THYROID STORM WITH COMA IN A PATIENT WITH METASTATIC THYROID CARCINOMA AND GRAVES DISEASE: WON THE BATTLE BUT LOST THE WAR
|
|
- Reynard Davis
- 5 years ago
- Views:
Transcription
1 Case Report THYROID STORM WITH COMA IN A PATIENT WITH METASTATIC THYROID CARCINOMA AND GRAVES DISEASE: WON THE BATTLE BUT LOST THE WAR Ashna Pinto, MBBS 1 ; Tyler Drake, MD 1,2 ; Zuzan Cayci, MD 3 ; Lynn A. Burmeister, MD 1 ABSTRACT Objective: To describe the background and events that may precipitate thyroid storm (TS) with coma as well as the course of treatment intervention and our patient s response to treatment. Methods: We present a case of TS with coma including precipitants, thyroid function tests, thyroid ultrasound, computed tomography findings, course, treatment, and outcome. Results: A 71-year-old woman was hospitalized with back pain and right leg weakness due to a newly diagnosed, 12.4-cm sacral tumor. The tumor had metastasized from poorly differentiated papillary thyroid carcinoma. The patient developed TS characterized by thyrotoxicosis with fever, tachycardia, and mental status change progressing to coma over several days. Treatment including antithyroid drugs, steroids, saturated solution of potassium iodide, L-carnitine, therapeutic plasma exchange, and thyroidectomy reversed the prolonged coma and TS, but left residual flaccid quadriplegia. The patient eventually died. Conclusion: This patient presented with multiple rare causes of TS (computed tomography contrast and Graves disease in the setting of high-volume thyroid cancer) and a rare manifestation of TS (coma). The TS included fever, tachycardia, and rapid onset of prolonged coma in the setting of thyrotoxicosis. Precipitants of the TS may have included enlarged thyroid tissue from goiter, distant metastasis, the operation, computed tomography contrast exposure, and high levels of thyroid-stimulating immunoglobulin. Multifaceted treatments, most importantly therapeutic plasma exchange, resolved the coma and TS, but the patient still succumbed to comorbidity. We agree with the Japan Thyroid Association recommendation for therapeutic plasma exchange in patients with TS, especially those in a coma who do not awaken within 24 to 48 hours of starting conventional TS treatment. (AACE Clinical Case Rep. 2019;5:e7-e12) Abbreviations: CT = computed tomography; GD = Graves disease; SSKI = saturated solution of potassium iodide; TS = thyroid storm; TSH = thyroid-stimulating hormone; TSI = thyroid-stimulating immunoglobulin; TT3 = total triiodothyronine; TT4 = total thyroxine Submitted for publication May 31, 2018 Accepted for publication July 13, 2018 From the 1 Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, 2 Division of Endocrinology, Department of Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, and 3 Department of Radiology, University of Minnesota, Minneapolis, Minnesota. Address correspondence to Dr. Lynn A. Burmeister, 420 Delaware Street Southeast, MMC 101, Minneapolis, MN burme008@umn.edu. DOI: /ACCR To purchase reprints of this article, please visit: INTRODUCTION Thyroid storm (TS) is a rare, life-threatening state of extreme decompensated thyrotoxicosis (1-5). We report an unusual case of TS manifesting with prolonged coma, occurring in the setting of large-volume metastatic thyroid carcinoma and Graves disease (GD). Failure to respond to conventional drug treatment necessitated therapeutic plasma exchange and thyroidectomy, with reversal of coma but continued near quadriplegia. AACE CLINICAL CASE REPORTS Vol 5 No. 1 January/February 2019 e7
2 e8 Thyroid Storm with Coma, AACE Clinical Case Rep. 2019;5(No. 1) CASE REPORT A 71-year-old female with history of hypertension, atrial fibrillation, congestive heart failure, and chronic kidney disease presented with a 2-month history of lower back pain and progressive right lower extremity numbness and weakness, making her unable to walk. Lumbar imaging on the first hospital day (including both magnetic resonance imaging and computed tomography (CT) with contrast) showed a 12.4-cm sacral mass with extension into the sacral canal and involvement of right S1 through S5 sacral nerve roots (Fig. 1 A). Incisional biopsy of the sacral mass on the same day showed follicular variant papillary thyroid carcinoma. The CT results also showed multiple sub-centimeter pulmonary nodules indicating possible metastatic disease. One year prior to admission, thyroid-stimulating hormone (TSH) was 0.01 mu/l (normal range for this laboratory is 0.35 to 4.94 mu/l) and free thyroxine was 1.27 ng/dl (normal range for this laboratory is 0.70 to 1.8 ng/dl). She denied symptoms of thyrotoxicosis, personal or family history of thyroid disease, or history of radiation exposure. She was alert, oriented, afebrile, her heart rate was 77 beats per minute, and blood pressure was 148/66 mm Hg. Right foot drop and leg weakness were present. Admission labs, including liver function tests, were normal. High-dose dexamethasone was started for treatment of radiculopathy. Severe thyrotoxicosis was noted on day 3 with TSH <0.01 mu/l (at our laboratory, normal range is 0.40 to 4.00 mu/l), free thyroxine >8.00 ng/dl (at our laboratory, normal range is 0.76 to 1.46 ng/l), total thyroxine (TT4) >24.0 µg/dl (normal range is 4.5 to 13.9 µg/dl), total triiodothyronine (TT3) >460 ng/dl (normal range is 60 to 181 ng/dl), thyroglobulin 79,090 ng/ml (normal range is <40 ng/ml, thyroid intact), and bilirubin 1.9 mg/dl (normal range is 0.2 to 1.3 mg/dl). Despite this, she was alert, oriented, afebrile with hyperdynamic heart rate of 96 beats per