THYROXINE SUPPRESSION THERAPY IN NODULAR THYROID DISEASE. Rhonda Carter, MD Resident Grand Rounds December 15,1998. CASE PRESENTATION.
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Rhonda Carter, MD
Resident Grand Rounds
HPI: 32 y.o. Indian-American female w/o sig. PMH presented with a complaint of a “lump in her neck” that had been slowly enlarging for one year. Denied history of thyroid disease, dyspnea or dysphagia but was concerned about cosmetic appearance. Denied any hair/skin changes, heat/cold intolerance, weight changes, palpitations or menstrual irregularities. She did have occasional constipation.
PMH: None Meds: None NKDA
Soc: No Etoh/tob FH: asthma, DM ROS: N/C
Gen: WDWN Indian female, NAD
VS: Wt. 138lbs, HR 68, BP 96/60, T98.5, RR 16
HEENT: no exopthalmos or lid lag
Neck: diffuse nontender goiter, smooth, approx. twice normal size, no nodules/thrills/bruits
Heart: RRR w/o MRG
Abd: BS+, soft, NTND
Ext: no edema
Neuro: DTRs 2+ throughout
Skin: warm, dry
Total thyroxine 7.4 (5.5-11.8) ug/dl
Thyroid uptake 24.8 (24-34) %
Free thyroxine index 6.1 (4.8-10.3)
TSH 2.19 (0.40-5.5) mcu/ml
Kuma et al., 1994
Sawin et al., 1994
Ching et al., 1996 compared:
Fazio et al., 1995
No studies have shown an increase rate of bone fractures among patients on thyroxine therapy.