If Mrs Patel's Hba1c is being monitored, so presumably is her TSH
(thyroid stimulating hormone), yet she is on a sub-physiological dose of
Levothyroxine. My immediate thought (long shot I grant you!) is papillary
carcinoma of the thyroid with lung metastases.
Investigations: chest x-ray, and scanning of chest and thyroid.
Start NSAID for pain and if my most tentative diagnosis is confirmed
high dose Levothyroxine.
I would explain that it is unusual for such a low dose of thyroid
replacement to work adequately which suggests "there might be something
else going on" - hence the need for further tests.
Competing interests:
None declared
Competing interests:
No competing interests
20 February 2006
Stephen Head
General Practice Performer
Middleton Lodge, New Ollerton, Newark, Nottinghamshire, NG22 9SZ.
Rapid Response:
Is this a thyroid issue?
If Mrs Patel's Hba1c is being monitored, so presumably is her TSH
(thyroid stimulating hormone), yet she is on a sub-physiological dose of
Levothyroxine. My immediate thought (long shot I grant you!) is papillary
carcinoma of the thyroid with lung metastases.
Investigations: chest x-ray, and scanning of chest and thyroid.
Start NSAID for pain and if my most tentative diagnosis is confirmed
high dose Levothyroxine.
I would explain that it is unusual for such a low dose of thyroid
replacement to work adequately which suggests "there might be something
else going on" - hence the need for further tests.
Competing interests:
None declared
Competing interests: No competing interests