Pearls from Dr. Robert McConnell

Young woman with Grave's disease on methimazole presenting with acute liver injury


  • Grave's disease diagnosis:
    1. Presentation of new onset ophthalmopathy, large non-nodular thyroid, or other signs of hyperthyroidism
    2. Measure TSH, free T4 - TSH will be suppressed, free T4 will be elevated
    3. Radioactive iodine uptake scan - will have diffusely high radioiodine uptake
    4. Measurement of thyroidal blood flow on ultrasound - will see increased blood flow
    5. Measurement of thyrotropin receptor antibodies 

    Posted 06/29/16 10:50:36 AM by Anna Krigel

  • Hyperthyroidism-unique physical exam signs

    Posted 06/29/16 10:56:36 AM by Anna Krigel

  • Management of Grave's disease

    Methimazole - primary drug used to treat Grave's disease
    Radioiodine ablation

    Posted 06/29/16 11:13:19 AM by Anna Krigel

  • Methimazole toxicity

    Posted 06/29/16 05:14:39 PM by Anna Krigel

  • Hyperthyroidism Diagnosis and Treatment Review
    Methimazole toxicity case series

    Posted 06/29/16 05:15:37 PM by Anna Krigel

  • 85 y/o F hx of Graves who p/w thyroid storm


  • Epidemiology of Thyroid Disease

    Posted 01/12/17 09:39:22 AM by Ying Liu

  • Pathophysiology of Thyroid Storm

    Posted 01/12/17 09:43:16 AM by Ying Liu

  • 5 Blocks of Treating Thyroid Storm
    1. Block thyroid hormone synthesis with thionamides
    2. Block thyroid hormone release by giving Iodine
    3. Block T4 to T3 conversion with steroids
    4. Block enterohepatic circulation (10-30% of thyroid hormone metabolism occurs in the liver) with bile acid sequestration (cholestyramine)
    5. Block effects of thyroid hormones using beta blockade

    Posted 01/12/17 09:48:19 AM by Ying Liu

  • Wolff-chaikoff Effect

    Posted 01/12/17 09:51:10 AM by Ying Liu

  • 30yo man with lethargy, nausea, and headache found to be hypercalcemic from sarcoidosis


    63yoF w/ AMS and heavy EtOH abuse p/w myxedema coma


  • -Severe hypothyroidism can suppress ACTH.  Always check cortisol and treat for adrenal insufficiency if indicated in patients with severe hypothyroidism/myxedema coma

    Posted 01/29/18 08:59:07 AM by Emily Miller

  • Infection is often a trigger for myxedema coma.  Hypothermia from severe hypothyroidism can mask fever.  

    Posted 01/29/18 08:59:50 AM by Emily Miller

  • 30yo M with acute onset LE weakness found to have thyrotoxic periodic paralysis


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