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THYROID PBL, Diffusely large Rubbery consistency - Coggle Diagram

- - - - T3 T4 TSH
        
        Different people respond differently, if hyper -> may undergo another thyroidectomy, if hypo -> Give L-T4 50mcg/day and dose adjust accordingly every 1 to 2 weeks until normal TSH achieved
      - Calcium Level
        
        Radioiodine can affect parathyroid gland, damage to Parathyroid gland affects calcitonin secrete, which affects calcium homeostasis
        
        IV Calcitriol, Calcium supplement, IV calcium infusion
  - - - TSH & TRAb
    - - Iodine level and its absorption by thyroid
    - - To check for the size of thyroid
  - - - Radioiodine Therapy
        
        Reasons
        
        Patient is allergic to both carbimazole and propylthiouracil (PTU) and must be discontinued
        
        Thyroidectomy is not suitable for this patient, due to patient's career as a singer, as this procedure will affect his voice.
        
        This treatment might not be the ideal treatment for this patient because this patient's hyperthyroidism is not stable. However this treatment is the best option out of the three
        
        Before starting the radioiodine therapy, patient must be given medication to manage his hyperthyroidism situation
    - - Lithium Carbonate
        
        :check: Inhibits thyroidal iodine uptake.
        :check: Inhibits iodotyrosine coupling.
        :check: Alters thyroglobulin structure.
        :check: Inhibits thyroid hormone secretion.
        
        The dose shell be given ranging from 0.6 to 1.2 mmol/L and It is relatively safe that lithium carbonate was given 0.75 g/day. The dose is adjusted according to the serum-lithium concentration.
      - Propranolol Hydrochloride
        
        :check: It doesn't inhibit the production of thyroid hormone
        :check: It helps to relieve symptoms of hyperthyroidism
        :check: It blocks the peripheral conversion of inactive T4 to active form T3
        :check: Help relief the patient's systolic hypertension and elevated hear rate
        
        10 to 40 mg, 3 to 4 times a day. Max 160mg/day
    - - Radioiodine therapy
        
        This treatment is needed only once, but it can be repeated every 3 month if addition treatment is needed.
- - - - Since the patient's condition is classified as subclinical hypothyroidism. Dose given is 50-100ug per day. Dosage can be adjusted to maintain normal TSH levels in the patient.
      - Initial dose: 1.5ug/ kg orally once a day
      - Adjustment dose is done at 6-8 weeks intervals until clinically euthyroid and TSH is normal level
    - - Diet changes
        
        High adaptogen content
        
        Ginseng
        
        Wild Blueberries
        
        Tumeric
        
        High selenium content
        
        Brazil nuts, egg yolk, seafood such as octopus, oyster and cuttlefish
        
        Reduce consumption of inflammatory foods
        
        Sugar, saturated fats, preservatives, dairy
        
        May have to perform allergy test to check allergic food
      - Stress relief
        
        Activities such as yoga, meditation and breathing exercises
  - - - Large painless swelling
      - No signs ❌:
        
        Thyrotoxicosis
        
        Thyroid : failure
    - - 2 years
    - - a. Normal
        
        T3
        
        T4
        b. TSH elevated(5.3mU/l)
        c. Presence of anti-thyroid peroxidase
        Euthyroidism
        
        Hashimoto disease -> Autoimmune disorder.
        
        Chronic Lymphocytic Thyroiditis or Autoimmune Thyroiditis.
      - Research:
        
        Loyola university
        Women to Men
        8:1
        
        Jialal I (NIH)
        
        Pathophysiology not well understood
        Common lab findings:
        
        Anti-thyroid peroxidase (anti-TPO).
        
        Elevated thyroid-stimulating hormone (TSH)
        
        Low levels or normal T4.
        
        Presence of thyroid peroxidase ~ Biochemical marker of Hashimoto disease.
        
        Hashimoto's commodities by Ruggeri
        
        Different nonthyroidal autoimmune diseases
        
        Further investigation may needed
  - - - After 14 days we need to follow up the patient condition for adjusting the drug regimen
      - monitor her TSH, T3 and T4 level this can be done by doing thyroid blood test or more specific the triiodothyronine test to specifically, test can be done by every 6-8 weeks
      - weight management, pulse and blood pressure routinely check-up. We need to monitor patient TSH and Thyroid hormone
      - Steroid can be given when necessary : prednisolone15mg OD
      - Selenium supplement
      - superior laryngeal nerve injury - voice might change
      - thyroidectomy may damage/remove parathyroid gland, if so then patient might experience hypocalcaemia. Should be monitored and given IV Calcitriol, Calcium supplement, IV calcium infusion