Wednesday, September 25, 2013

9/25/2013

9/25/2013

Answers:
An elderly patient with "apathetic hyperthyroidism" might present with symptoms such as...
A) weight loss, severe depression and slow afib 
B) weight loss, heat intolerance, sweating 
C) anxiety, insomnia, palpitations 
D) hand tremor, increase stool freq,weight loss

Elderly patients with hyperthyroidism do not always have the classic presentation of tachycardia, insomnia, tremor, heat intolerance etc.  Depression, weight loss and Afib should raise suspicions of hyperthyroidism in elderly patients and TFTs should be performed.

What are the three symptoms that are unique to Graves' hyperthyroidism?

Ophthalmopathy (exophthalmos) 
Dermopathy (thick skin) 
Osteopathy (pretibial myxedema).

MC Questions:
A patient with hyperthyroidism who recently underwent a laparoscopic appendectomy complicated by wound infection and who is noncompliant with her home medications presents to the ED with fever, agitation and abdominal pain.  On exam the patient is diaphoretic, tachycardic and in afib.  Which of the following is part of appropriate initial management of this patient?
A) Propranolol 1-2 mg IV 
B) Propylthiouracil 250mg q6 
C) Saturated Iodine PO 
D) Aspirin 325 
E) All of the above 
F) None of the above

Free Response Question:
What antiarrhythmic drug may cause both hyperthyroidism and hypothyroidism?


Quick Facts:

Hydatidiform Mole
-Produce chorionic gonadotropin which has TSH-like activity.
-No clinical evidence of hyperthyroidism but lab workup can show suppressed TSH and elevated T3/4.
-Resect Mole.

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