Case 4

A 38-year-old woman was referred by her PCP because of a goiter. The patient described an enlarging mass in her neck over at least the past year. She was not sure whether it was continuing to enlarge. She denied dysphagia, but noted pressure sensation in her neck when she was lying on her right side. She had no neck pain and no symptoms of hyperthyroidism or hypothyroidism. Family history was negative for thyroid disease. Laboratory studies included a TSH of 3.1 and elevated antithyroglobulin...

Introduction

Hashimoto's thyroiditis or chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the United States and a common cause of goiter. It was described by Dr. Hashimoto in 1912 as a lymphocytic infiltration of the thyroid gland with goiter. It has since been well established as an autoimmune disease and circulating antibodies against the thyroid (microsomal or peroxidase and thyroglobulin antibodies) can be found in the majority of cases. Like most thyroid diseases, it is much...

Case 2

A 74-year-old woman was referred for evaluation of a goiter. The right lobe had been noted by her primary care physician (PCP) to be enlarging recently. History was obtained using the patient's daughter as interpreter because the patient spoke only Spanish. A goiter had been noted by a physician approx 2 years before. At that time, she was being evaluated for paroxysmal atrial fibrillation (PAT). The patient had a history of intermittent palpitations and shakiness, cold intolerance, and loss of...

Summary

This chapter discussed several patients with thyroid cancer. Like most patients with thyroid cancer, these patients presented with a thyroid nodule or neck mass. FNAB was the initial approach to diagnosis. Case 1 was a man who was found to have a papillary thyroid carcinoma on FNA and was treated with total thyroidectomy and postoperative RAI. He had elevated levels of TG over several years suggesting residual or recurrent tumor, but the source of the TG could not be found. Case 2 was a woman...

Case 3

A 52-year-old man was referred by his PCP for thyroid evaluation. Over the previous 6 months, he had lost 20 lb despite a very good appetite and increased food intake. He complained of heat intolerance, fatigue, increased frequency of bowel movements, and tremor of the hands. He had noted some tearing of the eyes but vision was good. The patient was a nonsmoker and was on no medications. He had a family history of thyroid disease in his mother, who was on medication. Test results from his PCP...

Indication Of Hyperthythroidism

Whereas most thyroid problems result from endogenous thyroid dysfunction, some problems are secondary to treatment of other medical conditions. The case discussed here demonstrates how challenging the treatment of drug-induced thyroid dysfunction may be in the face of other serious illness. This 52-year-old man was referred because of an abnormal TSH of less than 0.03. He had a long history of ischemic heart disease with serious arrhythmias. Over the previous several months, he had noted heat...

Tsh

Thyroid - Pituitary - Hypothalamus Relationship in a Normal Patient TRH - Thyrotropin Releasing Hormone TSH - Thyroid Stimulating Hormone T4 - Thyroxine T3 - Triiodothyronine Fig. 1. Thyroid-pituitary-hypothalamus relationship in a normal patient. TRH, thyrotropin-releasing hormone TSH, thyroid-stimulating hormone T3, triiodothyronine T4, thyroxine. TSH, T4, and T3, as well as measurement of thyroid-binding proteins and antithyroid antibodies. Nuclear medicine tests, such as the radioiodine...

Thyroid Disease

A Case-Based and Practical Guide for Primary Care Dermatology Skills for Primary Care An Illustrated Guide, Daniel J. Trozak, Dan J. Tennenhouse, and John J. Russell, 2006 Thyroid Disease A Case-Based and Practical Guide for Primary Care, Chronic Pain A Primary Care Guide to Practical Management, Dawn A. Marcus, 2005 Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome The Primary Care Guide to Diagnosis and Management, Ronald A. Codario, 2005 Bone Densitometry in Clinical Practice...