1. - Normal TFT lab values: TSH =0.5 to 5.0, T3 µU/mL, T4 =5-12 µg/dL, - Screening of women over 50 Years with TFT is recommended -SUB-Clinical Hypothyroidism= TSH of 5 to 10 + Normal T4 + NO S/S =NO Rx -SUB-Clinical Thyrotoxicosis= low TSH + Normal T4 + NO S/S -American college of Physicians recommends screening w/ TSH for all Females over 50 years -Dx of PheoChromoCytoma is EXTR-adrenal in 10% of pt., and is Bilateral in 10% of pt. -Rx. of Hyperthyroidism with ANY Cardiac S/S is 1st Propanolol (PO) 2nd Anti-thyroid Rx. -Rx. of intraoperative hypertension is phentolamine(IV) -Rx of intraoperative Hypotension is Normal Saline(IV) Bolus. -MCC of atrial fibrillation in the US is Grave's Disease NOT mitral stenosis. -ALL types of thyroiditis, including Hashimoto's thyroiditis present with Hyperthyroidism 1st, then become hypothyroidism. - TSH, Free T4, & Free T3 are NOT changed during pregnancy.
2. Symptomatic Hypothyroidism
   1. S/S Hypothyroidism
      1. High TSH
         1. Low free T4
            1. positive Anti-Thyroid Peroxidase Antibody
            2. Dx. PostPartum Thyroiditis if hx. or recent delivery
            3. 20% stay hypothyroid
            4. 80% recover
            5. Inv. Radio-Active Iodine uptake scan= Diffuse reduction in thyroid uptake
            6. Dx. Hashimoto's thyroiditis
            7. young = Thyroiditis
            8. painful
            9. Dx. Sub-Acute Thyroiditis
            10. Painless
            11. Dx. Painless Thyroiditis
            12. 100% recover
            13. Dx. Iodine Deficiency
   2. S/S Ob/Gyn
3. Normal Physical Exam especially in an over 50 y. female
   1. High TSH
      1. Normal free T4
         1. Asymptomatic
            1. + Anti-thyroid-Ab.
            2. Abnormal lipid profile
            3. more then 10
            4. Rx. Levothyroxine
            5. + Hx of thyroid CA
            6. Increase Levothyroxine to keep TSH @ a level of 0.1-0.3
            7. 5-10
            8. No Rx. needed
   2. LOW TSH
      1. Normal free T4 & Normal Bone density test
         1. Asymptomatic
            1. No Rx & Repeat TSH level in 6 weeks
4. Symptomatic HYPERthyroidism
   1. LOW TSH
      1. HIGH free T4
         1. test for serum Thyroid Receptor Antibodies (TRAb) & Thyroid Stimulating Immunoglobulins (TSI). & Anti-Thyroid Peroxidase Antibody
            1. Positive
            2. Dx. Grave's Disease
            3. Negative
            4. Inv. Radio-Active Iodine uptake scan
            5. INCREAS UPTAKE
            6. FOCAL uptake confirms
            7. Dx. Toxic nodule
            8. DECREASE uptake
            9. Dx. excess thyroxine medication
            10. Anti-Thyroid Peroxidase Antibody
            11. Dx. Hashimoto's Thyroiditis
   2. NOrmal TFT
      1. Episodic attacks of Hypertension and hyperthyroidism
         1. Initial test : Bl. Plasma free META-NEPHRINE levles OR 24h Urinary levels of META-NEPHRINE & Catecholamine & Venillyl-Mandilic Acid (VMA)
            1. Dx. PheoChromoCytoma
            2. 1st:Phenoxybenzamine(PO) for 14 days before surgery to Rx. HTN
            3. 2nd step: MRI is better then CT to localize the tumor
            4. Radio-Active Meta-Iodo-Benzyl-Gyanidine (MIBG) Scan can aid in confirming the Dx if Bl., Urine, or imaging tests are equivocal
5. Apathetic thyrotoxicosis= Elderly with mental Status changes, weight loss