nyu medical grand rounds clinical vignette
Download
Skip this Video
Download Presentation
NYU Medical Grand Rounds Clinical Vignette

Loading in 2 Seconds...

play fullscreen
1 / 14

NYU Medical Grand Rounds Clinical Vignette - PowerPoint PPT Presentation


  • 60 Views
  • Uploaded on

NYU Medical Grand Rounds Clinical Vignette. Arnab Ghosh, MD PGY-2 10/23/12. U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS. Chief Complaint. U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' NYU Medical Grand Rounds Clinical Vignette' - roden


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
nyu medical grand rounds clinical vignette

NYU Medical Grand Rounds Clinical Vignette

Arnab Ghosh, MD

PGY-2

10/23/12

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

chief complaint

Chief Complaint

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

The patient is a 67 year old male who presented to his primary care physician with palpitations.

history of present illness

History of Present Illness

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

  • When reviewed in clinic by his primary physician, he appeared clinically euthyroid although he did have evidence of an enlarged thyroid gland on examination by his primary care physician.
  • He was referred to an endocrinologist.
additional history

Additional History

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

  • Past Medical History: Nil
  • Past Surgical History: Nil
  • Social History: Works as a dentist, occasional social drinker, non smoker, nil illicit drug use
  • Family History: Nil family history of thyroid disease
  • Medications: Nil
physical examination

Physical Examination

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

  • General: He appeared well
  • Thyroid Examination: a palpable thyroid approximately one and a half times the normal size
    • Nil evidence of tenderness, dominant nodules nor lymphadenopathy
    • Nil peripheral stigmata of thyroid disease
  • Remainder of Physical Exam was normal
laboratory findings

Laboratory Findings

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

  • CBC: within normal limits
  • Basic Metabolic panel: within normal limits
  • Hepatic panel: within normal limits
  • Thyroid Stimulating Hormone (TSH)
        • 2.7 miU/L (N:0.4-4.0 mIU/L)
  • T4 5.9 mcg/dL (N: 4.8-11.0 mcg/dL)
  • T3 0.78 ng/mL (N:0.8-1.7 ng/mL)
  • Anti-thyroglobulin antibody: 2.4 U/mL (>1.0 U/mL – positive)
  • Anti-thyroperoxidase antibody:14.0 U/mL (>1 U/mL – positive)
other studies

Other Studies

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

  • ECG: normal sinus rhythm with occasional premature ventricular contractions
  • Thyroid Ultrasound:
    • 1.7x1.1cm nodule in the R lobe (hypoechoic)
    • 9x11mm nodule in R lobe (hypoechoic)
    • Nil microcalcifications, nil increased vascularity
  • Fine Needle Aspiration performed of larger nodule:
    • Colloid in a population of lymphocytes
slide8

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Working Diagnosis

Euthyroid lymphocytic thyroiditis

slide9

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Outpatient Course

  • The patient was referred back to his primary care physician, who intermittently checked TSH levels, which remained normal
  • 8 years later, the patient was referred back to his endocrinologist with a TSH measured at 4.16 mIU/L (N:0.4-4.0mIU/L)
  • Patient was clinically euthyroid during this time
slide10

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Outpatient Course

  • On repeat labs by the endocrinologist, the TSH was measured 11.4 mIU/L
  • Other laboratory values of note:
    • T4 6.3 mcg/dL (N: 4.8 - 11.0 mcg/dL)
    • T3 Uptake 31.7% (N: 23.5 - 40.6%)
    • Free thyroid index 4.0 (N: 1.5 - 3.8)
    • Anti-thyroperoxidase antibody: 239 IU/mL (normal < 27 iU/mL)
    • Anti-Thyroglobulin antibody: < 20 IU/mL (normal)
slide11

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Outpatient Course

  • Repeat Thyroid Ultrasound performed:

Coarsely and diffusely multinodular

Mild hyperaemia of the entire thyroid

R lobe: 2 solid hypoechoic nodules, 15x10mm and 9x9mm

L inferior lobe: 8x6mm nodule

Nil calcifications

    • Fine Needle Aspiration of 3 nodules:

R and L nodules: colloid with lymphocyte background

L inferior lower lobe: colloid accumulation

slide12

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Outpatient Course

The patient was started on Levothyroxine 25 μmcg daily by mouth

slide13

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Outpatient Course

Repeat lab values 3 months later in clinic

  • TSH 2.74 miU/L (N:0.4-4.0 mIU/L)
  • T4 5.7 mcg/dL (N: 4.8 - 11.0 mcg/dL)
  • T3 Uptake 33.9% (N: 23.5 - 40.6%)
  • Free thyroid index 1.9 (N: 1.5 - 3.8)
slide14

UNITED STATES

DEPARTMENT OF VETERANS AFFAIRS

Final Diagnosis

Hashimoto’s thyroiditis (with failing thyroid)

ad