth Hormone
400
54 year old woman presents with anxiety and racing heart for 2 weeks. She has lost 5 pounds and has a heart rate of 110.
Labs show: TSH: <0.01, T4 5.2, Anti-TPO negative, TR ab negative
Imaging: Radioactive iodine uptake low
Exogenous Thyroid Hormone use
(Stop thyroid medicine (or decrease))
400
Marty Feldman, seen here in his role as Igor in Young Frankenstein, suffered from Grave's Disease: a condition caused by this rogue antibody.
Thyroid Receptor Antibody
400
Tirzepatide is not like any other FDA approved GLP-1 agonist for this reason.
It is also a GIP agonist.
400
This common cardiovascular medicine class is known to increase the risk of type 2 diabetes mellitus
Statins
400
An adenoma in this gland can cause Osteitis Fibrosa Cystica, seen here on a leg X-ray.
Parathyroid
500
45 year old woman presents with anxiety and racing heart for 2 weeks. She has lost 5 pounds and has a heart rate of 110.
Labs show: TSH: <0.01, T4 2.6, Anti-TPO negative, TR ab negative
Imaging: Radioactive iodine uptake highly localized
Toxic Nodular Goiter
(Radioactive iodine or thyroidectomy)
500
The hyperpigmentation seen in these photos is caused by an insufficiency of this gland.
Adrenal
500
This diabetic medicine class is contraindicated in gastroparesis.
GLP-1 agonists
500
Fournier's Gangrene is a well documented adverse reaction to this medicine class.
SGLT-2 Inhibitors
500
Severe hypothyroidism is sometimes accompanied by this physical exam finding.
Myxedema