Which of the following tests is used to monitor the levothyroxine (Synthroid) dose when treating primary hypothyroidism?

A 34-year-old male with Type I diabetes, presents for an acute office visit complaining of uncontrolled blood sugars, with high and low readings throughout the day and night.  When he called to make the appointment, he was advised to bring in his blood glucose log, and to check a few 3:00AM blood sugar levels.  His current daily insulin regimen is 40 units NPH insulin and 20 units of Regular insulin before breakfast, and 20 units of NPH insulin and 10 units of Regular insulin before dinner. Time 7am 11 am 5 pm 11 pm 3 am Average blood glucose mg/dL 393 210 175 140 50 Which of the following insulin adjustments is most appropriate, based on the patient’s average glucose readings?

All of the following clinical features may be commonly associated with a diagnosis of hypothyroidism EXCEPT:

A 12-year-old girl became comatose and was rushed to the hospital by her parents. Two days previously, she went to school feeling ill and vomited that evening. Her vomiting persisted, with only an 8-hour pause during sleep. The emergency room physician assistant noted that she was breathing deeply and rapidly, and that her breath had a fruity odor. Her parents also noted that her appetite has increased, she has been drinking lots of fluids, and subsequently, urinating more than normal. Urinalysis reveals 3+ glucose levels and 2+ ketone bodies.Based on the above information, what is the most likely underlying cause of this patient’s symptoms?

Adult bone cannot increase in length when stimulated by an excess of growth hormone because of the lack of epiphyseal cartilage, but they do increase in width by periosteal growth.  In adults, an excess of growth hormone causes which of the following conditions:

An 11-year-old Hispanic girl presented to the Emergency Department with a one-day history of respiratory distress, fever, and dysphagia that developed after several days of upper respiratory infection symptoms and sore throat.  PMH is significant for prematurity (26 weeks gestational age), associated with chronic lung disease.  On examination, patient is noted to be moderately agitated.  T: 101.4ºF, HR: 200/min, RR: 40/min; O2 sat (room air): 91%, BP: 164/92.  She had diffuse erythema of the pharynx, exophthalmos, and a diffuse bilateral goiter.  There were no palpable thyroid nodules or tenderness, but a thyroid bruit was present. On her lung exam she had bilateral wheezes.  Diagnostic tests/Laboratory test results: Nasal swab (+) respiratory syncytial virus (RSV); CXR: suggestive of viral pneumonia; (+) serum anti-thyroid antibodies. Labs (with normal ranges) At diagnosis TSH (0.37–4.42mIU/L) 0.01 Free T4 (0.65–1.80ng/dl) 8.17 Free T3 (335– 480pg/dl) 1918 Based on this information, which of the following conditions is the most likely diagnosis for this patient?

Endocrine causes of hypertriglyceridemia include untreated diabetes mellitus and hypothyroidism.

A 50-year-old female with PMH significant for HTN comes to your clinic for a refill of her lisinopril medication. She is also taking lovastatin and hydrochlorothiazide. Vital signs are: HR 80, BP 150/100, and BMI 40. Physical exam is remarkable for a waist-to-hip ratio of 1.0 and the presence of diffuse dark patches on her skin (see image below). Her fasting lab results are: Sodium: 145 mmol/L, Potassium: 5.0 mmol/L, Chloride: 105 mmol/L, Bicarbonate: 25 mmol/L, BUN: 10 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 200 mg/dL, Triglyceride: 200 mg/dL, LDL: 250 mg/dL, Total cholesterol: 300 mg/dL, HDL: 30 mg/dL, and Hemoglobin A1C: 7.0%.                                                       The patient’s history, physical exam, and laboratory findings are most consistent with which of the following conditions?  

Clinical presentation associated with a diagnosis of hyperglycemic hyperosmolar state (HHS) includes which of the following clinical findings?

A 74-year-old male presents to the emergency department acutely obtunded. The patient lives alone and was found unresponsive by his son. Generally, the patient manages his own finances, medications, and works part-time. He has not been responding to phone calls for the past 3 days. The patient is unable to offer a history. He has a past medical history of hypothyroidism, depression, and diabetes. His temperature is 88.0°F (31.1°C), blood pressure is 92/62 mmHg, pulse is 35/min, respirations are 9/min, and oxygen saturation is 92% on room air. The patient is cold to the touch and moves all extremities to painful stimuli. His pupils are reactive and sluggish, and he does not follow commands. There are no signs of trauma or skin infections.  Which of the following conditions is the most likely diagnosis?