May 1998 Mailbag
I ran across your web site, I was wodering do
you answer questions, I have low
potassium and high blood pressure and weaknes in my body parts. I urate at
times a whole lot. I have numbness and tingling in my hands. Could you tellme what tests to talk to my doctor about taking.Thank You for your question.
Sounds like you need an endocrinology evaluation to rule out primary aldosteronism as the cause of your low potassuim and high blood pressure. Also, a thyroid check and additional adrenal gland work up as the examining doctor sees fit.
After having a right lobectomy of the thyroid gland, how long is it necessary to continue with lab values regarding thyroid function? And how often, if necessary after 1 year post op?
Almost all patients will be able to maintain their TSH
and T4 within the normal range after a lobectomy is performed. The remain
lobe will grow and increase the output of thyroxine (T4) to maintain the needs
of the body. About 7 - 8 weeks after lobectomy, checking the TSH and Free
T4 will determine if the lobe can suport the body's needs. After that,
a yearly check up in individuals over age 50 would be reasonable, otherwise,
in younger individuals, if symptoms of hypothyroidism occur.
It seems as though you daughter has had an excellent
work up to date. She has a normal bone age and height and weight are still
reasonable. She has not yet menstruated, but shows signs of adrenarche
(early Tanner Stage and breast buds). She has had a negative screening
test for Cushing's disease. At this point I would agree with your doctor...waiting.
Remember, primary amenorrhea is defined as no menstruation by age 17 and your
daughter is 12.5! Regarding the necessity of growth hormone therapy, stature
less than the 2nd percentile would be a consideration for treatment. Your
county medical society should be able to help with a referral. If not,
contact the American Association of Clinical Endocrinologists, based in Jacksonville,
FL for a mebership listing.
I'm a medicine student from Universidad Latina de Panama, I want to review a patient with you (is my mother) because we have diferent opinion in what to do in her case, I will send you her clinical history that made my self, with all the test that she have, I'll try to scan the ultrasound, and a tyroid scintillation (radioactive iodine)but I'm not sure if I can make it.
Name Eneida Riera S. Civil state: join
age:52 gender: F City: Panama
Actual disease: The patient relate that she feel a little mass in the front part of her neck since two weeks ago, when she had to apply on the neck a medicine for (I don't know what it's his name, but in spanish is cloasma) spots on the check and neck and it hurt when she touch it.
Father: dead :complication post operation for a prostate cancer
Mother: dead :gallbladder cancer
Parents: brother:3 sister:1 alive
grandmother: dead :trouth cancer
uncle: dead : colon cancer
Falciform anemia: no Tuberculosis: no
Diabetes: no Syphilis: no
Arthritis: no Alcoholism: yes
Cancer: yes Dementia: no
Heart disease: no Epilepsy no
Hypertension: no Hepatitis: no
Hemophilia: no Goiter: no
note: Sister was oper
Drugs: oral anticonceptive and Fosamac
Scholastic dreegre: University
Pathologic personal antecedents:
Anemia: no Syphilis: no Nephrophaties: no
Hepatitis: no Asthma: no Heart disease: no
Epilepsy: no TBC: no Lungs disease: no
Malaria: no Allergy: no Hypertension: no
Parotitis: yes Diabetes: no Cancer: no
liver disease: no
No others disease.
Interrogatory by system and devices:
Digestive: pyrosis after meals, she deny hematemesis, melena, diarrhea and constipation.
Cardiovascular: She deny thoracic pain, dyspnea, hypertension and edema.
Respiratory: She deny hemoptysis, asthma and cough.
Urinary: She deny frecuently urina, pyuria, hematuria and dysuria
Genital: Pregnancy:4 Birth:3 Cesarea:0 abort:1
Nervous System: normal
Endocrinology System: she deny polyuria, polyphagia,goiter.
General Inspection: awareness, good nutritional condition
eyes: normoreactives, symmetrical pupillas, normal fundus of the eye, without icteritious.
Mouth: normal teeth, hydrated mucosa, rest normal.
Nose: without epistasis, without secretions.
ears: clear, otoscopy normal.
neck: present a nodule in the rigth lobule of the tyroid, without adenophaty, without yugular dilatation.
Thorax: normal, symetrical.
breast: normal, without masses, symetrical.
heart: normal, withoutheart bruit.
lungs: normal, without murmurs, without bruit.
skin and mucose: normal
Nervous system: normal
Description: Growth of the tyroid gland predominantly of the rigth lobule. There is two focal defects in the rigth lobule.
- There is a focal defect of approximately 1 cm of diameter in the medial side of the upper 1/3 of the rigth lobule
- There is a focal defect that occupy approximately the 70% of the inferior 2/3 of the rigth lobule.
The visual index of the tyroid function (relation given by the tyroid activity/ the activity in the salivary gland and the bottom) is normal.
Nodular Goiter. The focal defects describes in the rigth lobule correspond to a solid cold nodule. Is suggested to consider a biopsy by fine neddle.
from: rigth lobule.
Hemorragic slide, with a few leucocytes and to
little folicular cells without pathology.
Cytologic diagnosis: Negative by malignant cell.
T4: 9.49 ug/dl (4.5 - 12.5)
TSH: 0.38 uUI/ml (0.3 - 5.0)
One Doctor want to make a surgery of the rigth
half of the tyroid gland, he said that it's better to remove it now because
althougth it is not malignant, in the future it may become malignant and
it's better to do it now, than later. Another said that is better gave
she some medicine first to see if the nodule disintegrate, and he prescribe
to her: Synthroid (100mg) #100 1 capsule once per day oral.
We haven't decide yet what to do. Would you please discuss the case bettwen you and give me your advice, we don't know wath to do. We will appreciate it.
I'm sorry for all the mistake that I made in here, but I hope you'll understand, I did my best to traslate the case. Any thing that you don't understand or that is not clear, just ask me and I'll find the way to send you the rigth words.Thanks.
It sounds as though your mother has a goiter with a palpable
thyroid nodule which was photopenic on the scan. the isotope used Tc99
or I123 is not known. The aspiration of the thyroid indicated that there
was inadequate amounts of follicular material to make a conclusive diagnosis.
My advice would be to obtain a second aspiration the nodule, preferrable using
ultrasound guidance. Failing to gain a secure diagnosis at that point,
perhaps a biopsy or lobectomy would then be indicated to make certain thyroid
cancer is not being missed. also, a serum thyroglobulin level should be
obtained as a potential marker for thyroid cancer.
The American Association of Clinical Endocrinologists and The Endocrine Society (both links on our pages) maintain a listing of members for referral.
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