Competence in the E and M of type 1 and 2 diabetes including: Learn the team approach to diabetes management, the role of patient education, …
Curriculum for FELLOWs in the ENDOCRINOLOGY Training program at JCESOM at
Marshall university
OVERALL GOAL: To train residents to acquire the competency of a specialist
in the field of endocrinology, diabetes and metabolism Competencies will
include:
1 Overall assessment of patient care that is effective, safe, timely,
efficient, equitable and patient-centered
2 Medical knowledge about established and evolving biomedical, clinical
and cognate sciences eg, epidemiological and social-behavioral and
the application of this knowledge to patient care
3 Interpersonal and communication skills that result in effective
information exchange and teaming with patient, their families and other
health professionals
4 Professionalism, as manifested through a commitment to carrying out
professional responsibilities, adherence to ethical principles and
sensitivity to a diverse patient population, providing cost-effective,
ethical and humanistic care
5 System-based practice, as manifested by actions that demonstrate an
awareness of and responsiveness to the larger context and system of
health care and the ability to effectively call on
system resources to
provide care that is of optimal value
6 Practice-based learning and improvement that involves investigation
and evaluation of their own patient care, appraisal and assimilation of
scientific evidence and improvement in patient care
Content:
Clinical Experience
1 To meet this overall goal, the fellows will be given opportunities to
assume responsibility for and follow patients throughout the training
period Fellows will see both inpatients and outpatients to observe
the evolution and natural history of endocrine disorders as well as the
effectiveness of therapeutic interventions The program will provide a
minimum of 2 half days of ambulatory care per week averaged over the 2
years of training
2 The fellows will be given opportunities to function in the role of an
endocrinology consultant in both the inpatient and outpatient settings
3 The curriculum will provide the fellows with formal instruction and
clinical experience to enable them to demonstrate:
a Competence in the evaluation E and management M of the
following endocrine organs
1 Hypothalamus and pituitary
2
Thyroid
3 Adrenal cortex and medulla
4 Pancreatic islets
5 Ovaries and testes
6 Parathyroid
b Competence in the E and M of type 1 and 2 diabetes including:
1 Acute, life-threatening complications of hyper and hypoglycemia
2 Intensive insulin management in critical care and surgical
patients
3 Long term goals, counseling, education and monitoring
4 Intensive management of glycemic control in the ambulatory
setting
5 Prevention and surveillance of microvascular and macro vascular
disease
6 Diabetes detection and management during pregnancy
7 Multidisciplinary diabetes education and treatment program
c Competence in E and M of multifactorial disorders
associated with hormonal regulation including:
1 Disorders of fluid, electrolyte, and acid-base metabolism
2 Disorders of bone and mineral metabolism with particular
emphasis on the diagnosis and management of osteoporosis and
primary and secondary hyperparathyroidism and other
metabolic bone diseases
3 Primary and Secondary Hypertension
4 Nutritional Disorders
Autoimmune disease and their role in pathogenesis of endocrine
excess and deficiency and poly glandular syndromes
5 Calcium, phosphorus and magnesium imbalance
6 Diagnosis and treatment of ectopic hormone production due to
neoplasms
7 Endocrine adaptations and maladaptations to systemic disease
8 Endocrine Aspects of Psychiatric disorders
9 Endocrine aspects of aging
Technical and Other Skills
The fellow will have formal instruction on the appropriate utilization
and interpretation of clinical laboratory, radionulcide and radiological
studies for diagnosis and treatment of endocrine and metabolic diseases
combined with clinical experience to demonstrate competence in the
interpretation of:
Hormone assays, including results of provocative and supression tests
Interpretation of radiological studies for diagnosis and treatment
including radionulcide localization of endocrine tissues and
ultrasound of the neck
FNA
c 4 Formal
Instruction will be provided in biochemistry, physiology,
and molecular and cell biology This will be incorporated into the
curriculum as they relate to endocrinology, diabetes and metabolism
Should know scientific basis of disease and pathophysiological basis
of endocrinologic and metabolic problems and disease, particularly
diabetes
a Genetics as it relates to endocrine diseases
