#ecuimres transcript

Healthcare Social Media Transcript

From: Fri Nov 09 0:00:00 PST 2012
To: Fri Nov 09 8:00:00 PST 2012

What is #ecuimres? Who were the influencers during this time period? #ecuimres analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

nephondemand
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#ecuimres #grandrounds 11/9: MultiNodular goiter by Dr A Drake. Profile here http://t.co/xvpUvbcI #endocrinology #goiter #hyperthyroidism
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: #thyroid nodule prevalence increases w/age, almost 4x greater in women than men #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: thankfully 95% of #thyroid nodules r benign; many pts have incidental nodules #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: probability incr w/age, female sex, iodine deficiency, & cig smoking #endocrinology
ecuimchiefs
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#ecuimres #grandrounds Dr Drake begins his talk "Multinodular Goiter: Evaluation & Management" #meded #medicine #endocrinology #goiter
ecuimchiefs
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#ecuimres #grandrounds: in a proliferating thyroid local growth factor expression is inc #meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: exact etiology of MNG development is still not clearly understood but has 2 do w/either #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: ...genetic susceptibility or iodine deficiency or both #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: think there is underlying genetic susceptibility in MNG ESP in endemic areas#meded #endocrinology #medstudents
ecuimchiefs
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#ecuimres #grandrounds: Pendreds syndrome: AR defect in pendrin; pt has deafness, goiter & hypothyroidism #meded #endocrinology #medstudents
ecuimchiefs
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#ecuimres #grandrounds: environmental goitrogens: iodine,millet, soybean,selenium & iron def #meded #endocrinology #medstudent #medstudents
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: growth rate of the #thyroid gland in MNG is variable but considered 2 b 4.5% annually #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: long term #goiter growth rate is poorly studied!! #meded #endocrinology #medstudent #medschool #medstudents
ecuimchiefs
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#ecuimres #grandrounds: work up of MNG: check TSH, then US thyroid to characterize #goiter nodules #meded #endocrinology #medstudent
ecuimchiefs
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#ecuimres #grandrounds:w/u does NOT routinely include thyroglobulin. Best eval is FNA! #goiter #meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: an FNA is the most effective method 2 eval a suspicious nodule; hot nodules generally don't need FNA
ecuimchiefs
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#ecuimres #grandrounds: ask pts about RTX to neck or FHx of MNG or sx hypo- or hyperthyroidism #meded #endocrinology #medstudent
ecuimchiefs
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#ecuimres #grandrounds: overall risk of #cancer of MNG approx 5% same as solitary nodule #meded #endocrinology #medstudent #oncology
nephondemand
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#ecuimres #grandrounds 11/9: in MNG, it is rec'd 2 FNA more than 1 nodule as long as size is > 1-1.5 cm Radiology 237:794 #endocrinology
ecuimchiefs
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#ecuimres #grandrounds:if u only bx largest nodule in MNG, risk 30-50% chance missing #cancer #meded #endocrinology #medstudent #oncology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: a #thyroid scan is not needed if TSH is normal #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: "indeterminate" bx results doesn't tell u much! Haven't ruled out #cancer #meded #endocrinology #medstudent
ecuimchiefs
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#ecuimres #grandrounds: MCC of "indeterminate" path = follicular #cancer #meded #endocrinology #medstudent #oncology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: most common dx of an "Indeterminate" FNA is follicular neoplasm; can't tell if benign or malignant
ecuimchiefs
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#ecuimres #grandrounds: repeat FNA if molecular testing is done-mRNA expression analysis being studied now#meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: FNA can't distinguish between follicular adenoma from follicular carcinoma #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: 4 an indeterminate FNA, u can do an mRNA expression analysis w/NPV 4 carcinoma of 95% #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: MNG can cause local compressive sxs=dysphagia, DOE, hoarseness, pressure sensation #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9: local compressive sxs can b eval by non-con neck CT 4 trach deviation or substernal extension #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: Eval of compressive sx from #goiter includes a good PE & non contrast CT neck #meded #endocrinology #medstudent
ecuimchiefs
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#ecuimres #grandrounds: flow-volume loop can show extra thoracic restriction from #thyroid #goiter #meded #endocrinology #medstudents
nephondemand
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#ecuimres #grandrounds 11/9: a PFT w/flow-volume loop will show extra-thoracic compression like a MNG #endocrinology http://t.co/Aj4vOwwx
nephondemand
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#ecuimres #grandrounds #goiter: total or near-total thyroidectomy indicated 4 local compressive sxs; synthroid doesn't work #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: any alt to #surgery in nontoxic MNG? Large doses of I131 study by @AnnalsofIM #meded #endocrinology #medstudent
ecuimchiefs
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#ecuimres #grandrounds: @AnnalsofIM study showed 75% improvement in nontoxic MNG sx! #meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds: 4 a non-toxic MNG, I-131 can reduce #thyroid volume by 40% in 1yr w/improvement in compressive sxs #endocrinology
nephondemand
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#ecuimres #grandrounds: major drawbacks 2 I-131 is radiation thyroiditis, large radiation exposure --> incr lifetime risk of CA
ecuimchiefs
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#ecuimres #grandrounds: 35-56% improvement when pretreat with rTSH prior to I131 in nontoxic MNG #meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds: recombinant TSH + I-131 further lowers #thyroid volume by additional 35%, but not yet FDA approved #endocrinology
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: rTSH and I-131 https://t.co/DfMhsbQB #endocrinology
ecuimchiefs
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#ecuimres #grandrounds: thyroid scan- functional charact #thyroid & Radioactive I- scan is a num charact #meded #endocrinology #medstudent
nephondemand
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#ecuimres #grandrounds 11/9 #goiter: levothyroxine not rec'd 4 treatment OF MNG #endocrinology

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