METHODOLOGICAL DEVELOPMENT OF PRACTICAL LESSON

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Methodical development of a practical lesson, EPP "Medicine", 4th year, International Faculty,

Discipline: "Endocrinology" Page 1

ODESA NATIONAL MEDICAL UNIVERSITY

Department of Internal Medicine No. 1 with the cardiovascular pathology course

APPROVED

Head of the Department _______ (I.I. Karpenko) September 27, 2021.

METHODOLOGICAL DEVELOPMENT OF PRACTICAL LESSON

Course: 4 Faculty: International Academic discipline: Endocrinology

Practical lesson № 06 Topic: Thyroiditis. Thyrotoxicosis: clinical forms. Diffuse toxic goiter: complications of treatment. Hypothyroidism

The methodological

recommendation of the practical lesson was developed by:

Assistant

_________ (Mariakhina E.Y.)

Methodical development was discussed at the methodological meeting of the department

September 27, 2021 Protocol №2

Odesa – 2021.

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Practical lesson № 06

Topic: Thyroiditis. Thyrotoxicosis: clinical forms. Diffuse toxic goiter:

complications of treatment. Hypothyroidism

Purpose: to explain the essence of the thyroiditis, thyrotoxicosis, hypothyroidism, the causes of its occurrence, the role of various factors in the etiopathogenesis, approaches to diagnosis, treatment and prevention.

Key words: thyroiditis, thyrotoxicosis, Grave`s disease, hypothyroidism

Equipment: laptop with a presentation, a multimedia projector, individual assignments on the topic of a practical lesson

Study time: 4 academic hours (180 minutes)

Plan and organizational structure of the practical lesson І. Organizing time

1. Greetings

2. Verification of present students

3. Messages of the topic and purpose of the lesson 4. Motivation of students to study the topic

ІІ. Control of basic knowledge (written work, written test, frontal survey, etc.) 2.1 Questions to test basic knowledge of the topic of the lesson:

1. Determination of HТ, Т.

2. Epidemiology of HТ and Т in the world.

3. Risk factors for HТ and Т.

4. The mechanism of hormonal and metabolic disorders in HТ and Т.

5. Etiology and pathogenesis of HТ and Т.

6. Clinical presentation of HТ and Т.

7. Typical clinical presentation of HТ.

8. Multiple organ complications of HТ.

9. Diagnostic criteria for HТ and Т.

10. The indications for use and analysis of results of hormonal assays.

ІІІ. Formation of professional skills, skills (mastering the skills of supervising patients, mastering the skills of diagnosis, determining the treatment regimen):

3.1 task content:

1. The 45-year-old patient, after suffering from subacute de Kerven's thyroiditis, complained of progressive general and muscular weakness, fatigue, chills,

drowsiness, weight gain on the background of swelling of the face and extremities, constipation, dry skin, hair loss. On examination: the patient is lethargic, adynamic, the skin has a pale yellowish tinge, cold. The face is puffy, the eyelids are swollen, the lips are thickened. Body temperature 35.8 ° C. PS 58 per minute. An. blood total:

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Hb 100g / l, Er-3,5 * 1012 / l, L -3,5 * 109 / l, ESR 25 mm / h. The content of thyrotropin in the blood is increased, and T3 and T4 are reduced

1.What is the most likely diagnosis?

2.Plan of investigations?

3.Treatment plan?

2. Patient X., 36 years old, was admitted to the hospital with complaints of paroxysmal chest pain, palpitations, feeling of heart failure, fatigue, weakness,

sweating, frequent diarrhea, significant weight loss over the past 4 months, low-grade fever. The onset of the disease is associated with a severe protracted stressful

situation in the family 7 months ago. On examination: increased skin moisture, tremor of the fingers, trembling of the eyelids, lips, exophthalmos. On the ECG:

tachycardia, paroxysms of atrial fibrillation, elevation of the ST segment. The thyroid gland is slightly enlarged on palpation. AD 145/60 mm Hg.The doctor made a

preliminary diagnosis: "vegetative-vascular dystonia , Hyperthyroidism , Prescribed tranquilizers and cardiac drugs, but no improvement in the patient's condition was observed. The course of treatment with propylthiouracil (a substance that blocks the synthesis of thyroid hormones) carried out after additional studies gave positive results, the patient's condition significantly improved.

1.What is the most likely diagnosis?

2.Plan of investigations?

3.Treatment plan?

3.2 recommendations (instructions) for completing tasks:

# Consequence of actions Indications

1 Diagnosis of Hypothyroidism Plan of patient

examination 2 Basic clinical and instrumental laboratory data

of Hypothyroidism

Criterions of Hypothyroidism

diagnosis, tests 3 Practical actions in clinics Clinical diagnosis,

prescribe medicine

3.3 control materials for the final stage of the lesson

1. The patient was operated in connection with a diffuse toxic goiter. In 2 weeks after the operation she had short-term convulsive contractions of the limb muscles, paresthesia. Seizures occurred 1-2 times a day, more often during work. Objectively:

pulse - 72 in 1 min, blood pressure 120/70 mm Hg. From the side of internal organs, there were no abnormalities. There are symptoms of Khvostek, Tissot. Specify a presumptive diagnosis.

