1. SE
1.1. HEPATITIS
1.2. AGRANULOCYTOSIS
1.3. VASCULITIS
2. general approach
3. goal
3.1. relife symtoms
4. goal
4.1. symptomatic relife
5. symtoms
5.1. pretibial mexodema
5.2. exophthalus
5.2.1. pathognomonic
6. graves
6.1. AUTOIMMUNE
7. step4: hypothesis organization
7.1. endocrine
7.2. psychaietry
8. step5: OBJ
8.1. stress: effect on endocrine system
8.2. THYROID PHYSIOLOGIC FUNCTION
8.2.1. HYPERTHYROIDISM
8.3. CRITERIA OF ANXIETY DIGNOSIS
8.4. PHYOCHROMCYTOMA
8.4.1. TRIAD
8.4.2. PATHOPHYSIOLOGY
9. step6: reporting
9.1. thyroid physiology
9.1.1. TRH
9.1.1.1. ACTIVATE pit
9.1.2. TSH
9.1.2.1. activate thyroid
9.1.2.1.1. t4 and t3
9.2. HYPERTYROIDISM
9.2.1. DIFFRENT ENTITIIES
9.2.1.1. GRAVES
9.2.1.1.1. AUTOIMMUNE
9.2.1.1.2. TSI do the function of TSH
9.2.1.1.3. prolonged activation
9.2.1.1.4. symptoms
9.2.1.1.5. POPULATION
9.2.1.2. POSTPARTUM
9.2.1.3. AMIODARON INDUCED THYROTOXICOSIS
9.2.1.4. THYROTOXICOSIS
9.2.1.4.1. HIGH serum of thyroid hormone regardless of etiology
9.3. GENARILISED ANXITY DISORDER
9.3.1. criteria
9.3.1.1. WORRING
9.3.1.2. RESLESS
9.3.1.3. SLEEP PROBLEM
9.3.2. MEDICATION CONTROL
9.4. PHEOCHROMOCTOMA
9.4.1. TUMOR OF CHROMAFFIN CELL
9.4.2. CRITERIA
9.4.2.1. paroxismal hypertention
9.4.2.2. diaphoresis
9.4.2.3. headaches
9.4.2.4. PALPITATION
10. STEP7: INQURY PLAN
10.1. HISTORY
10.1.1. SLEEP AFFECTED
10.1.2. TREMOR
10.1.3. ANXOUIS
10.1.4. morning palpitation
10.1.5. breathless
10.1.6. 3kg in last month
10.1.7. late mensis
10.1.8. PRESPIRE
10.1.9. exophthalmus
10.2. past history
10.2.1. asthma
10.3. personal
10.3.1. heavy workload
10.3.2. no smoke
10.3.3. OCCASIONAL DRINKING
10.4. FAMILY
10.4.1. grandma has thyroid problem
10.5. physical exam
10.5.1. VITALS AND APPEARANCE
10.5.1.1. RR110
10.5.1.2. 140\50
10.5.1.3. 37C
10.5.1.4. ANXIUS
10.5.1.5. 64KG, 170
10.5.1.6. sweaty and tremor
10.5.1.7. ENLARGED THYROID
10.5.2. lid lag
10.5.3. exophthalmus
10.5.4. proximal muscle waekness
10.5.5. hyperreflexia
10.5.6. palbable lymphnodes in neck
10.6. INVESTIGATION
10.6.1. THYROID SCAN
10.6.1.1. HIGH UPTAKE 20%
10.6.2. cbc
10.6.3. CHEMICALS AND ELCTROLYTES
10.6.4. TH
11. STEP8: DIGNOSTIC DESICION
11.1. graves disease
12. OBJ
12.1. MANAGMENT OF GRAVES DISEASE
12.2. IS IT NORMAL TO HAVE AUTOANTIBODY TO TSHR IN NORMAL INDIVISUAL?
13. Step 10: Management
13.1. goal
13.1.1. relife symtoms
13.1.1.1. BB
13.1.1.1.1. AT START
13.1.2. DECREASE THYROTOXICOSIS
13.1.2.1. THYONAMIDE
13.1.2.1.1. INHIBIT tpo
13.1.2.1.2. METHMIZOLE
13.1.2.1.3. PROPYLTHIOERACIL
13.1.2.1.4. SE
13.1.2.1.5. methods
13.1.2.2. RADIOIODINE
13.1.2.2.1. GIVEN PO
13.1.2.2.2. HYPOTHYRODISM
13.1.2.2.3. GIVE WITH LITHUM
13.1.2.3. THYRODECTOMY
13.1.2.3.1. REMOVE ALL OR PART
13.1.2.3.2. PARATHYROID IS NOT SPARED SOMTIMES
13.1.2.3.3. COMPLICATION
13.1.2.4. IODINE ADMINSRTATION
13.1.2.5. GLUCOCORTICOIDS AND CLOSTRAMINE
13.1.2.5.1. NOT FISRT LINE
13.1.2.6. TYROTOXIC CRISES
13.1.2.6.1. PRESPITATING FACTORS
13.1.2.6.2. CORRECTION
13.1.2.7. OPHTHALMOPATHY
13.1.2.7.1. MILD
13.1.2.7.2. SEVERE
13.1.2.8. PRETIBIAL MEXYDEMA
13.1.2.8.1. TOPICAL STRROID
13.1.3. DIFFRENT METHOD BUT NO SUPERIORITY
13.1.4. EDUCATION
13.1.4.1. ABOUT SE
13.1.4.1.1. HEPATITIS
14. STEP12
14.1. RESORCES
14.1.1. HARRISON
14.1.2. MEDSCAPE
14.1.3. UPTODATE
14.1.4. ENDOCRINEWEB .COM
14.1.5. CUMAR
14.1.6. DAVIDSON
14.1.7. GREENSFAN
15. step1:
15.1. cues
15.1.1. 28y-F
15.1.2. ANXIOUS about the exam
15.1.3. functional impact noticed
15.1.4. difficulty concentrate
15.1.5. nervous at work
15.1.6. prespire
15.1.7. tremor
15.1.8. palpitation
15.1.8.1. at night
15.1.9. weight loss- last 2 m
15.1.10. sleep disturbance
15.2. words
15.2.1. FRACP: FOLLOW OF ROYAL AUSTRALIAN COLLEGE OF PHYSICIAN
15.2.2. RIGISTRAR:
16. step2: problem formulation
16.1. 28y medical registrar feeling anxous and difficult to concentrate in her work. she has perspiration and slight tremor with weight loss jn last two month. palpitation an sleep disturbance for a couple of weeks.
17. step3: hypothesis generation
17.1. PALPITATION
17.1.1. ANEMIA
17.1.2. SYMPATHETIC
17.1.3. THYROID HORMONES SECRETION
17.1.3.1. STRESS
17.2. TREMOR
17.2.1. POSTURAL WITH ANXIETY
17.3. overactive thyroid
17.4. triggered anxiety
17.4.1. exam
17.5. psychatric case
17.5.1. inability to cope with stress
17.6. why it is not stress?
17.7. stress+endocrine problem
17.8. stress responce
17.8.1. PHA axis
17.8.1.1. high metabolic rate
17.8.1.1.1. weight loss
17.9. adrenal tumor
17.9.1. pheochromocytoma
17.10. anxiety
17.10.1. stressor
17.11. hyperpitutarism
17.12. autoimmune
17.12.1. gravis disease
17.13. vitamin B1 deficence
17.13.1. beri-beri