b Developmental endocrinology including growth and
development, sexual differentiation and pubertal maturation
c Endocrine physiology and pathophysiology in systemic diseases and
principles of hormone action
d Biochemistry and physiology, including cell and molecular biology and
immunology in relation to endocrinology and metabolism
e Signal transduction pathways and biology of hormone receptors,
performance of endocrine clinical laboratory and radionulcide studies
and basic laboratory techniques including quality control, quality
assurance and proficiency standards
f Pathogenesis and epidemiology of diabetes mellitus
g Whole organ and islet pancreatic transplantation
SPECIFIC GOALS AND
SPECIFIC OBJECTIVES
1a Goals of that educational endeavor
1b Description of specific, measurable knowledge objectives for
particular educational endeavors
2a Define specific skills objectives and procedures to be learned
2b Description of objectives for particular educational skills
3 Define the educational environment and specify implementation of the
curriculum
4 Define evaluation of the learner and the curriculum
5 Specify feedback process for the learner
1 Knowledge
1a Goals
This subspecialty program is designed to provide advanced training and
experience at a level for the trainee to acquire the knowledge skills,
attitudes and experience required for all of the competencies needed by a
consultant At the completion of the program, the fellow should be able to
enter the clinical practice of endocrinology, function as a clinician-
educator, or enter academic medicine as a clinician scientist The fellow
will learn basic and advanced endocrine biochemistry, physiology and
pathophysiology that provide the basis for understanding endocrine disease
The fellow will learn a critical mass of fundamental information and
practical approaches for diagnosis,
management and prevention of endocrine
disease The fellow will acquire the technical and practical skills that
are required by a consultant in endocrinology, diabetes and metabolism
This will include knowledge and skills necessary for critical analysis for
laboratory testing and the endocrine literature This knowledge and skills
will be acquired in a progressive fashion and with increasing
responsibility throughout the training period The fellow will acquire
knowledge and skills necessary for providing cost-effective, ethical and
humanistic care of patients
The curriculum will:
1 Enable the resident to recognize congenital or acquired endocrine
problems, diseases and syndromes due to infections, endocrine disrupters,
trauma, and neoplasms or other causes of dysfunction and to initiate the
decision-making sequential steps in the diagnostic evaluation
2 Enable the resident to evaluate and manage uncomplicated common and rare
endocrine deficiencies and select first line hormone replacement and
chose alternative options if first line therapy fails
3 Enable the resident to evaluate and manage acute and chronic
complications of diabetes in the ambulatory and hospital
setting
4 Enable the resident to design and perform hypothesis-drive endocrine
research and participate in such research or equivalent scholarly
activity such as grant writing and scientific presentation
1b Objectives
Diabetes and Hypoglycemia
1 Should be able to classify type 1 and 2 diabetes on the basis
of etiology and pathogenesis
2 Comprehensive assessment of control and management of blood sugar levels
in keeping with ADA guidelines Should be able to determine the goals for
blood sugar, blood pressure, and lipid control and target levels to
attain those goals
3 Comprehensive assessment, treatment, and surveillance of the
microvascular and macrovascular complications of diabetes Should have
knowledge and skills to document retinopathy, nephropathy, neuropathy
including mononeuritis of cranial nerves, dermopathy, and macrovascular
disease involving the coronary arteries, cerebral and peripheral
extremity vessels Should be able to stratify patients by severity of
the complication and manage each complication accordingly
4 Should be able to diagnose types of neuropathy and manage peripheral and
autonomic neuropathy
and the diabetic foot with and without ulcers and
infection
5 Should have knowledge of the effects of insulin in metabolism, its
action on liver glucose production and muscle uptake, its clearance by
the kidney, and the relation to the pathophysiology to hyperglycemia and
hypoglycemia
6 Identify causes of hypoglycemia including insulinoma, mutations of the
sulfonylurea receptor and how diet, exercise and insulin dosing can
cause hypoglycemia
7 Know the duration of action of glargine, ultralente, NPH, lente,