A Polyneuropathy

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B Hypothyroidism

C Hypoparathyroidism D astheno-neurotic

2. A 32-year-old patient had an attack a few hours after the removal of the parathyroid glands, which was accompanied by convulsions, laryngospasm, and convulsions of the respiratory musculature. What kind of first medication should I give to a patient?

A Prozerin IV / 0.05%, 0.5-1 ml

B Calcium chloride iv in 10%, 5-10 ml C atropine sulfate in / in 0.1%, 0.5-1 ml

D Potassium chloride inside 10%, 1 table each. spoonful E Dibazol in / m 0,5%, 2 ml

3. A 47-year-old patient, within 4 years, addressed to different specialists with complaints of weakness in the limbs, constant pain in the calf muscles and back. On the roentgenogram of bones revealed osteoporosis, bones, pathological fractures. The level of calcium in the blood is increased. Which of the following diagnoses is most likely?

A. Myeloma disease

B. Primary hyperparathyroidism S. Osteoblastoma

D. Postmenopausal osteoporosis E. Sarcoma Jung

4. A man turned 50 years old to an endocrinologist about the appearance of a tumor- like formation on the lateral surface of the neck on the right, which appeared 1 month ago. Objectively: the thyroid gland is 2 tbsp., In the right lobe a dense area with a diameter of about 1.5 cm is palpated, the gland does not ache. Over the back surface m. The sternocleidomastoideus case is palpated by an enlarged lymph node. What kind of research is needed to clarify the diagnosis?

A. Fine-needle-aspirating-puncture biopsy B. Ultrasound examination of the thyroid gland C. Neck Thermography

D. Scintigraphy of the thyroid gland with 99тТсс

E. Determination of the level of thyroid hormones in plasma

5. The patient, 55 years old, turned to the endocrinologist in connection with the appearance of a tumor-like formation on the neck. During the ultrasound of the thyroid gland, a hypoechoic node of the right lobe was found without a clear contour with a diameter of 2.5 cm. The research method will allow to choose the correct medical tactics?

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A Neck Thermography

B Magnetic resonance imaging of the neck C Scintigraphy with radioactive iodine

D Fine needle aspiration puncture biopsy of the thyroid nodule E Computed tomography of the neck

6. A woman, 32 years old, asked about an increase in the thyroid gland. With anamnesis it is known that during the accident at the Chernobyl NPP was in the zone of increased radioactive fallout. The enlargement of the thyroid gland marks within 1 year, it gradually progresses. Objectively: thyroid enlarged to 2 in. In it a dense knot is palpated, sedentary, painless. Submandibular lymph nodes are enlarged, painful. At US in thyroid gland the hypoechoic formation without precise borders with kaltsinatami is revealed. Blood pressure 120/70 mm Hg Pulse 78 in min. Based on the data given, the patient can be suspected

A Thyroid cancer

B Diffuse nontoxic goiter C Thyroid adenoma

D Pidgestriroiditis

7. The patient is 40 years old, has an autoimmune thyroiditis, frequent ventricular extrasystoles have appeared. The doctor appointed amiodarone for a long time. What laboratory indicators are monitored once a year in a patient?

A complete blood count B Ionogram

C Level of thyroid hormones

D Concentration of thyroid antibodies E Level of uric acid in blood plasma

8. A 37-year-old woman is treated in a hospital due to thyrotoxicosis of a severe course, goitre 2, endocrine ophthalmopathy. takes Mercazolil in a dose of 60 mg / day. For 3 weeks of treatment, a feeling of the throat began to disturb. What is the possible cause of worsening of the patient's condition?

A Neurotic condition B allergy to Mercazolil

C Medication hypothyroidism

D Ineffective treatment with Mercazolil Ezobogenny influence of Mercazolilum

9. In the first hours after subtotal resection of the thyroid in connection with a toxic goiter, the patient developed a marked mental and motor arousal. A sharp hyperemia of the face, neck, upper and lower extremities. t body - 40-41 ° C, increased sweating.

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Tachycardia is rapidly increasing, in 140-200 per minute, atrial fibrillation. What complication develops in the patient?

A Asphyxiation B Anaphylaxis Shock C Hypoparathyroidism D Myocardial infarction E thyrotoxic crisis

10. At the patient of 30 years after the transferred or carried influenza constantly there is a delicacy, irritability, a sweating. The patient lost weight, appeared tremor, palpitations, exophthalmos. On examination: skin moist, exophthalmos, pulse - 120 in 1 min., Thyroid gland enlarged, soft, painless. Blood TSH - 0.2 mIU / l (N - 0.4-4 mIU / l). Your diagnosis?

A Endemic goiter B Dysfunctional goiter C Autoimmune thyroiditis D Diffuse nontoxic goiter E Thyroid cancer

IV. Summarizing

Recommended reading list

1. Davidson’s “Principles of Practice of Medicine” 22th edition, 2014..

Endocrinology p. 733-837

2. Harrison’s “Principles of internal medicine”, 19th edition, 2015. Endocrinology p. 2260-2518

3. Williams Textbook of Endocrinology by Shlomo Melmed; Ronald Koenig;

Clifford Rosen; Richard Auchus; Allison Goldfine , 2019.

4. Greenspan's Basic and Clinical Endocrinology, Tenth Edition by David Gardner;

Dolores Shoback, 2017