Identify something from the PriMed video( transcrip of the video below) Approach to Common Thyroid Disorders, that you found useful. Explain how you will apply it with patients.
Transcript of Approach to Common Thyroid Disorders video:
I want to go through three learning objectives—identify risk factors for hypothyroidism, especially since we are seeing a lot more people getting atrial fibrillation, that’s up in the 20th percentile as you get into the 70s, so there’s a lot of atrial fibrillation out there in the 80s and a lot of us are going to live to 100, so there will be a large population of people getting atrial fibrillation. I want to talk to you about why it’s important in the hospital not just a measure TSH but to get a free T4 on patients. If there are any mental status issues are dementia, make sure you check a free T4. Lastly, I will talk a little bit about what to do about these mildly elevated TSHs that we think may be causing symptoms or maybe they’re not.
Slide 4:
To start with, this is a goiter. You can kind of see it—nice, large goiter. You can see this in the mall when you’re walking down the mall. You see a lot of people with goiters. It’s not very uncommon—
Slide 5:
But when you raise your hands like this and you get short of breath, it’s actually called thyroid cork. Thyroid cork is not uncommon, but it can be seen.
Slide 6:
Here’s a picture of the thyroid. You can see this nasty -looking thyroid. That means biopsied by the way, but it pushes back and it closes off the breathing apparatus here so you lose your breath, so this is not an uncommon finding for people with large goiters.
Slide 7:
I was working—I have been working now in endocrine 30 years at Harbor. I really love the place. I finished my fellowship there and just stayed. This case really got me interested. This is a case of an 82-year-old guy who came to an outside hospital. He had a normal CBC, chemistry, ANA, B12, folate—all of the different labs looked normal. They even did a biopsy on this guy and it showed some axonal degeneration, so this neurologist saw him and did an LP, found elevated protein which is unusual, so this patient was diagnosed with chronic inflammatory demyelinating polyneuropathy, which he was treated for with 5 courses of IV IgG without any help.
So then he comes to another hospital in somebody measures the TSH, right? To whom you know the end of the story. What is interesting about this point is that if you are old and 80 it takes about 12 months to recover from this, and if you are 1-year-old it takes about 8 months to 12 months to normalize your TSH. Our body normally normalizes TSH in normal 6 weeks but in the 1-year-olds and 80-year-olds, it takes sometimes 6 months, so be cautious when you’re treating a patient like this. Give them a dose of thyroid hormone. Sit on it for 6 months, maybe not measure it at 6 weeks in an older patient. Maybe measure at three months because they are going to get better on the drug, so this patient got out of his wheelchair about 8-9 months after starting thyroid hormone. His muscle function came back and recovered.