regular, and lispro, aspartated and glulisine insulins and different
patterns of BS response to different long-acting insulins normal,
delayed, transient and different treatment regimens
a Recognize diabetes and causes for poor control including
waning insulin action, the dawn phenomenon, and rebound
hyperglycemia
b Be able to recognize and discern problems in sick diabetic
patients who call in for advice, and advise and manage sick patients
on the sick day diet and insulin management to prevent DKA by
telephone communication
c Recognize causes for resistance including infection and
appropriate management of causes and insulin resistance
8 Be able to implement intensive management of glycemic control
in the ambulatory setting
9 Be able to implement intensive insulin management including insulin
infusion protocols in critical care and surgical patients perioperatively
and intraoperatively
10 Should recognize the importance and methods of diabetes detection
during pregnancy and manage patients the patient throughout pregnancy
11 Evaluate and manage acute, life threatening complications of
hyper- and hypoglycemia
12 Should be proficient in the use of insulin pumps and
continuous glucose monitoring systems
13 Understand the need for and organization and function of a
multidisciplinary diabetes education and treatment program Learn the
team approach to diabetes management, the role of patient education,
dietary principles and management, psychosocial and ethical issues
14 Should be able to set long-term goals, counsel patients, and provide
education and methods of monitoring
Disorders of fluid, electrolyte, and acid-base metabolism
1 Should be able to evaluate
hypernatremia and hyponatremia, hyperkalemia
and hypokalemia, metabolic acidosis and alkalosis, and have knowledge of
their interrelationships and treatment
2 Endocrine Emergencies
Primary and Secondary Hypertension and Hypotension
1 Should be able to differentiate between and know the diagnostic
strategies for diagnosis and treatment of essential hypertension and
secondary hypertension including adrenal causes of hypertension and
renovascular hypertension
2 Should have knowledge of the causes of hyptentssion including autonomic
dysunction, idiopathic hypotention, Shy-Drager, neurogenic syncope,
adrenal insufficiency
Nutritional Disorders
1 Should have knowledge of the genetic and non-genetic basis of
obesity and its diagnosis and management
2 Should be able to make the diagnosis of eating disorders eg,
anorexia and bulimia
3 Should have knowledge of the indications of enteral and parenteral
nutrition and skills in administering nutrition, fluids, and minerals
Thyroid Disease
1 Clinical knowledge and skills to diagnose variety of types of
hyperthyroidism and hypothyroidism and be aware of atypical
presentations
2 Should have
knowledge of different approaches to the treatment of
hyperthyroidism including antithyroid medication, surgery and radioactive
iodine treatment
3 Should have knowledge of different presentations and skills to diagnose
autoimmune, subacute or acute thyroiditis and be manage different stages
of the disease
4 Should have knowledge of the pituitary-thyroid axis and management fine-
tuning of thyroid patients with thyroxine using serum free T4 and 2nd
and 3rd generation TSH values
5 Should have knowledge of the causes, diagnostic approaches, and
management of thyroid nodules, and risk factors for cancer
6 Should have knowledge of types of thyroid cancer, natural history, and
management with monitoring of thyroglobulin and diagnostic scans and
therapy over time
7 Should have knowledge and skills to interpret tests and assess sick
patients for abnormal thyroid function tests due to non-thyroidal
illness
8 Should have knowledge and skills to assess changing requirements and
treatment with thyroxin, the effects of thyroid status on pregnancy and
fetal development and outcome, effects of pregnancy on thyroid function
Hypothalamic and Pituitary
Disease
1 Should have knowledge of causes of primary and acquired target organ
failure eg, craniopharyngiomas and other space occupying and
infiltrative disorders due to hypothalamic or pituitary disease, and
their clinical presentations including galactorrhea and diagnostic
steps in their evaluation
2 Should have knowledge of the approach to diagnosis and management of
different secreting prolactinoma, acromegaly, Cushings disease, alpha
subunit, FSH, TSH and non-secreting pituitary tumors, including surgical
approaches to remove pituitary tumors; diagnostic imaging with CT and
MRI; radiation modes of therapy; and specific medical therapy
3 Should understand the role of vasopressin and diagnosis and treatment
of diabetes insipidus DI or action nephrogenic DI, or excess SIADH
