Today at MEDS
Clinician Reviews and the Primary Care Metabolic Group welcomed more than 300 NPs, PAs, RNs, CDEs, and other clinicians involved in the diagnosis and management of metabolic and endocrine disorders from across the United States and abroad to the 2018 Metabolic and Endocrine Disease Summit (MEDS). This annual conference, headed by Meeting Chair Scott Urquhart, PA-C, DFAAPA, and Co-Chair Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, was held August 1-4, 2018, at the Wyndham San Diego Bayside in San Diego, California, providing the opportunity for attendees to earn up to 24.25 CE/CME credits.
View summaries from the event on the following pages.
Morning session
Managing Thyroid Disease: Preparing for Battle
Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, Metabolic Medicine Associates, and Chris Sadler, MA, PA-C, CDE, DFAAPA, Janssen Pharmaceuticals, Inc.
What lab tests should I order when patients present with signs and symptoms suggestive of thyroid disease, and how should I interpret results? In answering these questions, Kessler and Sadler described the inverse relationship of T3 and T4 to thyroid stimulating hormone (TSH), why free T4 is superior to total T4, and how to proceed when FT4 and TSH seem discordant. They also discussed additional tests that may be needed based on initial screening results, and factors (eg, agents such as biotin) that can affect the accuracy of thyroid test results.
Case Studies in Hypo and Hyperthyroidism for Clinical Consideration
Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, Metabolic Medicine Associates, and Chris Sadler, MA, PA-C, CDE, DFAAPA, Janssen Pharmaceuticals, Inc.
Hypothyroidism and hyperthyroidism can be difficult to diagnose, especially in the elderly. In addition to pointing out the aspects of the physical exam and lab studies that can aid in diagnosing both conditions, Kessler and Sadler presented strategies to safely initiate, titrate, and monitor therapies; addressed controversies surrounding the management of subclinical forms; and identified triggers and early symptoms of acute thyrotoxicosis (thyroid storm) and myxedema coma.
Thyroid Concerns in Pregnancy
Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, Metabolic Medicine Associates
Kessler reviewed the physiologic changes of pregnancy that influence thyroid conditions and associated lab tests, the potential complications to mother and fetus of untreated thyroid disease, and strategies for managing hypo- and hyperthyroidism throughout pregnancy and lactation. She reminded that pregnant women with hypothyroidism generally require 30% to 50% more of their thyroid medications. And when treating hyperthyroidism, use the lowest dose of antithyroid drugs that keeps maternal free T4 and free T3 near the upper limit of the normal range.
Managing the “Hot” Mess of Thyroiditis
Christine Kessler, MN, ANP-BC, CNS, BC-ADM, FAANP, Metabolic Medicine Associates, and Chris Sadler, MA, PA-C, CDE, DFAAPA, Janssen Pharmaceuticals, Inc.
While thyroiditis is transient in most patients, it requires ongoing follow-up because of the increased risk of permanent hypothyroidism. Kessler and Sadler reviewed the work-up and differential for suspected acute and subacute thyroiditis and how to interpret laboratory and thyroid scan data. They also discussed postpartum thyroiditis (the signs of which are often misdiagnosed as anxiety and stress about motherhood) and silent thyroiditis, which is similar to postpartum thyroiditis but is unassociated with pregnancy.
Continue to: Expert Tips on Evaluating Thyroid Nodules
