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  #1  
Old 10-20-2011
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A 46-year-old woman comes in for a followup visit. She has been checked every year since she had a pheochromocytoma of her left adrenal gland successfully removed at the age of 36 years. Her blood pressure is normal, she gives no recent history of palpitations, headache, or perspiration, and she has no complaints. On physical examination, a 2-cm hard nodule is felt in the right lobe of her thyroid gland that was not present a year ago. There is no cervical adenopathy. Which of the following laboratory studies would be most helpful at this time?



A.

Serum calcitonin


B.

Serum renin and angiotensin


C.

Thyroid stimulating hormone (TSH)


D.

Thyroxin (T4)


E.

Urinary catecholamines
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  #2  
Old 10-20-2011
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the pheo and thyroid nodule triggers an automatic response of MEN 2 (a or b)

but still first we need to look at that nodule so lets do a function test Usally TSH and t4 are done together but since this question seperates them il choose T4 lvl
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Old 10-20-2011
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i think its TSH levels
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Old 10-20-2011
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Crap, your right mazrodin TSH lvls are first checked in thyroid disorders not t4
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Old 10-20-2011
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A. Serum calcitonin ?
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Old 10-20-2011
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The correct answer is A. Given the past history, the obvious concern is medullary carcinoma. Calcitonin is likely to be elevated, confirming the diagnosis. If the patient has the Sipple syndrome, there also may be elevations of parathyroid hormone, ACTH, vasoactive intestinal polypeptide, prostaglandins, kallikreins, and serotonin, none of which were offered as options, leaving calcitonin as the only correct answer.
Renin and angiotensin (choice B) are not abnormal in medullary cancer, and neither is TSH (choice C) or T4 (choice D). Although presenting clinically as a thyroid nodule, medullary cancer is not a tumor of thyroid tissue and it does not affect thyroid function.
A thyroid mass in someone who had a pheochromocytoma is not suggestive of either metastasis or recurrence of the original tumor, and thus there is no need to pursue catecholamines (choice E) to ascertain the nature of the thyroid mass.
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Quote:
Originally Posted by docnas View Post
Crap, your right mazrodin TSH lvls are first checked in thyroid disorders not t4
See question-Patient has no history palpitation or perspiration
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