minute, and normotensive. The thyroid was enlarged, somewhat fixed with right sided prominence. Pemberton sign was negative. Eye signs of GD were absent. A CT scan (with contrast) on day 3 showed a multinodular goiter with substernal extension, coarse calcifications, and mild tracheal compression (Fig. 1 B). A 3.4-cm, right sided thyroid nodule (Fig. 1 C) was later found to be positive for follicular variant papillary thyroid carcinoma on fineneedle aspiration cytology. Her treatments and thyroid hormone response are depicted in Figure 2. On day 4, cholestyramine was started to treat the lab abnormality in the context of a clinically euthyroid appearance and pending diagnostic tests. However, she later developed tachycardia, hypertension, and overnight delirium. By day 5 she became increasingly agitated and confused, lethargic, more tachycardic, hypertensive, tachypneic, and was transferred to the intensive care unit. TT4 returned µg/dl (normal range is 4.5 A B C Fig. 1. (A) axial post-gadolinium T1 fat suppressed images and sagittal T2-weighted magnetic resonance images demonstrate T2 intermediate signal, enhancing a cm, irregular mass (outlined by white arrows) involving the right hemi-sacrum and adjacent iliac bone. The mass extends into the sacral canal, right sacral neuraminal foramina, encasing S1 through S5 sacral nerve roots, and posteriorly into the gluteus and posterior paravertebral muscle. Incisional biopsy of the sacral mass showed follicular variant papillary thyroid carcinoma, with immunohistochemistry positive for thyroid transcription factor 1 and thyroglobulin. (B) post-contrast axial computed tomography scan of the chest and coronal reformatted images of the neck demonstrate enlarged right and left thyroid lobes. The gland is of heterogenous density with a nodular area of course calcifications (curved arrows). Left thyroid lobe extends into the superior mediastinum (star). The enlarged thyroid gland results in mild narrowing of the tracheal lumen (arrow). (C) grey-scale ultrasound of the thyroid demonstrates a cm, predominantly hypoechoic nodular mass in the right thyroid lobe. Linear hyperechoic area (star) with posterior shadowing represents calcification. Fine-needle aspiration cytology was positive for follicular variant papillary thyroid carcinoma.
3 Thyroid Storm with Coma, AACE Clinical Case Rep. 2019;5(No. 1) e9 to 13.9 µg/dl), TT3 >450 ng/dl (normal range is 60 to 181 ng/dl). Methimazole was started. By day 6 she was comatose, unresponsive to painful stimuli, and requiring intubation. Glascow coma score was recorded as 3 to 8 (6). Thyroid-stimulating immunoglobulin (TSI) index was high at 4.0 (normal range is <1.3). Her fever reached 101.2ºF on day 7, and infection with Clostridium difficile was diagnosed on day 8. She developed progressive renal insufficiency requiring continuous renal replacement therapy dialysis with intermittent norepinephrine starting on day 12. Unfortunately the treatments for hyperthyroid TS decompensation (Fig. 2), including antibiotics, produced no clinical improvement. Serial electroencephalograms performed on days 11, 12, and 13 showed delta theta slowing and diffuse encephalopathy that worsened over time. T2 hyperintensity visualized in the bilateral high parietal lobes on magnetic resonance imaging was interpreted as artifactual. Cerebrospinal fluid had 14 red cells, 0 white cells, glucose of 82 mg/dl, and protein of 31 mg/dl. Bilirubin peaked at 8.1 mg/dl on day 15. Due to continued coma, therapeutic plasma exchange was initiated on day 15 (Fig. 2). With this, the thyroid hormone levels greatly improved (Fig. 2 and Table 1), with corresponding improvement in vital signs and level of consciousness. By day 18, she opened and closed her eyes on command. On day 20, total thyroidectomy was performed, removing a 4.7-cm, poorly differentiated thyroid carcinoma with diffuse necrosis with a focal papillary and follicular pattern. Levothyroxine was started on day 25. Despite resolution of the TS and normalization in her mental status, she was severely weakened with near quadriplegia, achieving only a head nod by day 19 and a shoulder shrug by day 25. Neurologic consultation, spinal imaging, and electromyography concluded she had critical illness myopathy and polyneuropathy. Given the associated poor prognosis (7) and the metastatic cancer burden, she elected to stop aggressive medical cares. She was compassionately extubated and passed away shortly thereafter on day 30. DISCUSSION We present a patient with multiple rare causes of TS (CT contrast exposure, GD in the setting of goiter and high-volume thyroid cancer) as well as a rare manifestation of TS (coma). The patient had severe biochemical thyrotoxicosis, with thyroid hormone levels exceeding assay detection limits, but was not in TS at early presentation. Her status then deteriorated from normal mental status to TS with coma over a period of 3 days. Fig. 2. Serum total thyroxine (normal range is 4.5 to 13.9 µg/dl) and triiodothyronine (normal range is 60 to 181 ng/dl) concentrations over the 30-day hospital course. Methimazole was started day 5, changed to propylthiouracil on day 7, and then changed back to methimazole on day 18. A saturated solution of potassium iodide and L-carnitine were started on day 11. The dexamethasone dose was 4 mg every 6 hours on days 1 through 12, 2 mg every 6 hours starting on day 12, 2 mg every 12 hours starting on day 17, and 1 mg every 12 hours starting on day 26. exchange was performed on days 15, 16, 18 and 19. The patient was comatose from days 6 through 17.