4 Should have knowledge of the causes and treatment of gynecomastia and
prolactinemia
Adrenal Cortex and Medulla Disease
1 Should have knowledge of the pathophysiological basis of disease and
steps in the diagnosis of Cushings syndrome and primary adrenal
insufficiency including adrenogenital syndrome
2 Should be familiar with emergency management of
acute adrenal
insufficiency using hydrocortisone
3 Should be able to initiate and withdraw a variety of steroids and be
aware of metabolic and other complications of steroid treatment and their
avoidance
4 Should have knowledge of presentation and causes of primary
aldosteronism and pheochromocytoma and their diagnosis and management
Disorders of Bone and Mineral Metabolism with particular emphasis on the
diagnosis and management of osteoporosis and primary and secondary
hyperparathyroidism and other metabolic bone diseases
1 Understanding of disorders of magnesium and calcium/vitamin D
metabolism and parathyroid hormone secretion, including hyper- and
hypomagnesemia, hyperparathyroidism, hypoparathyroidism, osteoporosis,
osteomalacia, hypophosphatemia, and urolithiasis
2 Knowledge of the importance of calcium and vitamin D maintenance and
treatment with bisphosphonates, raloxifene, PTH 1-34 and calcitonin in
the intervention of osteoporosis and fractures
3 Knowledge of the tests to diagnose primary and recurrent
hyperparathyroidism and indications for surgery and tests for
surveillance
4 Knowledge of Pagets disease, its
presentation and management
Hirsutism/Ovary
1 Knowledge of the causes of and source of ovarian dysfunction,
androgen excess and hirsutism, including the adrenal, ovary, and
peripheral production and diagnostic and management approaches based on
the pathophysiology of disease
2 Knowledge of the causes of primary and acquired amenorrhea and
the steps in the evaluation and management
Hypogonadism and Impotence
1 Knowledge of the causes of impotence including hypogonadism,
neuropathy, vascular insufficiency, and other causes and steps in the
evaluation and variety of approaches to treat erectile dysfunction and
impotence
2 Should know the role of estrogens and clinical manifestations
including dysfunctional uterine bleeding of estrogen lack or excess and
its management in the perimenopausal and menopausal period
3 Knowledge of reproductive endocrinology and causes of infertility
including congenital absence of the vas deferens, spermatogenic arrest,
adrenogenital disease, and acquired causes, and approaches to diagnosis
and treatment of infertility
4 Knowledge of the causes of primary ovarian and testicular failure
including Turners syndrome, Klinefelters syndrome, spermatogenic arrest
5 Knowledge of different types of testicular and ovarian tumors and
their presentation
Lipid and Lipoprotein Metabolism
1 Should have knowledge of the patterns and common and rare causes of
hyperlipidemia and risk of development of subsequent vascular disease
2 Should have knowledge of general approaches to therapy of
common and rare lipid disorders and combination therapy if initial
therapy fails
Psychiatric Disorders
1 Know the impact of psychiatric disorders and drugs used for
psychiatric disorders on endocrine function and laboratory tests
including effects on parathyroid secretion, insulin secretion, renal
handling of sodium excretion, the pituitary-adrenal and gonadal axis,
ovulation, and thyroid hormone secretion, action and function tests
Aging
1 Should have knowledge of endocrine aspects of aging as it
relates to care of geriatric patients, including those with diabetes,
thyroid disease, and osteoporosis
Autoimmune Polyglandular Failure Syndromes
1 Should have knowledge of the autoimmune basis for single and
syndromes associated with
multiple organ deficiencies
Endocrine Oncology
1 Should be able to assess and manage patients for hormone-
producing neoplasms, including carcinoid syndromes, ectopic hormone
production, islet cell tumors and MEN1, MEA 2a and 2b
Systemic Diseases
1 Should have knowledge of effects of systemic illness and disease
adaptations and maladaptations and their impact on the thyroid,
adrenal and gonadal axes
2 Technical and Other Skills
2a Goals - Providing skills of examination and interpretation of
tests and procedures necessary for evaluation and management of
patients
1 Appropriate clinical examination of a patient with endocrinologic
disease and diabetes
2 Appropriate performance and interpretation of stimulation and
suppression tests and/or interpretation of procedures including RIA,
ELISA, chemiluminescent assays and IRMA hormone assays and test results
used for diagnosis and management of endocrinologic diseases and
