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Approach to a Case of Thyroid Disorder

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Approach to a Case of Thyroid Disorder

  1. Patient Presentation
    • Symptoms of thyroid dysfunction (e.g., fatigue, weight changes, palpitations, temperature intolerance)
  2. Initial Evaluation
    • Detailed history (family history, medications, radiation exposure, autoimmune diseases)
    • Physical examination (thyroid enlargement, nodules, signs of hyper/hypothyroidism)
  3. Laboratory Tests
    • TSH (Thyroid Stimulating Hormone)
      • High TSH
        • Check Free T4
          • Low Free T4: Primary Hypothyroidism
          • Normal Free T4: Subclinical Hypothyroidism
      • Low TSH
        • Check Free T4 and Free T3
          • High Free T4/T3: Primary Hyperthyroidism
          • Normal Free T4/T3: Subclinical Hyperthyroidism
  4. Further Evaluation (if abnormal TSH)
    • Thyroid Antibodies
      • Anti-TPO (Thyroid Peroxidase Antibodies)
        • Positive: Hashimoto’s Thyroiditis (Hypothyroidism)
      • TSI (Thyroid Stimulating Immunoglobulin)
        • Positive: Graves’ Disease (Hyperthyroidism)
    • Thyroid Ultrasound
      • Evaluate for nodules, goiter, cysts
    • Radioactive Iodine Uptake (RAIU) and Scan
      • High uptake: Graves’ disease, toxic multinodular goiter, toxic adenoma
      • Low uptake: Thyroiditis, exogenous thyroid hormone
  5. Diagnosis
    • Hypothyroidism  (Mnemonic – THYROID’S)
      • Primary: Hashimoto’s thyroiditis, iodine deficiency, post-radioactive iodine therapy/surgery, medications
      • Secondary: Pituitary/hypothalamic dysfunction
    • Hyperthyroidism (Mnemonic – GRAVE HIM)     
      • Graves’ disease, toxic multinodular goiter, toxic adenoma, thyroiditis, iodine-induced
  6. Management
  7. Follow-Up
    • Regular monitoring of thyroid function tests
    • Adjust treatment based on clinical response and lab results

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