4 e10 Thyroid Storm with Coma, AACE Clinical Case Rep. 2019;5(No. 1) Table 1 Thyroid Function Tests Before and After Therapeutic Plasma Exchange exchange 1 (day 15) exchange 2 (day 16) exchange 3 (day 18) exchange 4 (day 19) Reference range Before After Before After Before After Before After Free T ng/dl > Total T µg/dl Total T ng/dl TSH mu/l < < < Abbreviations: T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone. The diagnosis of TS was based on her rapidly deteriorating clinical status with worsening tachycardia, fever, and mental status change. However, available scoring systems also support the diagnosis of TS. Burch-Wartofsky scores significantly increased from 20 to 70 between days 4 and 5 (Table 2), where a score of <25 is unlikely to represent TS and a score of >45 is highly suggestive of TS (1). She also met the Japan Thyroid Association criteria for TS on the evening of day 5 (19). Other causes of coma were not apparent. The clinical decline to TS with coma occurred despite being on beta blockers, high-dose dexamethasone, cholestyramine, and starting methimazole. Multiple factors likely participated in the pathogenesis of the TS, including the large volume of the thyroid and metastatic thyroid tissue driven by high TSI. Other precipitants including incisional biopsy operation on day 1 and iodine contrast exposure on both days 1 and 3 may also have contributed (3,8,9). Low TSH had been measured 1 year prior, suggesting preexisting toxic autonomy or GD. The large size of the substernal goiter, containing a 4.7-cm focus of poorly differentiated thyroid carcinoma and a large-volume (12.4- cm), distant metastasis further indicated a long duration of the thyroid conditions. High thyroglobulin reflected both the large thyroid volume (from both the goiter and the metastatic sites) as well as the hyperthyroid state. The high TSI levels supported the presence of coexistent GD. High TSI could have driven the TS process at both the level of the thyroid, and also by stimulation of metastatic thyroid hormone production. If the high TSI levels were longstanding, they may have also played a role in the aggressiveness of her thyroid cancer course (10). A thyroid uptake scan was not performed due to the expectation of interference from iodinated contrast exposure prior to the CT scan. Thyrotoxicosis in association with thyroid cancer may arise from several mechanisms, including autonomous production at differentiated metastatic sites (11), or by TSI stimulation (12-15). The latter may have been the case in our patient if the carcinoma was sufficiently differentiated to respond to TSI. TS has been even more rarely reported in the setting of thyroid cancer, including following treatment with radioactive iodine-131 (16) or burn (17) or trauma (18) to the metastatic sites. Indeed, our patient underwent incisional biopsy of the sacral metastasis on day 1, which we cannot exclude as a contributing precipitant of the TS. She developed hypothyroidism following thyroidectomy, despite continued presence of the metastatic tumor burden, Table 2 Burch-Wartofsky Point Scale for Thyrotoxicosis* Scores Day 3 Day 4 Day 5 Day 6 Day 7 Thermoregulatory Central nervous system Gastrointestinal-hepatic dysfunction Cardiovascular dysfunction a Precipitant b Total *Based on Burch and Wartofsky (1); a The patient had chronic atrial fibrillation preceding the hospitalization, for which 10 points were assigned on all days; b Computed tomography contrast exposure and incisional biopsy on day 1 were considered as precipitants, for which 10 points were assigned on all days.
5 Thyroid Storm with Coma, AACE Clinical Case Rep. 2019;5(No. 1) e11 speaking to the inefficiency of thyroid hormone production at those sites, if present. Because thyroid blood levels were above assay measurement limits, dilutions were used to follow the response of TT4 and TT3 to therapy. Multiple modalities of treatment were used to manage the TS, including beta blockers, dexamethasone, antithyroid drugs, a saturated solution of potassium iodide (SSKI), L-carnitine, therapeutic plasma exchange, and thyroidectomy (2,4,20). In our patient SSKI treatment was not started until day 11 out of concern that the TS had been precipitated by exposure to iodinated CT contrast. The largest drop in TT4 (12 fold) and TT3 occurred early in response to methimazole and propylthiouracil followed by SSKI. Once SSKI was given, the TT4 level dropped to 18.2 µg/dl and TT3 dropped to 250 ng/dl by day 15. Nonetheless, it appeared that therapeutic plasma exchange achieved the degree of thyroid hormone improvement necessary to resolve the coma (Table 1), as she began to awaken on day 18 (12 days after onset of coma and after 2 sessions of therapeutic plasma exchange). Others have also reported improvement in TS coma with therapeutic plasma exchange (4). Our patient s TS course had several features associated with higher risk of mortality, including coma, intubation, dialysis, therapeutic plasma exchange, and corticosteroid use (5,21). We believe she recovered from the TS and could have achieved long-term survival had she not had other critical comorbidities including disabling, unresectable metastatic cancer, as well as near quadriplegia. Flaccid quadriplegia has been reported in only 3 cases of thyroid myopathy (22,23). High doses of steroids, given for tumor radiculopathy, TS-related relative adrenal insufficiency, or to inhibit conversion of T4 to T3 could have also contributed to quadriplegia due to critical illness myopathy or neuropathy (7). It may be relevant to note that, for unclear reasons, steroid treatment was associated with higher mortality in a Japanese inpatient TS database (5,24). Therefore, we recommend minimizing prolonged high-dose steroid exposure during TS treatment. CONCLUSION We present a patient with multiple rare causes (CT contrast, GD in the setting of high-volume thyroid cancer) and a rare manifestation (coma) of TS. Multimodal treatment, most importantly therapeutic plasma exchange, resolved the coma and TS, but the patient still succumbed to comorbidity. We agree with the Japanese Thyroid Association recommendation for therapeutic plasma exchange in patients with TS (24), especially for those in a coma who do not awaken within 24 to 48 hours of starting conventional TS treatment (4). DISCLOSURE The authors have no multiplicity of interest to disclose. REFERENCES 1. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22: Bahn Chair RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21: Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med. 2015;30: Satoh T, Isozaki O, Suzuki A, et al Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition). Endocr J. 2016;63: Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Factors associated with mortality of thyroid storm: analysis using a national inpatient database in Japan. Medicine (Baltimore). 2016;95:e Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2: Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10: Weber C, Scholz GH, Lamesch P, Paschke R. Thyroidectomy in iodine induced thyrotoxic storm. Exp Clin Endocrinol Diabetes. 1999;107: Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006;35: Pellegriti G, Mannarino C, Russo M, et al. Increased mortality in patients with differentiated thyroid cancer associated with Graves disease. J Clin Endocrinol Metab. 2013;98: Salvatori M, Saletnich I, Rufini V, et al. Severe thyrotoxicosis due to functioning pulmonary metastases of well-differentiated thyroid cancer. J Nucl Med. 1998;39: Valenta L, Lemarchand-Béraud T, Nĕmec J, Griessen M, Bednár J. Metastatic thyroid carcinoma provoking hyperthyroidism, with elevated circulating thyrostimulators. Am J Med. 1970;48: Yoshimura Noh J, Mimura T, Kawano M, Hamada N, Ito K. Appearance of TSH receptor antibody and hyperthyroidism associated with metastatic thyroid cancer after total thyroidectomy. Endocr J. 1997;44: Suzuki K, Nakagawa O, Aizawa Y. A case of pulmonary metastatic thyroid cancer complicated with Graves disease. Endocr J. 2001;48: Ishihara T, Ikekubo K, Shimodahira M, et al. A case of TSH receptor antibody-positive hyperthyroidism with functioning metastases of thyroid carcinoma. Endocr J. 2002;49: Cerletty JM, Listwan WJ. Hyperthyroidism due to functioning metastatic thyroid carcinoma. Precipitation of thyroid storm with therapeutic radioactive iodine. JAMA. 1979;242: Naito Y, Sone T, Kataoka K, Sawada M, Yamazaki K. Thyroid storm due to functioning metastatic thyroid carcinoma in a burn patient. Anesthesiology. 1997;87: Raef H, Dahhan, Ahmed M, Mubarak M, Rana T, Tulba A. Recurrent thyroid storm induced by heretofore unrecognised causes in a patient with thyroid cancer. BMJ Case Rep. 2009; Akamizu T, Satoh T, Isozaki O, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. 2012;22: Erratum in: Thyroid. 2012;22: Kimmoun A, Munagamage G, Dessalles N, Gerard A, Feillet F, Levy B. Unexpected awakening from comatose thyroid storm after
6 e12 Thyroid Storm with Coma, AACE Clinical Case Rep. 2019;5(No. 1) a single intravenous injection of L-carnitine. Intensive Care Med. 2011;37: Angell TE, Lechner MG, Nguyen CT, Salvato VL, Nicoloff JT, LoPresti JS. Clinical features and hospital outcomes in thyroid storm: a retrospective cohort study. J Clin Endocrinol Metab. 2015;100: Mizokami T, Fukui T, Imoto H, et al. Onset of reversible flaccid quadriplegia during treatment of thyrotoxic crisis. Intern Med. 2015;54: Couillard P, Wijdicks EF. Flaccid quadriplegia due to thyrotoxic myopathy. Neurocrit Care. 2014;20: Isozaki O, Satoh T, Wakino S, et al. Treatment and management of thyroid storm: analysis of the nationwide surveys: the taskforce committee of the Japan Thyroid Association and Japan Endocrine Society for the establishment of diagnostic criteria and nationwide surveys for thyroid storm. Clin Endocrinol (Oxf). 2016;84:
THYROID STORM WITH COMA IN A PATIENT WITH METASTATIC THYROID CARCINOMA AND GRAVES' DISEASE: WON THE BATTLE BUT LOST THE WAR
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
More informationThyroid Storm: Uncommon Presentation. Noora M. Butti, MBBcH*
Bahrain Medical Bulletin, Vol. 36, No. 3, September 2014 Thyroid Storm: Uncommon Presentation Noora M. Butti, MBBcH* Thyroid storm could lead to mortality; it is rare and characterized by severe clinical
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationDisclosures. Learning objectives. Case 1A. Autoimmune Thyroid Disease: Medical and Surgical Issues. I have nothing to disclose.
Disclosures Autoimmune Thyroid Disease: Medical and Surgical Issues I have nothing to disclose. Chrysoula Dosiou, MD, MS Clinical Assistant Professor Division of Endocrinology Stanford University School
More informationSlide notes: This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications,
1 This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications, including ophthalmic complications, treatments (both permanent solutions
More informationMulti-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report
Multi-Organ Distant Metastases in Follicular Thyroid Cancer- Rare Case Report Dr. Mohammed Raza 1, Dr. Sindhuri K 2, Dr. Dinesh Reddy Y 3 1 Professor, Department of Surgery, JSS University, Mysore, India
More informationA retrospective cohort study: do patients with graves disease need to be euthyroid prior to surgery?
Al Jassim et al. Journal of Otolaryngology - Head and Neck Surgery (2018) 47:37 https://doi.org/10.1186/s40463-018-0281-z ORIGINAL RESEARCH ARTICLE Open Access A retrospective cohort study: do patients
More informationImaging in Pediatric Thyroid disorders: US and Radionuclide imaging. Deepa R Biyyam, MD Attending Pediatric Radiologist
Imaging in Pediatric Thyroid disorders: US and Radionuclide imaging Deepa R Biyyam, MD Attending Pediatric Radiologist Imaging in Pediatric Thyroid disorders: Imaging modalities Outline ACR-SNM-SPR guidelines
More informationHyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D.
Hyperthyroidism Diagnosis and Treatment Family Practice Refresher Course April 2015 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any
More informationOUTLINE. Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis
THYROID DISEASE OUTLINE Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis OUTLINE Hypothyroidism - Hashimoto s thyroiditis,
More informationEvaluation and Management of Thyroid Nodules. Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada
Evaluation and Management of Thyroid Nodules Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada Disclosure Consulting Amgen Speaking Amgen Objectives Understand the significance of incidental
More informationCalcitonin. 1
Calcitonin Medullary thyroid carcinoma (MTC) is characterized by a high concentration of serum calcitonin. Routine measurement of serum calcitonin concentration has been advocated for detection of MTC
More informationHyperthyroidism. Objectives. Clinical Manifestations. Slide 1. Slide 2. Slide 3. Implications for Primary Care. hyperthyroidism
1 Hyperthyroidism Implications for Primary Care Laura A. Ruby, DNP, CRNP Wellspan Endocrinology 2 Objectives! Discuss the clinical manifestations of hyperthyroidism! Review the use of the diagnostic studies!
