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Culture Documents
((HASHIMOTO's THYROIDITIS))
. Anti-TPO Abs (Anti-thyroid peroxidase antibodies).
. High risk of developing THYROID LYMPHOMA.
((GENERALIZED RESISTANCE to thyroid hormones))
. ++ T3 & T4 levels.
. ++ or Normal TSH level.
. features of HYPO-thyroidism despite having ++ free T3 & T4.
((SICK EUTHYROID $YNDROME = LOW T3 $YNDROME))
. Abnormal thyroid function tests with an acute severe illness.
. May be due to caloric deprivation.
. Fall in total & free T3 levels with NORMAL T4 & TSH. !!!
((FACTITIOUS THYROTOXICOSIS))
. Due to exogenous thyroid hormone.
. H/O of psychiatric illness or attempted weight loss (Herbal remedy!).
. Thyrotoxicosis syms (Palpitations - sweating - weight loss - hyperactivity &
diarrhea).
. Lid lag may be present but NO exophthalmos (Excluding Grave's dis.).
. The ingested thyroid hormone disturbs the native thyroid axis !
. RAIU is decreased (-- Radio Active Iodine Uptake).
. Dx -> "LOW SERUM THYROGLOBULIN" is the main stay of diagnosis.
. Dx -> -- TSH & ++ T3 &/or T4.
((THYROID RADIOACTIVE IODINE SCAN))
. HASHIMOTO's THYROIDITIS -> Heterogenous pattern.
. GRAVE's DISEASE ---------> Diffusely ++ uptake.
. MULTINODULAR GOITER -----> PATCHY.
. PAINLESS THYROIDITIS ----> -- markedly reduced uptake.
____________________
. YOUNGER age.
____________________
. Older.
. LESS confusion.
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. MORE confusion.
. Less common.
. LESS common.
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. > 600
____________________
. > 18
____________________
__________________
_________________
. NORMAL.
. NEGATIVE.
. > 320.
((DIABETIC NEPHROPATHY))
. Begins with HYPERFILTRATION (++GFR) & MICROALBUMINURIA.
. If not ttt well .. Micro becomes Macroalbumiuria > 300 mg/dl.
. INTENSIVE BLOOD PRESSURE CONTROL to prevent worsenening of the condition.
. Use ACE Is with blood pressure goal 130/80 mmHg.
. Most sensitive screening test is -> RANDOM URINE MICROALBUMIN/CREATININE RATIO.
((DIABETIC NEUROPATHY))
. DISTAL SYMMETRIC SENSORIMOTOR PLOYNEUROPATHY.
. STOCKING GLOVE pattern.
. It is the most common risk factor of foot ulcerations in diabetics.
. Tx -> TCAs (Amitriptyline - Gabapentin).
((DIABETIC GASTROPATHY))
. Autonomic neuropathy of the GIT.
. Symptoms of delayed gastric emptying & gastroparesis.
. -- Esophageal dysmotility -> Dysphagia.
. -- Gastric emptying -------> Gastroparesis.
. Gastroparesis (Nausea - vomiting - early satiety - postprandial fullness).
. -- intestinal function ----> diarrhea - constipation - incontinence.
. Tx -> DM control - SMALL FREQUENT MEALS - METOCLOPROMIDE (prokinetic &
Antiemitic).
. SEs of Metoclopromide -> Extrapyramidal syms -> Tardive dyskinesia
(Give Erythromycin).
((ERECTILE DYSFUNCTION in D.M))
. Due to vascular complications & neuropathy.
. 1st line of ttt is phosphodiesterase inhibitor (Sildenafil).
. Contr'd in pts being ttt with NITRATES.
. Sildenafil may predispose to PRIAPISM.
. When combined with an Alpha blocker (Prazosin), it is imp. to give them 4 hrs
apart,,
. to avoid SEVERE HYPOTENSION.
.((DIABETIC FOOT management -> DEBRIDEMENT & proper wound care)).