diabetes, including effects of nonendocrine disorders on these studies
3 FNA of thyroid nodules
4 Appropriate performance of ultrasound of thyroid and other soft tissues
of the neck
5 Approprate use and
interpretation for radionulcide studies for detection
of endocrine tissues and the diagnosis and treatment of endocrine
disorders
6 Perform ultrasound guided FNA of the thyroid and interpret cytological
evaluation of thyroid fine needle aspiration
7 Appropriate measurement and interpretation of bone mineral densitometry
or DXA and the interpretation of bone biopsy and other tests used in the
management of osteoporosis and other metabolic bone disease
8 Appropriate experience in evaluation for disease of endocrine target
organs using radiological studies for detection and localization of
normal and abnormal tissue using radionuclides, CAT, PET and MRI
9 Methods of gene analyses
10 Epidemiological assessment and statistical analyses
11 Evaluation of medical literature-Understanding of existing and emerging
endocrine literature
12 Personal scholarship, self instruction and evaluation of quality and
performance
2b Objectives for particular educational skills
1 Proper interpretation of thyroid function tests, performance of
ultrasound of soft tissues of the neck, and review of thyroid aspiration
cytology
2 Proper interpretation of tests used for blood
sugar control and
management of diabetes mellitus - Fasting and postprandial glucose levels
and patterns, hemoglobin A1C; fructosamine, glucose tolerance test, serum
and urine ketones, qualitative or quantitative, microalbumin
3 Proper interpretation of lipid profile
4 Proper interpretation of procedures low and conventional doses of ACTH
used for ACTH stimulation test for adrenal insufficiency and
adrenogenital syndrome; GHRH/arginine stimulation test, insulin
stimulation test for GH and cortisol deficiency; clonidine suppression
and glucagon stimulation test for pheochromocytoma; TRH stimulation test
for hyperthyroidism and tests used in the differential diagnosis and
evaluation of endocrine etiologies of pituitary disease GnRH stimulation
test, FSH and LH, testosterone, prolactin and adrenal insufficiency and
hyponatremia, hypertension serum and plasma osmolality, plasma rennin,
aldosterone, urine sodium and potassium, plasma free metanephrine and
urine metanephrines, VMA and catecholamines, and hyperthyroidism
5 Proper interpretation of serum calcium, phosphorus, alkaline
phosphatase, urinary calcium, bone markers, and review of bone
biopsy
reports used to diagnose and manage disorders or bone and calcium
metabolism
6 Proper interpretation of serum and urine uric acid used to diagnose and
manage metabolic diseases of uric acid metabolism
7 Identify abnormalities in thyroid size and consistency, fundoscopic
retinal and lens abnormalties in diabetes, extra-occular movements and
conjunctival abnormalities in Graves disease, hirsutism, testes
abnormalities in primary and secondary hypogonadism
8 Management of adolescent and adult patients of all ages with diabetes
mellitus
a Appropriate interpretation of finger stick blood sugars patterns in
conjunction with proper use of long, intermediate and short acting
insulin products alone or in combinations
b Should be able to determine appropriateness of either oral medication
or insulin and prescribe sulfonylureas, metformin,
thiazolidinediones, or insulins of different types alone or in
combination with different modes of delivery
c Should know the rationale for calculation of diabetic diets with and
without dyslipemia and be able to prescribe a diabetic diet and
exercise program
d Use
autoimmune markers of islet cell rejection and C-peptide for the
diagnosis of the type of diabetes, its management and counseling
e Use intravenous insulin in acute decompensated diabetes
f Prescribe a glucose-monitoring device for SGM to meet the patients
needs
g Perform a fundoscopic examination, and recognize and appropriately
refer patients with diabetic retinopathy
h Examine the diabetic foot and recognize problems requiring inserts of
addressing by a podiatrist
i Be aware of the psychosocial effects of diabetes mellitus on patients
and families
j Participate in community education
9 Proper interpretation of gene sequencing and restriction analysis and
patient counseling for mutations
10 Proper analyses of publication results including study design and
statistical analyses
11 Proper indications and interpretation of MRI and CT for diagnosis and
management of endocrine diseases
12 Should engage life-long in independent learning, continuing
scholarship, and continuous quality improve of practice and practice
performance
Other content
Core Competencies - Definitions
HTTP://WWWACGMEORG/OUTCOME/ASSESS/TOOLBOXASP
