Sterling-PC - Subclinical Hyperthyroidism Cheryl P....

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Unformatted text preview: Subclinical Hyperthyroidism Cheryl P. Sterling, MD, MPH VCU/MCV Hospitals February 20, 2003 Case Presentation 48 yo Black female with well controlled HTN, h/o borderline hyperthyroidism • No specific complaints or concerns • Meds: – HCTZ for BP control • FHx remarkable for HTN, DM, no other endocrine D/O’s, no known AIDz • SHx unremarkable Case Presentation 48 yo Black female with well-controlled HTN, h/o borderline hyperthyroidism • ROS positive for low but normal appetite, no wgt loss, no signif fatigue • Pap UTD • No prior BMD study – Physical exam = nonobese female; no obvious features c/w hyperthyroid state Case Presentation LABS – WBC 6.0, Hgb 12.4, Platelets 378 – BMP unremarkable except for Ca 8.9 – LFT’s wnl – Fasting Lipid Profile • Chol 173, HDL 45 • TG 120, LDL 97 Serial thyroid testing – 11/00 TSH – 0.15 – 3/01 TSH – 0.35 – 7/01 TSH – 0.22 – 9/02 TSH – 0.16 – 2/03 TFT’s • TSH - 0.21 • Total T4 - 8.4 • T3RU – 37.2% • FTI - 10 Clinical Question Premenopausal female patient with hx of “borderline” hyperthyroidism, no obvious clinical signs nor subjective symptoms of thyroid hormone excess What are the management options for this patient in your practice? The Thyroid Subclinical Hyperthyroidism- Characterized by the presence of low or undetectable plasma TSH concentration and normal circulating free thyroid hormones.-Also referred to as mild hyperthyroidism-Exogenous vs. endogenous Common Signs/Symptoms Fatigue Weight loss Heat intolerance Hyperhidrosis Nervousness Insomnia Muscle weakness Hyperdefecation Tremor Dyspnea Palpitations Menstrual irregularity Anxiety Irritability Exophthalmos Lid lag or stare Subclinical Hyperthyroidism Goiter Exophthalmos Etiology Presage to overt hyperthyroidism – Early Graves’ disease – Multinodular goiter – Hashimoto’s Thyroiditis – Subacute – Silent – Postpartum Thyroid carcinoma Iodine-associated hyperthyroidism – e.g. amiodarone Solitary autonomous adenoma Nonthyroidal illness Steroid or dopamine administration Health food supplement Shrier, D.K., Burman, K.D. American Family Physician , 2002; 65(3)....
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Sterling-PC - Subclinical Hyperthyroidism Cheryl P....

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