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.
2. Symptomatic Hypothyroidism
   1. S/S Hypothyroidism
      1. High TSH
         1. Low T4
            1. Inv. Radio-Active Iodine uptake scan= Diffuse reduction in thyroid uptake
            2. young = Thyroiditis
            3. painful
            4. Dx. Sub-Acute Thyroiditis
            5. Painless
            6. Dx. Painless Thyroiditis
   2. S/S Ob/Gyn
3. Normal Physical Exam especially in an over 50 y. female
   1. High TSH
      1. Normal 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 T4 & Normal Bone density test
         1. Asymptomatic
            1. No Rx & Repeat TSH level in 6 weeks
4. Symptomatic HYPERthyroidism
   1. LOW TSH
      1. HIGH T4
         1. test for serum Thyroid Receptor Antibodies (TRAb) & Thyroid Stimulating Immunoglobulins (TSI).
            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
   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