and evaluation methods
HTTP://WWWACGMEORG/OUTCOME/ASSESS/TOOLBOXASP
OSHA regulations and universal precautions and protection of health care
workers
Quality Assessment and Improvement, Continuous quality improvement,
Performance improvement
Cost Effectiveness
Health Care Policy
Clinical Trial and Study Design
Medical Decision-Making
Cultural, Social, Family, Behavioral, and Economic Issues
Principles of Palliative Care for Terminally Ill Patients
3 Educational Environment and Implementation
3a Setting
1 Endocrine and Diabetes Clinics at UPIM - Monday 1:00 PM-5:00 PM,
Wednesday 8:00-12:00, Thursday 8:00-12:00, and Friday 8:00-12:00 Noon
and 1:00-5:00
2 VA Medical Center Endocrine and Diabetes Clinics - Wednesday and
Thursday 1:00- 5:00
3 VA Medical Center Osteoporosis Clinic- First Tuesday PM
4 VA Medical Center Thyroid Radiotherapy Clinic- Third Tuesday PM
5 On Call for ambulatory care problems to be handled by telephone
communication
6 Indigent Patient Diabetes Clinic at Cabell Huntington Hospital Mon 8:00-
10:30
7 St Marys Hospital Indigent Patient Endocrinology Clinic -Second
Friday 12:30 - 4:00
8 Radionulcide Image Interpretation and
Case Discussion 10:30 to 12 noon
9 Gestational Diabetes Clinic- once weekly for 4 to 5 weeks
10 Reproductive Endocrinology Clinic- twice weekly for 2 weeks
11 Inpatient Consultations and Co-care at St Marys, CHH, and the VA
hospitals
12 Daily work rounds and teaching rounds with fellow and attending
physicians
13 Core Curriculum Conference twice monthly for two consecutive hour
sessions at UPIM
14 Some core Curriculum Conferences on Gestational Diabetes and
Pregestational Diabetes and Reproductive Endocrinology
15 Research Conference once monthly
16 Basic Science Conference once monthly
3b Methods Teaching
1 Interactive discussion
2 Individual discussion
3 Self directed inquiry learning and testing
4 Role modeling
5 Oral case presentation
6 Didactic lectures
7 Use of computers, software programs including Excel, Access,
PowerPoint, and on line services including Medline, ADA, AACE, and
Endocrine Society web sites
3c Resources and Facilities
1 Teaching Faculty, Visiting Professors
2 Fellows
3 Reading Materials - faculty, Health Science Library, endocrine syllabus
4 Recommended reading- bibliography- see attached
5 Departments
and National Meetings CME
6 MKSAP, ACE, and Endocrine Society self assessment questions and
answers, UpToDate
7 MUSOM Web Site
8 ACGME web site on competencies and tool box methods for assessing
competencies
9 Diagnostic Laboratory Services
10 Complete biochemistry laboratory and facilities for hormonal
immunoassay
11 Access to karyotyping and immunohistologic studies
12 Imaging services including nuclear, ultrasound, and radiological
facilities including bone densitometry
13 Surgical and Pathological Services
14 Dietary and Nutrition Services
15 Specialties in surgery, nephrology, neurology, neurosurgery, obstetrics
and gynecology, ophthalmology, pediatrics, podiatry and urology
16 Sufficient population of adults and adolescent in- and outpatients with
the full range of endocrinologic disorders
4 Assessment of Competencies of Fellow and Curriculum
4a Fellow
Direct interaction during rounds or when appropriate
Evaluation of topic presentation quarterly
1 Quarterly evaluation of portfolios
2 Evaluation of competencies by faculty using ABIM-ACGME form
3 Formative evaluation of competencies at 6 months and 18 months
4 Summative formative
review of competencies at 1 year and 2 years
4b Curriculum and Teacher
1 Formal Annual Review
4c Fellow Feedback
1 Any time
2 Quarterly feedback
3 Semi-Annual and Annual Summative Formative Review by Program Director
and Fellows
Bibliography-Recommended Reading
Endocrinology ed DeGroot 5th edition 2005 WB Saunders Company
Harcourt Brace and Company
Williams Textbook of Endocrinology 10th Edition ed Wilson and Foster
2002 WB Saunders Company Harcourt Jovanovich Inc Philadelphia
Werner and Ingbar The thyroid A Fundamental and Clinical Text 9th
Edition 2005 ed Braverman and Utiger Lippincott, NY, NY
Molecular Endocrinology Basic Concepts and Clinical Correlations ed
Weintraub 1995 Raven Press LTD NY, NY
Surgical Management of the Diabetic Patient ed Bergman and Sicard 1991
Raven Press LTD NY, NY
Statistics for Research ed Dowdy and Wearden 1983 John Wiley and Sons,
Inc
J Clin Endocrinol and Metabol Clinical Reviews
Endocrinology and Metabolism Clinics of North America Saunders Company
Harcourt Jovanovich Inc Philadelphia
Baskin, Jack Ultrasound of the thyroid
http://wwwthyroidmanagerorg/
See PDF file of reprints
APDEM recommended readings See
supplement
Revised July 25, 2005
c:\chertow\fellowship\fel_goalobj 072505
Source:obesity.org
