Discussions By Condition: I cannot get a diagnosis.

Endocrine Disorder: can you help me to confirm that my diagnosis is right please?!

Posted In: I cannot get a diagnosis. 3 Replies
  • Posted By: tanja145
  • May 23, 2009
  • 07:39 AM

60 male,
weakness and confusion
hypotension
bradycardia
looked pale but had erythematous cheeks and hand
core Temperature 36 degrees celcius
slow relaxing ankle jerks

his condition improved quickly with treatment, was discharged on oral medication looking well and feeling better.

represented to A&E after 6 weeks with shock.


UNDERLYING ENDOCRINE PROBLEM AT PRESENTATION: i think it's hypothyroid, but his looking pale with erythematous cheeks and hands does not convince me.

MANAGEMENT ON PRESENTATION: replacement therapy for hypothyroid: T4. start with loading dose then adjust according to response. lower doses in IHD and elderly pts.

TWO POSSIBLE CAUSES OF PTS's READMISSION: - HELP WITH THIS PLEASE!!!
* He took too much T4, resulting in cardiac arrythmias
* He suffered myxoedema coma
OR * pt had IHD, and the treatment precipitated angina and MI => cardiogenic shock
OR * addisonian crisis because he was not given concurrent hydrocortisone theraphy.

WHAT IS THE ACUTE AND LONG TERM MANAGEMENT OF THIS CONDITION?
acute - levothyroxine loading dose then tail off for maintenance on a daily basis
correct metabolic disturbance
warm patient if hypothermic
treat precipitating factors

long term: + IV hydrocortisone as impaired adrenal function is present in profound hypothyroid.


That's all! Please help, I just couldn't get around this thing! :o

Reply Flag this Discussion

3 Replies:

  • Was patient on any other medications including OTC meds before the shock episode? DOM
    acuann 3080 Replies Flag this Response
  • no, he should not have been on any other medication, apart from that given the first time around.(Btw, this here is a case i found in a book, which I am doing as practice for my exams. There are no answers, and I got stuck. Thanks a lot for any help!)
    tanja145 5 Replies Flag this Response
  • Any help please?? I would appreciate any help coz I have a test soon! thanks to all who respond!:(
    tanja145 5 Replies Flag this Response
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