__________________
(+)
______________________
(-)
_____
(-)
(-)
. Dx -> 3Ds SESTAMIBI scan + U/$ to locate the hyperactive parathyroid tissue presurgery.
. Tx -> Parathyroidectomy for symptomatic pts.
((Surgery indications))
-> Serum Ca level > 1 mg/dl above the upper limit of normal (11mg/dl).
-> Young age < 50 ys.
-> Bone mineral density < T-2.5 at any stage.
-> -- Renal function (GFR < 60ml/min.).
((HYPERCALCEMIA of MALIGNANCY))
. ++ Ca -> confusion - lethargy - fatigue - anorexia - polyuria & constipation.
. Associated with SQUAMOUS cell lung cancer.
. CXR finding of lung cancer (lobar mass & perihilar lymphadenopathy).
. Malignancy produces PTH related peptide PTHrP -> ++ Ca & -- PO4.
((HYPERCALCEMIA (++Ca) ALGORITHM))
(++Ca)
.|
.Measure PTH level
.|
.|
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.(+++)
.(---)
.(PTH dependent)
. (PTH-INdependent)
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.Measure urinary Ca
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._______________________________________________
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.________________
LABs
.|
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.+PTHrP
.|
.> 250
.< 100
.HYPERTHYROIDISM
.+1,25(OH)D
.+25(OH)D
.|
.|
.|
.TUMOR
.NORMAL
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.|
.MULTIP MYELOMA
1ry or 3ry
.Familial
.Adrenal tumor
Hyperpara- .Hypercalcemic
.Acromegaly
thyroidism
toxicity
.Hypocalciuria
.Vit.A
.Immobilization
((IMPORTANT CASE SCENARIO))
. Rapid ascend to a height of 10000 feet -> HYPO-calcemia ! HOW ?? (++ Albumin
bound Ca).
. Respiratory alkalosis = ++ pH level -> ++ the affinity of serum albumin to
calcium.
. ++ the levels of ALBUMIN-bound Ca -> -- the level of IONIZED Ca (Active form).
. -- Ionized Ca (Active form) -> Hypocalcemia manifestations.
((ACTH defeciency (2ry adrenal insuffeciency): "-- Glucocorticoids"))
-> Postural hypotension & tachycardia.
-> Fatigue & weight loss.
-> -- libido, hypoglycemia & eosinophilia.
N.B: no hyperkalemia /no salt wasting/-- in skin pigmentation (KAPLAN)
((OSTEOPOROSIS))
. Postmenopausal woman.
((OSTEOMALACIA))
. Vit. D defeciency in ADULTS.
. Bony pain & tendrness.
. -- serum Ca & PO4.
. -- urinary Ca.
. ++ ALP & ++ PTH.
. -- 25 OH-D.
. X-ray -> BILATERAL SYMMETRIC PSEUDO-FRACTURES (LOOSER ZONES).
((PAGET's DISEASE))
. NORMAL serum Ca - PO4 & PTH.
. INCREASED ++ ALKALINE PHOSPHATASE.
. Tx -> BIPHOSPHONATES -> inhibit OsteoCLASTs asctivity.
Condition
Calciu
Phosphat
Alkaline
phosphatas
e
Parathyroi
d hormone
Osteoporosis
unaffected unaffected
normal
unaffected
Osteopetrosis
unaffected unaffected
elevated
unaffected
Comments
decreased
bone mass
thick dense
bones also
known as
marble
Condition
Calciu
Phosphat
Alkaline
Parathyroi
phosphatas
d hormone
Comments
bone
decreased decreased
elevated
elevated
elevated
elevated
elevated
decreased
soft bones
brown
tumors
abnormal
Paget's disease of bone unaffected unaffected
elevated
unaffected
bone
architectur
e
1- Surreptitious vomiting.
2- Factitious diarrhea.
* 17 hydroxylase
- * ++ Adrenal androgens
- * -- Adrenal
- * Hirsutism
- * NO
* NO hypertension
HYPERTENSION
- * HYPERTENSION
- * NO
- * NO
-*