Todays discussion of a patient admitted with atrial fibrillation with RVR brought up several important points. Will not dwell on A-fib here as it was discussed extensively last week. One is proper dosing and adjustment of thryoid hormone supplements. Start low and go slow, especially in the elderly and patients with cardiac disease. Also remind patients to take their mediciation in the AM on an empty stomach. Erratic dosing produces erratic results.
Interpreting results of parathyroid hormone testing can be a challenge. Values in the "normal" range represent hyperparathyroidism if the calcium is elevated. Don't forget to evaluate for vitamin D deficiency as a cause of secondary hyperparathyroidism, but in those cases serum calcium should be low, not high. This July 11, 1999 Lancet review covers all you every wanted to know about hyperparathyroidism.
Pearl - hypothyroid patients often have elevated lipids, and thyroid hormone supplementation reduces LDL cholesterol but has no effect on HDL, triglycerides, apo AI or Lp(a). Expect to see something about this on boards. See here and here for more info.
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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