More informationThyroid disorders. Dr Enas Abusalim
Thyroid disorders Dr Enas Abusalim Thyroid physiology The hypothalamic pituitary thyroid axis And peripheral conversion of T4 to T3, WHERE, AND BY WHAT ENZYME?? Only relatively small concentrations of
More information5/3/2017. Ahn et al N Engl J Med 2014; 371
Alan Failor, M.D. Clinical Professor of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington April 20, 2017 No disclosures to report 1. Appropriately evaluate s in adult
More informationMandana Moosavi 1 and Stuart Kreisman Background
Case Reports in Endocrinology Volume 2016, Article ID 6471081, 4 pages http://dx.doi.org/10.1155/2016/6471081 Case Report A Case Report of Dramatically Increased Thyroglobulin after Lymph Node Biopsy in
More information( Thyrotoxicosis ) ( Hyperthyroidism ) ( Coma ) ( Hypercalcemia ) ( thyroid storm )
2007 18 201-205 ( thyroid storm ) ( 12.4 mg/dl ) ( intact parathyroid hormone ) 32 pg/ml ( 10-60 ) ( 140-150/min ) 36.9 ( 10.5 mg/dl ) ( BUN: 78 mg/dl, creatinine: 1.8 mg/dl ) TSH:
More informationThyroid Nodules. Dr. HAKIMI, SpAK Dr. MELDA DELIANA, SpAK Dr. SISKA MAYASARI LUBIS, SpA
Thyroid Nodules ENDOCRINOLOGY DIVISION ENDOCRINOLOGY DIVISION Dr. HAKIMI, SpAK Dr. MELDA DELIANA, SpAK Dr. SISKA MAYASARI LUBIS, SpA Anatomical Considerations The Thyroid Nodule Congenital anomalies Thyroglossal
More informationThyroid Nodule. Disclosure. Learning Objectives P A P A P A 3/18/2014. Nothing to disclose.
Thyroid Nodule Evaluating the patient with a thyroid nodule and some management options. Miguel V. Valdez PA C Disclosure Nothing to disclose. Learning Objectives Examination of thyroid gland Options for
More informationAn Unexpected Cause of Hypoglycemia
An Unexpected Cause of Hypoglycemia Stacey A. Milan, MD FACS Surgical Oncology Nothing to disclose Disclosures Objectives Identify indications for workup of hypoglycemia Define work up for hypoglycemic
More informationAACE 2018 Advanced Endocrine Neck Ultrasound and UGFNA Course
AACE 2018 Advanced Endocrine Neck Ultrasound and UGFNA Course Describe the sonographic appearance of diffuse thyroid diseases: autoimmune thyroid disease Review non thyroidal findings that can be encountered
More informationThyrotoxicosis from Metastatic Lung Cancer to the Thyroid Gland: A case report
CLINICAL VIGNETTE Thyrotoxicosis from Metastatic Lung Cancer to the Thyroid Gland: A case report Archana Sadhu, MD and Dorothy Martinez, MD Introduction Thyrotoxicosis from secondary thyroid cancer metastases
More informationUpdate In Hyperthyroidism
Update In Hyperthyroidism CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright
More informationAACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016
AACE/ACE Advanced Endocrine Neck Ultrasound Training Course 2016 This 9mm left inferior nodule should remind us all why we re here! There is no absolute number of images required for documentation
More informationEvaluation and Management of Thyroid Nodules. Overview of Thyroid Nodules and Their Management. Thyroid Nodule detection: U/S versus Exam
Overview of Thyroid Nodules and Their Management Matthew D. Ringel, M.D. Professor of Medicine Divisions of Endocrinology and Oncology, The Ohio State University Co-Director, Thyroid Cancer Unit Arthur
More informationTHYROTOXICOSIS DR.J.BALA KUMAR 2 ND YR SURGERY PG
THYROTOXICOSIS DR.J.BALA KUMAR 2 ND YR SURGERY PG What is the difference between thyrotoxicosis and hyperthyroidism Thyrotoxicosis Thyrotoxicosis is defined as the state of thyroid hormone excess and is
More informationChapter I.A.1: Thyroid Evaluation Laboratory Testing
Chapter I.A.1: Thyroid Evaluation Laboratory Testing Jennifer L. Poehls, MD and Rebecca S. Sippel, MD, FACS THYROID FUNCTION TESTS Overview Thyroid-stimulating hormone (TSH) is produced by the anterior
More informationLecture title. Name Family name Country
Lecture title Name Family name Country Nguyen Thy Khue, MD, PhD Department of Endocrinology HCMC University of Medicine and Pharmacy, MEDIC Clinic Hochiminh City, Viet Nam Provided no information regarding
More informationCase Scenario 1: Thyroid
Case Scenario 1: Thyroid History and Physical Patient is an otherwise healthy 80 year old female with the complaint of a neck mass first noticed two weeks ago. The mass has increased in size and is palpable.
More informationThe Thyroid: No mystery. Just need all the pieces to the puzzle.
The Thyroid: No mystery. Just need all the pieces to the puzzle. Todd Chennell, MS, RN ANP-C Endocrine surgery University of Rochester 2018 1 According to the American Thyroid Association, 12 percent of
More informationThyroid Cancer (Carcinoma)
Information for Patients Thyroid Cancer (Carcinoma) Prepared by the American Association of Clinical Endocrinologists (AACE), a not-for-profit national organization of highly qualified specialists in hormonal
More informationVirginia ACP Clinical Update Thyroid Clinical Pearls. University of Virginia. Richard J. Santen MD
Virginia ACP Clinical Update Thyroid Clinical Pearls University of Virginia Richard J. Santen MD Goal Provide a guide to frequently encountered problems in thyroid disease Follow my approach to recently
More informationCase Report Treatment of Ipilimumab Induced Graves Disease in a Patient with Metastatic Melanoma
Case Reports in Endocrinology Volume 2016, Article ID 2087525, 4 pages http://dx.doi.org/10.1155/2016/2087525 Case Report Treatment of Ipilimumab Induced Graves Disease in a Patient with Metastatic Melanoma
More informationThyroid Cancer: When to Treat? MEGAN R. HAYMART, MD
Thyroid Cancer: When to Treat? MEGAN R. HAYMART, MD ASSOCIATE PROFESSOR OF MEDICINE UNIVERSITY OF MICHIGAN MICHIGAN AACE 2018 ANNUAL MEETING Thyroid Cancer: When Not to Treat? FOCUS WILL BE ON LOW-RISK
More informationThyroid in the elderly. Akbar Soltani M.D. Endocrinology and Metabolism Research Center (EMRC) Shariati Hospital
Thyroid in the elderly Akbar Soltani M.D. Endocrinology and Metabolism Research Center (EMRC) Shariati Hospital soltania@tuma.ac.ir Case 1 A 79 year old female is seen because of a 6 month history of fatigue,
More informationThe Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2.
