n****a
发帖数: 2525 | 1 Young patient, 28 yrs old. Had Hx of Hashimoto, thyroid removed around 2001.
On Synthroid tx, but on 2002 had her first episode of pancreatitis, with
lipase in 3000s. Subsequently had repeated episodes of abdominal pain, many
thought it as pancreatitis, but lipase has always been normal, with CT ab
not showing any calcifications in the abdomen.
Patient here this time again, GI feels it is pancreatitis again. She takes
Synthroid regularly according to herself but TSH always elevated.
I know that Hashimoto can be associated with autoimmune pancreatitis, we are
waiting for serology. Hashimoto can also be related to Celiac, which then
can cause pancreatitis. I just checked for Celiac (but patient has been NPO
for last 3 or 4 days).
Not sure what this patient has this time? Is it pancreatitis? MRCP shows
normal pancreas this time.
Does anyone know what are the associations with severe hypothyroid and GI
symptoms. Does hypothyroid cause pancreatitis in any mechanism that I am not
aware of? I am still waiting for IgG4 to prove autoimmune pancreatitis.
Does anyone have any suggestions or ideas? | A*******s
发帖数: 9638 | 2 It seems to me besides the pancreatitis, something else may play a role in
her symptoms.
When plasma amylase is increased, but the lipase is normal, a nonpancreatic
condition is almost always the cause.
http://www.enotes.com/amylase-lipase-tests-reference/amylase-li
I would consider a GI workup for any other organic diseases including
diverticulitis. For a rare condition, porphyria can cause similar symptoms
in young females. | y******a
发帖数: 590 | 3 Can u describe the abdominal pain and your PE findings first? And what are
pertinent positive and negative tests result? And why pt had thyroidectomy
in the past? | n****a
发帖数: 2525 | 4 Thyroidectomy for Hashimoto's, because the Hashimoto caused multinodular
goiter.
Her PE findings are rather benign actually. Soft, tender in most quadrants,
but mostly in epigastric region, bowel sounds present, no masses, no rebound
. Basically a rather benign abdominal exam.
Somebody suggested porphyuria, but I can't see the link between the 2 though
...
are
thyroidectomy
【在 y******a 的大作中提到】
: Can u describe the abdominal pain and your PE findings first? And what are
: pertinent positive and negative tests result? And why pt had thyroidectomy
: in the past?
| a*********d
发帖数: 2763 | 5 what's the triglyceride?
what did abdominal CT show?
is she on OCP since she is 28 years old?
How elevated is her TSH?
severe hypothyroidism will show cognitive signs and rarely related to pancreatitis. her hypothyroidism might have nothing to do with her abdominal pain at all. tons of people who are admitted to hospitals have hypothyroidism because it's such a common disease. | A*******s
发帖数: 9638 | 6 I concur. Thyroid disease may just be an independent medical condition and
plays no roles in her abdominal pain.
pancreatitis. her hypothyroidism might have nothing to do with her abdominal
pain at all. tons of people who are admitted to hospitals have
hypothyroidism because it's such a common disease.
【在 a*********d 的大作中提到】
: what's the triglyceride?
: what did abdominal CT show?
: is she on OCP since she is 28 years old?
: How elevated is her TSH?
: severe hypothyroidism will show cognitive signs and rarely related to pancreatitis. her hypothyroidism might have nothing to do with her abdominal pain at all. tons of people who are admitted to hospitals have hypothyroidism because it's such a common disease.
| w***0
发帖数: 222 | 7 I see your point and the thinking process. It is legitimate to have the
autoimmune related as one of your differentials.
are you going to tell us the labs/studies? you mentioned MRCP NL and
previous recurrent abdominal pain and past diagnosed diseases including
pancreatitis.
I am following your thinking and thought you might show us some more
results
suggesting the patient has autoimmune cholangitis or "something like
that"
Personally, I still believe this is a recurrent pancreatitis (common
things first); if there is no abnormal lab at all; then I would say
clinically diagnosed
since your GI attending said so.
multinodular
quadrants
,
rebound
though
【在 n****a 的大作中提到】
: Thyroidectomy for Hashimoto's, because the Hashimoto caused multinodular
: goiter.
: Her PE findings are rather benign actually. Soft, tender in most quadrants,
: but mostly in epigastric region, bowel sounds present, no masses, no rebound
: . Basically a rather benign abdominal exam.
: Somebody suggested porphyuria, but I can't see the link between the 2 though
: ...
:
: are
: thyroidectomy
| I****a
发帖数: 407 | 8 I am not GI but to me it is hard to justify pancreatitis with normal enzyme
in acute setting plus a normal MRCP. With somebody who has autoimmune
tendency, GI vasculitis may be considered in the differential. I agree with
A++, acute intermittent porphyria is possible and a urine porphyrins
including porphobilinogen can be easily done. I guess if all are negative,
she then might have somatization disorder. | n****a
发帖数: 2525 | 9 Thanks everyone for replying.
It's been 12 days into her hospital stay, she is still in pain. Her IgG4 to
look for autoimmune pancreatitis was negative, lab ordered for possible
Celiac (which leads to poor absorption of Levothyroxine and pancreatitis
link) also negative. GI still thinks pancreatitis, might have been
exacerbated by cold meds she was taking that has some ETOH content. EGD was
done by GI only showing gastritis. CT ab showed nothing but cysts, no
pancreatic cyst or pseudocyst or other bowel pathology. Obviously Ob-Gyn
said these cysts are not the culprits.
Her U/S ab on admission did show liver of 18 cm. No stones.
Psych said she is not crazy, but who knows... but I am still bothered by her
symptoms... any other suggestion? | s**********t
发帖数: 217 | 10 What does she ask for pain? Dilaudid? You get the answer. Did you check her
UDS at adm? | w***0
发帖数: 222 | 11 Then she has hepatomegaly by the ultrasound; was it also noted on your
physical exam? MRCP "nl" reviewed by the GI?
12 days, is she still complaining abdominal pain? no change?
you may have to tell people more about the "pain", when, where, how and what
. assuming she was on NPO and now on what and since when?
fever ever?
if this is a real case, it might be difficult for you to provide her social
history here.
It will be very helpful for people to know if you have more lab results,
urine, blood, LFTs, ...... only if you comfortable to reveal whatever to the
public here.
to
was
【在 n****a 的大作中提到】
: Thanks everyone for replying.
: It's been 12 days into her hospital stay, she is still in pain. Her IgG4 to
: look for autoimmune pancreatitis was negative, lab ordered for possible
: Celiac (which leads to poor absorption of Levothyroxine and pancreatitis
: link) also negative. GI still thinks pancreatitis, might have been
: exacerbated by cold meds she was taking that has some ETOH content. EGD was
: done by GI only showing gastritis. CT ab showed nothing but cysts, no
: pancreatic cyst or pseudocyst or other bowel pathology. Obviously Ob-Gyn
: said these cysts are not the culprits.
: Her U/S ab on admission did show liver of 18 cm. No stones.
| n****a
发帖数: 2525 | 12 浪费大家的脑细胞了。。。
结果证明她除了精神，并没有其他病。。。
还是谢谢大家的建议 | A*******s
发帖数: 9638 | 13 IBS?
Did you test for porphyria?
【在 n****a 的大作中提到】
: 浪费大家的脑细胞了。。。
: 结果证明她除了精神，并没有其他病。。。
: 还是谢谢大家的建议
|
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