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

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Subclinical Hyperthyroidism Cheryl P. Sterling, MD, MPH VCU/MCV Hospitals February 20, 2003
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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
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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
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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
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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?
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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
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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
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Subclinical Hyperthyroidism Goiter Exophthalmos
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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.
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