Endocrine System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S14_F1.jpg"}},{"insert":"\n\nYou\u0027ve had a very long day, but finally, all the documentation is wrapped up. The smell from the box of Thai food next to you is almost irresistible\u2014and now, you don\u0027t need to resist it anymore.\n\nNo soon have you opened the box that your nurse calls out: \u201cDoctor, you need to see Mr. Mehta.\u201d \n\nPutting the box aside, you hurry out into the surgical ward.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S14_F3.jpg"}},{"insert":"\n\nForty-year-old Pratik Mehta first came to your clinic around three weeks ago, after he noticed a lump in his neck. A careful history revealed that he had lost five kilograms during the preceding three months, and that he had also experienced excessive sweating and heat intolerance. On physical examination, you found the thyroid glad to be diffusely enlarged, with a dominant nodule in the left lobe. Follow-up questioning revealed that no obstructive symptoms were present.\n\nUltrasound of the neck confirmed a multinodular goiter with a dominant nodule. Cytology showed this to be benign in nature. Thyroid stimulating hormone (TSH) levels were low and free T3 and free T4 were both elevated. Based on these results, you made a diagnosis of thyrotoxicosis secondary to a toxic multinodular goiter.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S14_F5.jpg"}},{"insert":"\n\nPratik had no other comorbidities; and once you discussed the various therapeutic options with him, he opted for surgery. You started him on iodine and then scheduled a date for surgery. Subsequently, you performed a near-total thyroidectomy earlier today.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S14_F6.jpg"}},{"insert":"\n\nYou reach Pratik\u0027s side. He is agitated and confused. His temperature is 103\u02daF (39.4\u02daC). His pulse and blood pressure are 140 bpm and 120\/80 mmHg respectively. His respiratory rate is 14\/min. His oxygen saturation is 98% on room air. There is no swelling of the neck. Chvostek\u0027s and Trousseau\u0027s signs are negative. Systems examination is unremarkable.\n"}]}


{"ops":[{"insert":"Which of the following do you suspect?\n"}]}
1. Thyroid storm
2. Hypoparathyroidism