The Thyroid and Pregnancy Francis S. Greenspan March 19, 2010 OUTLINE OF DISCUSSION 1. Normal Physiology 2. Hypothyroidism 3. Hyperthyroidism 4. Thyroid Nodules and Cancer NORMAL PHYSIOLOGY Iodine Requirements:
More informationA case of metastatic follicular thyroid carcinoma complicated with Graves disease after total thyroidectomy
2017, 64 (12), 1143-1147 Original A case of metastatic follicular thyroid carcinoma complicated with Graves disease after total thyroidectomy Mariko Aoyama 1), Hiromitsu Takizawa 1), Mitsuhiro Tsuboi 1),
More informationJohn Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989
John Sutton, DO, FACOI, FACE, CCD Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 No Disclosures Disease Of the Thyroid Iodide Metabolism/Synthesis of Thyroid Hormone Trap Oxidation Organification(catalyzed
More informationA UNIQUE PRESENTATION OF THYROID STORM AND MYOPERICARDITIS IN A YOUNG MUSCULAR MAN
Case Report A UNIQUE PRESENTATION OF THYROID STORM AND MYOPERICARDITIS IN A YOUNG MUSCULAR MAN Gina M. Mathew, MD 1 ; Aleida Rodriguez, MD 2* ; Lima Lawrence, MD 2* ; Kavita P. Krishnasamy, MD 2 ; Rajinder
More informationDISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID
OBJECTIVES DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT Stephanie Blackburn, MHS, MLS(ASCP) CM LSU Health Shreveport Clinical Laboratory Science Program Discuss the synthesis and action
More informationAlvin C. Powers, M.D. 1/27/06
Thyroid Histology Follicular Cells ECF side Apical lumen Thyroid Follicles -200-400 um Parafollicular or C-cells Colloid Photos from University of Manchester and tutorial created by Dr. James Crimando,
More informationHYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3
HYPERTHYROIDISM Hypothalamus Thyrotropin-releasing hormone (TRH) Anterior pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 In hyperthyroidism, there is an increased production of
More informationA Case of Pulmonary Metastatic with Graves' Disease. Thyroid Cancer Complicated
Endocrine Journal 2001, 48 (2), 175-179 A Case of Pulmonary Metastatic with Graves' Disease. Thyroid Cancer Complicated KATSUNORI SUZUKI, OsAMV NAKAGAWA AND YosrnFUsA AIZAWA First Department of Internal
More informationTransient Hypothyroidism after Radioiodine for Graves Disease: Challenges in Interpreting Thyroid Function Tests
Clinical Medicine & Research Volume 14, Number 1: 40-45 2016 Marshfield Clinic Health System clinmedres.org Clinical Overview Transient Hypothyroidism after Radioiodine for Graves Disease: Challenges in
More informationDepartment of Internal Medicine II, Kansai Medical University, Osaka , Japan 9)
2016, 63 (1), 1-10 OPINION Advance Publication doi: 10.1507/endocrj.EJ16-0336 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First edition)
More informationWomen s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases
Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Bill Fleming Epworth Freemasons Hospital 1 Common Endocrine Presentations anatomical problems thyroid nodule / goitre embryological
More informationHYPOTHYROIDISM AND HYPERTHYROIDISM
HYPOTHYROIDISM AND HYPERTHYROIDISM SHAHIDA PERVEEN, AMBREEN Post RN BSCN Semester II FACULTY SIR RAJA April 13, 016 Objectives: State the functions of thyroid hormone. Understand the pathologic mechanism
More informationThyroid and Antithyroid Drugs. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014
Thyroid and Antithyroid Drugs Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed
More informationA rare case of solitary toxic nodule in a 3yr old female child a case report
Volume 3 Issue 1 2013 ISSN: 2250-0359 A rare case of solitary toxic nodule in a 3yr old female child a case report *Chandrasekaran Maharajan * Poongkodi Karunakaran *Madras Medical College ABSTRACT A three
More informationINDEX. Note: Page numbers of issue and article titles are in boldface type. cell carcinoma. ENDOCRINE SURGERY
ENDOCRINE SURGERY INDEX Note: Page numbers of issue and article titles are in boldface type. Adenylate cyclase, in signal transduction 425-426 Adrenal incidentalomas, 499-509 imaging of, 502-504 in patients
More informationDisorders of Thyroid Function
Disorders of Thyroid Function Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Thyroid Hormone Axis Hypothalamus TRH
More informationAdjuvant therapy for thyroid cancer
Carcinoma of the thyroid Adjuvant therapy for thyroid cancer John Hay Department of Radiation Oncology Vancouver Cancer Centre Department of Surgery UBC 1% of all new malignancies 0.5% in men 1.5% in women
More informationAACE/ACE Principles of Endocrine Neck Sonography Course
AACE/ACE Principles of Endocrine Neck Sonography Course Primary objective of thyroid ultrasound: assess for malignant disease Nodular Disease Benign Malignant Goiter Iodine deficient Thyroiditis Organification
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hyperthyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hyperthyroidism. Background Hyperthyroidism
More informationApproach to Thyroid Nodules
Approach to Thyroid Nodules Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationDifferentiated Thyroid Cancer: Initial Management
Page 1 ATA HOME GIVE ONLINE ABOUT THE ATA JOIN THE ATA MEMBER SIGN-IN INFORMATION FOR PATIENTS FIND A THYROID SPECIALIST Home Management Guidelines for Patients with Thyroid Nodules and Differentiated
More informationLABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS
LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS Maryam Tohidi Anatomical & clinical pathologist Research Institute for Endocrine Sciences THYROID GLAND (15-25 gr), (12-20 gr), 2 lobes connected by
More informationThyrotoxicosis in Pregnancy: Diagnose and Management
Thyrotoxicosis in Pregnancy: Diagnose and Management Yuanita Asri Langi email: meralday@yahoo.co.id Endocrinology & Metabolic Division, Internal Medicine Department, Prof.dr.R.D. Kandou Hospital/ Sam Ratulangi
More informationA Case of Methimazole-Resistant Severe Graves Disease: Dramatic Response to Cholestyramine
C A S E REPORT pissn: 2384-3799 eissn: 2466-1899 Int J Thyroidol, Published online September 5, 2016 A Case of Methimazole-Resistant Severe Graves Disease: Dramatic Response to Cholestyramine Seung Byung
More informationIndex. radiologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACC. See Adrenal cortical carcinoma. Acromegaly and the pituitary gland, 551 Acute suppurative thyroiditis, 405, 406 Addison, Thomas and
More informationTreatment and management of thyroid storm: analysis of the nationwide surveys
Clinical Endocrinology (2016) 84, 912 918 doi: 10.1111/cen.12949 ORIGINAL ARTICLE Treatment and management of thyroid storm: analysis of the nationwide surveys The taskforce committee of the Japan Thyroid
More informationCase Report Cerebrovascular Accident due to Thyroid Storm: Should We Anticoagulate?
