Parrot CIS 2 Flashcards
What did the First Lady have?
Some kind of hypothyroidism
Differential for First Lady
- Hashimotos
- multinodular goiter
- neoplasm
- thyroid adenoma
- iodine deficiency
- diet high in goitrogens
What labs should we order for First Lady?
- TSH, CBC, FT4, CMP, TPO, TGB abs,
- discussion about checking urine?… Can screen urine for iodine
- rads: sono at minimum
On a radioactive iodine screen, is cold good or back?
Cold is bad
Hot is good
Is RAI uptake scan useful for Hashimoto’s thyroiditis?
No
What complication can come from a thyroidectomy?
Don’t bag the recurrent laryngeal nerve!
Second case: lady that lives alone, seems like she’s a little high strung…. Differential?
- Graves disease
- toxic multinodular goiter
- thyroiditis
- stress
- pheochromocytoma
- afib
- toxic follicular adenoma
The lady also had pretibial myxedema and proptosis and a lot of things having to do with hyperthyroidism…. What stays on our differential dx?
- pheochromocytoma (prob can exclude based on vitals)
- can’t really rule out a lot of the heart or thyroid things because we don’t have a TSH or EKG
What labs should we get?
- TSH
- serum metanephrines
- FT4
- TSI
- ultrasound
- EKG
Normal range for Ft4?
0.8-2.2
Normal range for TSH
0.4-4.0
Normal for TSI
Not present
What will Graves’ disease look like on ultrasound
Diffusely enlarged
Case 3, 45 y/o Native American male…. He had a tender to palpation thyroid nodule and had a bad viral cold for a couple of weeks… DDx?
- dequervains
- remember that this is transient and we don’t really do anything for it
Labs for this guy?
-CRP would be high
-
What do we do with someone if they get a thyroidectomy
They get to stay in the hospital for a night
If someone has hypocalcemia from a complete thyroidectomy, what will that look like
- chvostek sign
- trousseau’s sign
- hypocalcemic tetany
What labs would be elevated in someone who had a complete thyroidectomy?
- Phosphate
- ….look in book for the rest of these… Know what will be high, normal, and low
If we have someone with hyperparathyroidism and kidney stones, what labs will be high and low?
- Ca2+ would be high
- PTH would be high
- low P
- high Vit D
67 y/o female with a fractured hip… Slipped on wet kitchen floor… Small in stature and very thin (think osteoporosis)… What will she probably have to have in the near future?
-DXA scan! That’s the work up for osteoporosis
What score are we looking for in DXA scans?
T-scores!
What is the significant value for the T score
- 2.5!
- if less than this, then it is osteoporosis
- if a fracture is also involved, then it’s severe osteoporosis
- I think between -1.5 and -2.5 is osteopenia
What is the treatment for osteoporosis?
- bisphosphanates
- MUST be taken on empty stomach 30 minutes before a meal
- you have to be upright as well…. Because it affects your esophageal mucosa
What if she just gently bumped her hip on a car door and it broke? What disease?
-Paget’s disease of the bone vs. osteomalacia
