1 / 10

Hypothyroidism Case

Hypothyroidism Case. Edward Warren, MD, CMD, CAQ Geriatrics Chair, Geriatrics VCOM, Carolinas Campus May 2012.

bayard
Download Presentation

Hypothyroidism Case

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hypothyroidism Case Edward Warren, MD, CMD, CAQ Geriatrics Chair, Geriatrics VCOM, Carolinas Campus May 2012

  2. A 76-year-old woman presented with a 1 year history of 20 kg weight gain (wt 100 Kg), fatigue, thinning hair and tingling in her hands at night. Her husband saidthat she had developed a deeper, croaky voice. On exam she was overweight with generally dry skin and had thin, rather coarse hair. She was bradycardic with a pulse of 60. What other physical findings and labs would you expect to find in this patient?

  3. Question 1 A. Normal Achilles reflexes. B. Negative Tinels sign C. low cholesterol D. Slow speech.

  4. Further Evaluation • She had evidence of bilateral carpal tunnel syndrome and was felt to have slow relaxing reflexes. • Investigation confirmed the clinical diagnosis of primary hypothyroidism.

  5. Question 2 Initially howwould her thyroid profile look? A. TSH 0.5 U/ml free T4 0.5 ng/dl B .TSH 28 U/ml free T4 2.5 ng/dl C. TSH 30 U/ml free T4 0.4 ng/dl D. TSH < .02 U/ml free T4 3.0 ng/dl

  6. Question 3 What other test would be helpful in further defining the type of hypothyroidism? A. TRH release test B. Thyroid antibody tests C. Free T3 D. Free T4 E. Thyroxin index.

  7. Question 4 You now know that then patient has hypothyroidism would your treatment be? • Follow the patient without additional medication. • Add Radioactive iodine to reduce the amount of thyroid hormone. • Prescribe levothyroxine 300 µgm po qd. • Prescribe levothyroxine 25 µgm po qd. • Add methimazole to control the T4 production.

  8. Question 5 You have now made the diagnosis and treated the patient appropriately and schedule follow-up with labs . When would you see the patient back? • 2 weeks • 1month • 2 months • 5 months • 1 year

  9. Question 6 The patient returns in 2 months her TSH drops to 10. The levothyroxine is titrated until the TSH is normal. When you then see her back in follow up? • 1 Month • 6 months • 2 years • As needed for problems

  10. Answers to Question: • C. Low cholesterol • C. TSH 30 (elevated) and free T4 0.4 ng/dl (low). The high TSH is essential, but the low free T4 is not. • B. Thyroid antibody tests to show anti-TPO or anti-microsomal antibodies. • D. 25 mcg. She will need about 100 mcg po qd of levothyroxine, but full replacement in the elderly risks precipitation of CHF. • C. 2 months. It takes this long for the thyroid axis to reach steady state and there is no hurry. • B. 6 months. Recheck twice yearly when stable.

More Related