Case Reports in Endocrinology Volume 2016, Article ID 5218985, 4 pages http://dx.doi.org/10.1155/2016/5218985 Case Report Cerebrovascular Accident due to Thyroid Storm: Should We Anticoagulate? Alex Gonzalez-Bossolo,
More informationNone. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives
Thyroid Potpourri for the Primary Care Physician Ramya Vedula DO, MPH, ECNU Endocrinology, Diabetes and Metabolism Princeton Medical Group Assistant Professor of Clinical Medicine Rutgers Robert Wood Johnson
More informationDecoding Your Thyroid Tests and Results
Decoding Your Thyroid Tests and Results Wondering about your thyroid test results? Learn about each test and what low, optimal, and high results may mean so you can work with your doctor to choose appropriate
More informationCase Report. Michael H. Goldman, MD; Alison T. Gruber; Marc A. Herman, MD ABSTRACT
Case Report CONCURRENT PANHYPOPITUITARISM AND HYPERPROLACTINEMIA DUE TO A GIANT INTERNAL CAROTID ANEURYSM REVEALED BY THYROID HORMONE WITHDRAWAL DURING FOLLOW-UP MANAGEMENT OF THYROID CANCER Michael H.
More informationNon Thyroid Surgery. In patients with Thyroid disorders
Non Thyroid Surgery In patients with Thyroid disorders The Thyroid disease problem. Is Thyroid disease a problem with anaesthetic? Why worry? The Physiology The evidence. A pragmatic approach From: The
More informationMedical Sciences, 4301 W Markham Street, Little Rock, AR 72205, USA. Correspondence should be addressed to Syed A. Abid;
Case Reports in Endocrinology, Article ID 584513, 6 pages http://dx.doi.org/10.1155/2014/584513 Case Report Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without
More informationInternational Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer
Nuclear Medicine Review 2006 Vol. 9, No. 1, pp. 84 88 Copyright 2006 Via Medica ISSN 1506 9680 International Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer
More informationThyroid Disorders: Patient Education on Hypothyroidism and Hyperthyroidism
Thyroid Disorders: Patient Education on Hypothyroidism and Hyperthyroidism Nisreen Mourad, PharmD, MSc Clinical Assistant Professor School of Pharmacy Lebanese International University Disclosure Nisreen
More informationTable 1: Thyroid panel. Result (reference interval) TSH 89.5 miu/l ( ) Total T4 5.2 µg/dl ( ) T3 uptake 39% (22-35)
Introduction Thyroid disease is the second most common endocrine disorder (behind diabetes), and its prevalence increases with increasing age. The incidence of newly diagnosed thyroid cancer is increasing
More informationRole of Radioactive Iodine-131 in Management of Hyperthyroid Patients Seen at NEMROCK: a Local Experience Study
Egyptian J. Nucl. Med., Vol. 7, No. 1, June 2013 55 Original Paper, Therapy Role of Radioactive Iodine-131 in Management of Hyperthyroid Patients Seen at NEMROCK: a Local Experience Study Younis, J 1.
More informationBELIEVE MIDWIFERY SERVICES
TITLE: THYROID DISEASE IN PREGNANCY EFFECTIVE DATE: July, 2013 POLICY STATEMENT: Pregnancy changes significantly the values influenced by the serum thyroid binding hormone level (i.e., total thyroxine,
More informationAntithyroid drugs in Graves disease: Are we stretching it too far?
Original Article Antithyroid drugs in Graves disease: Are we stretching it too far? Muthukrishnan Jayaraman, Anil Kumar Pawah, C. S. Narayanan 1 Department of Internal Medicine, Armed Forces Medical College,
More informationSanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017
Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017 I will not be discussing this Outline of discussion Laboratory tests for thyroid function Diagnosis of hypothyroidism Treatment of
More information4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.
Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:
More informationTHE THYROID BOOK. Medical and Surgical Treatment of Thyroid Problems
THE THYROID BOOK Medical and Surgical Treatment of Thyroid Problems Trouble with Your Thyroid Gland The thyroid is a small gland in your neck that plays a big role in how your body functions. It impacts
More information- RET/PTC rearrangement: 20% papillary thyroid cancer - RET: medullary thyroid cancer
Thyroid Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: 1. Lenvina is the first line therapy with powerful durable response and superior PFS in pts with RAI-refractory disease.
