によって Mackenzie Smith 3年前.
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TSH- low
free T4- inc
lid retraction/lag
muscle weakness
moist skin
goiter
tremor
tachycardia
weight loss with increased appetite?
Subtopic
Fatigue or weakness?
palpitations?
heat intolerance?
increased irritability?
electrolytes- abnormal
shortness of breath
nausea
edema
recent hospitalization?
recent fatigue?
recent change in urine output?
25-hydroxyvitamin D- inc
1,25-dihydroxyvitaminD- not elevated
PTHrP- not elevated
abdominal pain
bone pain
N/V
Taking any other medications in addition to Metropolol?
Li, Antacids, Thiazide diuretic, Vit D. intoxication
PTHrP- now elevated
PTH- low
1,25-dihydroxyvitaminD- inc
infiltrative lesion
Increased thirst?
Hx of TB
Prolactin
Gastrin, insulin, glucagon, somatostatin levels
all possibly increases
Genetic testing
mutation in Menin gene
weakness
bone abnormalities, pain
weight loss
glucagonoma
pain with abdominal palpation
gastrinoma
FHx of MEN?
X-ray
SCC lung metastatic tumor
CBC w diff
leukemia, multiple myeloma
CT/MRI
pancreas metastatic tumor
Mammogram
Breast metastatic tumor
PTHrP assay
inc PTHrP, dec iPTH
Ultrasound
thyroid metastatic tumor
Non-tender, firm, immobile mass
PMHx or FHx of cancer?
1,25 dihydroxy vit D
dec
25 (OH) vit D
dec in surgical malabsorption
normal
alk phophs
inc +/-
blood work
anemia
serum PO4
serum Ca
hypocalcemia
Abdominal pain from nephrolithiosis
Bone/joint pain
Recent kidney issues, such as kidney stones?
New aches for pains?
EKG
heart block, bradyarrythmia
tall, peaked T waves, short QT interval
Cr/BUN, 24hr urine for Ca and Cr
rule out other etiologies
25 (OH) vitamin D
low +/-
Serum PO4
decreased
Urinary Calcium and PO4
increased
iPTH
increase
Pre-op sestamibi-iodine subtraction scanning and ultrasound of neck
X-ray/DEXA
PUD
may show show dec bone density, brown tumor
usual normal
PTH
High
Chronic duration- Parathyroidism
Acute duration- Primary hyperparathyroid
Repeat Calcium
Hypercalcemia
Palpitations
Abdominal pain
Decreased DTR
Myalgia
Proximal weakness
Mild bone pain
Change in energy levels?
Change in mood?
N/V?
Previous DEXA scan?
Last menstrual period?
chronic hypocalcemia requiring life-long calcium and vitamin D supplemention
hypoparathyroidism
injury to recurrent laryngeal nerve(s)