February 3, 2022 Type 1 Webinar on non-nodular thyroid diseases

Twin cases - case 195 and case conp 043


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Clinical data

Case 195

Clinical presentation: A 37-year-old woman requested a second opinion. She suffered from fluctuating periods of hypothyroidism and hyperthyroidism for more than 2 years. Despite great efforts including steroid therapy, combination of replacement and thyrostatic therapy and unusually frequent follow-up examinations (checking hormone-levels every 2 to 4 weeks) to maintain euthyroid state, the patient presented alternating severe hypothyroidism and hyperthyroidism within several weeks. The patient lost her patience because she wanted to be pregnant. It is worth noting that TSAb levels were repeatedly undetectable, while aTPO was in the range of 150 to more than 1,000 U/mL.

Palpation: no abnormality.

Laboratory tests: TSH 3.09 mIU/L, FT4 20.2 pM/L, aTPO 243 U/mL on daily 50 microgram levothyroxine.

Case conp 043

Clinical presentation: A 42-year-old woman was referred for aspiration cytology. She was examined because of 'lump in the throat' feeling two years ago. Laboratory investigations revealed euthyroidism, the anti-TPO level was elevated (880 U/mL). On repeat examination a hypoechogenic lesion was detected on ultrasound.

Palpation: Both lobes were firm, no nodule was palpable.

Laboratory tests: TSH 4.36 mIU/L, FT4 15.2 pM/L.

Topics

  • Interpretation of discrete lesions in Hashimoto's thyroiditis.

  • The role of the usual suspicious ultrasound characteristics in thyroiditis.
  • Respect/accept the limitations.

 

 

 

 

 

 

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