More informationA variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study
ORIGINAL ARTICLE A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study Joon-Hyop Lee, MD, Yoo Seung Chung, MD, PhD,* Young Don Lee, MD, PhD
More informationDOWNLOAD OR READ : TREATMENT OF THYROID TUMOR JAPANESE CLINICAL GUIDELINES PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : TREATMENT OF THYROID TUMOR JAPANESE CLINICAL GUIDELINES PDF EBOOK EPUB MOBI Page 1 Page 2 treatment of thyroid tumor japanese clinical guidelines treatment of thyroid tumor pdf treatment
More informationTHYROTOXICOSIS DUE TO ACUTE SUPPURATIVE THYROIDITIS IN A POSTPARTUM WOMAN
Case Report THYROTOXICOSIS DUE TO ACUTE SUPPURATIVE THYROIDITIS IN A POSTPARTUM WOMAN Leslee N. Matheny, MD; Shichun Bao, MD, PhD ABSTRACT Objective: Postpartum thyroiditis is usually painless, is typically
More informationThyroid nodules 3/22/2011. Most thyroid nodules are benign. Thyroid nodules: differential diagnosis
Most thyroid nodules are benign Thyroid nodules Postgraduate Course in General Surgery thyroid nodules occur in 77% of the world s population palpable thyroid nodules occur in about 5% of women and 1%
More informationRunning Title: Acute Flail Mitral Valve in Thyroid Storm
AACE Clinical Case Reports Rapid Electronic Articles in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited,
More informationW. Heath Giles, M.D. University of Tennessee College of Medicine Chattanooga Assistant Professor of Surgery Associate Residency Program Director
W. Heath Giles, M.D. University of Tennessee College of Medicine Chattanooga Assistant Professor of Surgery Associate Residency Program Director It is our duty to each learner to honor your right to expect
More informationSubacute Thyroiditis with Coexisting Papillary Carcinoma
C A S E REPORT J Korean Thyroid Assoc Vol. 4, No. 1, May 2011 Subacute Thyroiditis with Coexisting Papillary Carcinoma Pil-Soo Sung, MD 1, Min-Hee Kim, MD 1, Dong-Jun Lim, MD 1, Yoon-Hee Choi, MD 1, Moo-Il
More informationIodine 131 thyroid Therapy. Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego
Iodine 131 thyroid Therapy Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego OBJECTIVES Describe the basics of thyroid gland anatomy and physiology Outline the disease process
More informationTANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY
ENDOCRINE DISORDERS IN THE ELDERLY (part 2) TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY Pituitary axis Target organs of the pituitary gland Negative feedback Hypothalamus-Pituitary-Thyroid axis Thyroid
More informationAmiodarone Induced Thyrotoxicosis Treatment? (AIT)
Amiodarone Induced Thyrotoxicosis Treatment? (AIT) Presentation of a Case Report Annelies Tonnelier Brigitte Velkeniers 14-12-2013 1 1. Background 1. Case report 2. Investigations 3. Diagnosis 4. Treatment
More informationDiseases of thyroid & parathyroid glands (1 of 2)
Diseases of thyroid & parathyroid glands (1 of 2) Thyroid diseases Thyrotoxicosis Hypothyroidism Thyroiditis Graves disease Goiters Neoplasms Chronic Lymphocytic (Hashimoto) Thyroiditis Subacute Granulomatous
More informationB-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor.
Disorders of the endocrine system 38 Disorders of endocrine system mainly are caused by: A-Deficiency or an excess of a single hormone or several hormones: - deficiency :can be congenital or acquired.
More informationUpdates in Thyroid Disease. Thyroid Outline. Thyroid 10/5/2015. Leila Wing, MD. Endocrinology, Diabetes, and Metabolism
Updates in Thyroid Disease Leila Wing, MD Endocrinology, Diabetes, and Metabolism Background Hypothyroidism Hyperthyroidism Thyroid nodules Thyroid Cancer Conclusions Resources/References Thyroid Outline
More informationCommon Causes of Hypothyroidism
Common Causes of Hypothyroidism Autoimmune thyroidi4s Surgical removal of thyroid gland Medica4on Therapy Iodine and iodine containing medica4ons Neck radia4on Post Partum thyroidi4s Prevalence of Hypothyroidism
More informationThyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb,
Thyroid and Antithyroid Drugs Dr. Alia Shatanawi Feb, 24 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed of epithelial cells which
More informationSummary of Treatment Benefits Page 72 of 111. Page 72
1.8.2 Page 72 of 111 Page 72 need surgery to remove part or all of the thyroid gland. This procedure is known as a thyroidectomy (removal of thyroid gland), and is followed by life-long intake of levothyroxine.
More informationAustin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide)
Austin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide) Overview Indications I-131 therapy for Thyroid Cancer, of the papillo-follicular type, is
More informationManagement of Thyroid Nodules. February 2 nd, 2018 Sarah Hopkins
Management of Thyroid Nodules February 2 nd, 2018 Sarah Hopkins No disclosures Goals: Review Initial Evaluation of Thyroid Nodules Review Indications for Biopsy Approach to Multinodular Goiter Review Management
More informationAnaesthesia In Thyroid Disorder. Dr. Umme Salma Ayesha Hoque MBBS, DA Medical Officer Department of Anaesthesiology and SICU BIRDEM General Hospital
Anaesthesia In Thyroid Disorder Dr. Umme Salma Ayesha Hoque MBBS, DA Medical Officer Department of Anaesthesiology and SICU BIRDEM General Hospital Anatomy Endocrine gland : Consist of two lobe Located
More informationThyroid Nodules. Objectives. Clinical Practice Guidelines for the Management of Thyroid Disorders
9:45 1:45am Clinical Practice Guidelines for the Management of Thyroid Disorders SPEAKER Gregory Brent, MD Presenter Disclosure Information The following relationships exist related to this presentation:
More informationShadow because the air
Thyroid Ultrasound Thyroid US examination needs: 1. high frequency transducer 2. extended patient's neck 3. check all the neck area because the swelling could be in areas other than the thyroid such as
More informationApproach to thyroid dysfunction
Approach to thyroid dysfunction Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or
More informationReoperative central neck surgery
Reoperative central neck surgery R. Pandev, I. Tersiev, M. Belitova, A. Kouizi, D. Damyanov University Clinic of Surgery, Section Endocrine Surgery University Hospital Queen Johanna ISUL Medical University
More information