Case 2 Endocrinology Part 2 Answers

Endocrinology Case 2

Expanded Case Evaluation
Expert's Answers

A. Expanded Database - Diagnostic Test Results

1 Test / Procedure: Trichogram
Results:

The majority of roots are "club" shaped and hyperkeratotic.

Review indications & protocol in notes.

What is your assessment?
These are telogen hair and this finding is very suggestive of an endocrinopathy.

2 Test / Procedure: Skin Scraping
Results:

Negative

Review indications & protocol in notes.

What is your assessment?
Demodecosis is not present.

3 Test / Procedure: ECG
Results:

Marked bradycardia. Prolonged PR interval.

Review indications & protocol in notes.

What is your assessment?
First degree heart block is present.

4 Test / Procedure: Thyroid Profile
Results:

Total T4: 3 (5-22 ng/ml; fT4: 0.2 (0.5-3.0 ng/ml); cTSH: 1.2 ng/ml (0-0.6 ng/ml)

Review indications & protocol in notes.

What is your assessment?
Primary hypothyroidism is confirmed.

B. Final Diagnosis

Primary hypothyroidism with hyperlipemia and non-regenerative anemia

C. Therapeutic Plan

L-thyroxine: 20-40 mcg/kg divided q12 h for 3-4 weeks. Post pill testing should be performed at that time. Maintenance dose is 10-20 mcg/kg divided q12h. Assess lipemia status once euthyroidism has been established.

To view other manifestations of hypothyroidism, click on the image at right.

Endocrinology Case 2

Expanded Case Evaluation Expert's Answers

Expanded Case Evaluation
Expert's Answers