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  #1  
Old 07-25-2011
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Thyroid Pick the appropriate Thyroid/Parathyroid Study!

A 35-year-old woman is evaluated because of episodes of severe headaches, tremulousness, palpitations, and anxiety. The patient also has noted a change in her voice and difficulty swallowing solids. Blood pressure is 160/110 mm Hg, and pulse is 150 min. Physical examination shows a palpable, nontender swelling in the front of her neck that moves with deglutition. Nontender cervical lymphadenopathy is noted on both sides of the neck. Magnetic resonance imaging (MRI) of the abdomen discloses a mass in the right adrenal medulla. Laboratory studies show hypercalcemia. Which of the following serum studies is the most appropriate next step in diagnosis?

A. Antithyroglobulin antibodies
B. Calcitonin concentration
C. Parathyroid hormone (PTH) concentration
D. Thyroid-stimulating hormone (TSH) concentration
E. Thyroxine (T4) concentration
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  #2  
Old 07-25-2011
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i was confused between b or c but i think its a men 2a so its b)

Last edited by lucas05; 07-25-2011 at 03:47 PM.
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  #3  
Old 07-25-2011
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Really got me confuse this question, but lets work it..

Medullary Ca Thyroid ( The mass on the neck )
Hyperparathyoid ( because of levels of calcium )
and Adrenal mass... ( PheoChromocytoma )

So i would likely go for Levels of Calcitonin to asset a possible "Multiple Endocrine Neoplasias" type 2! which is

Medullary thyroid cancer ( calcitonin levels )
Parathyroid tumor ( Pth levels )
Pheochromocytome

So, i will go with answer B
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Old 07-25-2011
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I think is a MEN 2a....so B)
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Old 07-25-2011
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I think its C,,, coz in men 2a parathyroid hormone levels are more important
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Old 07-25-2011
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I'd probably choose B, because I suspect here MEN IIa... but I'm not sure. That's an interesting question.
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Old 07-25-2011
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B) Calcitonin cuz it might be medullary CA of thyroid
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Old 07-25-2011
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IT SHOULD BE b)
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Old 07-26-2011
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Correct Answer Correct answer

The correct answer is B)

The patient has multiple endocrine neoplasia (MEN) syndrome type 2a. It is an autosomal dominant disease with a triad of hyperparathyroidism (hypercalcemia, hypertension), pheochromocytoma (increased catecholamines, hypertension), and medullary carcinoma of the thyroid. The thyroid mass in this patient is medullary carcinoma, which derives from C cells. C cells synthesize calcitonin. Only 10% of cases of medullary carcinoma are familial (90% are sporadic). Serum calcitonin is the best tumor marker for the cancer. Calcitonin is converted into amyloid within the thyroid gland. Patients with the familial variant have a 50% five-year survival rate. This patient has metastasis to the cervical lymph nodes, so the prognosis is likely to be worse.

A) Serum antithyroglobulin antibodies are increased in Hashimoto thyroiditis. The patient does not have any signs of hypothyroidism (e.g., muscle weakness, periorbital puffiness).

C) The patient has primary hyperparathyroidism, which is most often due to a parathyroid adenoma. The serum PTH is increased in hyperparathyroidism. However, the parathyroid adenoma is not responsible for the thyroid mass, because they generally are nonpalpable and do not metastasize to cervical lymph nodes. Therefore, a serum PTH is not helpful in defining the cause of the thyroid mass.

D) The serum TSH would be normal in this patient, because there are no signs of either hypothyroidism or hyperthyroidism. Serum TSH is not altered by thyroid cancer.

E) The serum T4 would be normal in this patient, because there are no signs of either hypothyroidism or hyperthyroidism. Serum T4 is not altered by thyroid cancer.
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  #10  
Old 07-26-2011
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calcitonin concentration (pheochromocytoma + medullary carcinoma MEN type 2)
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  #11  
Old 03-22-2012
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Default WOW!

Fantastic explanations which make it easier to comprehend. Thx
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