1 / 32

Endocrinology Case

Endocrinology Case. Buyucan , K. Cueto , M. Cunanan , S. Dadgardoust , P. Daguman , E. Dator , D. General Data. FP Female 53 year old Tondo, Manila. Chief Complaint. Hoarseness of voice. History of Present Illness. 15 months PTA: Hoarseness of Voice

duc
Download Presentation

Endocrinology 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. Endocrinology Case Buyucan, K. Cueto, M. Cunanan, S. Dadgardoust, P. Daguman, E. Dator, D.

  2. General Data • FP • Female • 53 year old • Tondo, Manila

  3. Chief Complaint • Hoarseness of voice

  4. History of Present Illness 15 months PTA: Hoarseness of Voice X-ray showed PTB with fibrotic component on both upper lung fields Unrecalled medication-did not afford relief 11 months PTA: Mass on the left side of her neck Persistence of her previous symptom No consult No medication taken 9 months PTA: Persistence of symptoms prompted consult where TSH levels and ultrasound conducted Patient was advised surgery but deferred Took herbal medicines reported gave slight relief of symptoms.

  5. History of Present Illness 1 month PTA: Persistence of symptom and presence of mass on left side of neck prompted consult at a private clinic Referred to an ENT where laryngoscopy was done She was again advised surgery Admission

  6. Past Medical History • Previous Hospitalizations: none • Major childhood illnesses: none • Major adult illness: minimal PTB, hypertension • Immunizations: unrecalled

  7. Past Medical History • Medication: Therabloc25 mg 1 tab every morning Meloxicam15 mg 1 tab once a day CaltratePlus once a day Paracetamol1 tab q 8 hours PRN for mild to moderate pain Sulidingel apply to affected area PRN for pain • Adverse drug reactions: none

  8. OB-Gyne History • G9P8 (9017) via NSD: No complications, no transfusions • Menarche: 15yo • Menstrual Interval: irregular • Duration: 3-6 days • Amount: 3 pads/day, moderately-soaked • Symptoms: (-) dysmenorrhea, (-) headache

  9. Family History • (+) cancer(sibling) • (-) PTB • (-) diabetes • (-) hypertension • (-) stroke • (-) allergies • (-) asthma • (-) heart disease

  10. Personal History • Diet: mixed diet of meat and vegetables • Non-smoker • Non-alcoholic beverage drinker • Denies illicit drug use • Does not exercise regularly

  11. Review of Systems • General: (-) weight loss(-) loss of consciousness

  12. Review of Systems

  13. Physical Exam General Survey: conscious, coherent, ambulatory Vital signs: • BP: 110/60mmHg • PR 120bpm, regular • RR 30cpm • T 39.0 0C • Ht: 152 cm, Wt: 52 kgs

  14. Physical Exam Skin • Warm, dry skin, no active dermatoses, (-) alopecia (-) rashes (-) spider angiomata Head • No gross head deformity, no gross facial asymmetry • Pink palpebral conjunctivae, anicteric sclera, no ptosis • No nasoaural discharge, turbinates congested • Moist buccal mucosa, nonhyperemic posterior pharyngeal wall, tonsils not enlarged, uvula midline

  15. Physical Exam Neck • Supple neck, (-) parotid enlargement, trachea midline, (-) palpable cervical LN • (+) Left Anterior neck mass • JVP of 3cm at 45 degree angle, carotid pulse rapid upstroke, gradual downstroke, no carotid bruits • Neck mobility not rigid, non palpable lymph nodes Respiratory • Symmetrical chest expansion, no intercostalretractions • unimpaired tactile and vocal fremition both lung fields • resonant on percussion • clear breath sounds, no wheezes, crackles

  16. Physical Exam Cardiovascular • Adynamic precordium, AB 4th LICS MCL, (-) heaves, thrills and lift, S1>S2 at the apex, • S2>S1 at the base, (-) murmurs Abdomen • Flabby abdomen, (+) striae • normoactive bowel sounds, tympanitic on all quadrants, no obliteration of the Traube space, (-) hepatomegaly liver, • (-) tenderness, (-) fluid wave • no masses, no tenderness

  17. Physical Exam Extremities • Pulses full and equal on all extremities

  18. PATHOPHYSIOLOGY

  19. Non-toxic Goiter • varies with the etiology and duration of the goiter • uniform follicular epithelial hyperplasia (diffuse goiter)  thyroid architecture loses its uniformity with development of areas of involution or fibrosis interspersed with areas of focal hyperplasia  multinodular goiter (MNG)

  20. Non-toxic Goiter • many diffusely enlarged goiters are composed of multiple soft nodules which cannot be palpated individually • accumulation of colloid may also contribute to the nodularity of the goiter • hemorrhage or cystic degeneration of a hyperplastic nodule  sudden focal increase in size of a goiter

  21. Non-toxic Goiter • in areas of growth, regression and hemorrhage, irregular calcifications can occur • the evolution of this multinodular stage is accompanied by the development of "hot" (hyper-functioning) and "cold" (non-functional) nodules on thyroid nuclear scan with functional autonomy

  22. Non-toxic Goiter • nodules within a MNG are due to a combination of monoclonal and polyclonal expansion and correlates with the development of functional autonomy and reduction in TSH levels • the natural history for goiters is a continuous accumulation of multiple autonomously functioning, or "hot" nodules leading to mild thyrotoxicosis after several decades (developing into a toxic MNG)

  23. Laboratory Tests and Work-ups (Pre-Op)

  24. Thyroid Function Test

  25. Thyroid Ultrasound • Showed both thyroid glands to be enlarged • R lobe: 5.8 x 1.3 x 1.3 cm • L lobe: 6.1 x 2.4 x 2.4 cm • Impression: • Bilateral Thyromegaly

  26. Thyroid Scintigraphy • Px was given an oral dose of 1.9 MBq of 131-I, then uptake measurements were taken at 4 and 24 hours • R lobe: 5.1 x 2.2 • L lobe: 4.8 x 3.3 • The R lobe showed fairly homogenous radiotracer distribution with no definite labeling defect. • The L lobe showed non-uniform tracer localization with an area of diminished uptake in its lateral aspect corresponding to a clinically palpable nodule • Impression • BilobedThyromegaly • Large cold nodule, L lobe

  27. (Post-Op)

  28. Thyroid Hormone • Thyroxine should be administered to ensure that the px remains euthyroid • TSH suppression

  29. Thyroglobulin • Tg levels of Pxs who have undergone total thyroidectomy should be below 2 ng/ml when px is taking T4 and below 5 ng/ml when px is hypothyroid • Tg and antiTg Ab levels should be measured initially for 6 months then annually

  30. Management and Treatment

  31. Post-operative Pain Management • NSAIDs (Meloxicam) • Taken as needed for moderate to severe pain (5-7 days post-op) • Paracetamol • taken as needed for mild to moderate pain

  32. Levothyroxine 100mcg/day • Lifetime supplementation of thyroid hormones for maintenance because the patient undergone total thyroidectomy • Calcium supplements • Calcium levels usually go down post-operatively

More Related