a********n
发帖数: 182 | 1 病人的TSH升高，FREE-T3低，FREE-T4正常，甲低应该是能够诊断了。我的问题是，在
正式看内分泌专家前，作为pcp，需要给病人用上甲状腺素片吗？记得USMLE有一题类似
，是新生儿，筛查出甲低，只是TSH升高，其他化验还没有做的，正确答案是应该先用
上药。现在的问题是内分泌专家们是不是PREFER先看病人，做相关检查，化验，再决定
用药啊？病人是5岁儿童。多谢！ |
r*****2
发帖数: 309 | 2 先说明不是内分泌科的，但是儿科专业的。就儿科说一下。儿科有儿科专门的标准。一
般化验指标的正常值都是对成人而言的，不适用于儿科病人。新生儿甲减会造成智力发
育障碍，所以宁愿当甲减治疗，同时等待儿科内分泌专科的refer. 你现在的病人都5岁
了，有无临床症状？有没有对过儿科标准值，要我还是先refer，等专科确诊了再上药
也不迟。毕竟你是PCP,不是专科的，一旦有啥事说不清楚。 |
a*********d
发帖数: 2763 | 3 同意楼上，如果病人asymptomatic，可以等看专科以后再用药，儿科甲状腺药物给药有
专门的剂量，不是专科的可能会 confused.
我最怕看的是low testosterone, PCP什么检查都没做就上了testosterone，影响了后
面的work up |
U********e
发帖数: 20 | 4 I am a NP. Before we start testosterone, we usually check FSH, and LH level,
and recheck morning testosterone level. Of course, we also check H & H, and
LFT.
I would like to hear the suggestion from the specialist.
Thanks.
【在 a*********d 的大作中提到】
: 同意楼上，如果病人asymptomatic，可以等看专科以后再用药，儿科甲状腺药物给药有
: 专门的剂量，不是专科的可能会 confused.
: 我最怕看的是low testosterone, PCP什么检查都没做就上了testosterone，影响了后
: 面的work up
|
a*********d
发帖数: 2763 | 5 thats actually pretty good work up, so what do u do if fsh, lh normal or
abnormal?
【在 U********e 的大作中提到】
: I am a NP. Before we start testosterone, we usually check FSH, and LH level,
: and recheck morning testosterone level. Of course, we also check H & H, and
: LFT.
: I would like to hear the suggestion from the specialist.
: Thanks.
|
U********e
发帖数: 20 | 6 If FSH and LH are increased with low testosterone level, then we start
testosterone replacement. There is lots of patient education about the
replacement including helping pt to put realistic goals and the possible
infertility aftermath.
The teaching part is my favorite part.
If FSH and LH are normal or decreased, then we usually refer to Endo. There
are more work up needed to be done including the pituitary function panel.
Any comment?
【在 a*********d 的大作中提到】
: thats actually pretty good work up, so what do u do if fsh, lh normal or
: abnormal?
|
a********n
发帖数: 182 | 7 多谢Roamer2 and Againstwind两位。我也是担心SPECIALIST要做其他的WORKUP。不想
捣乱。看来所见略同呵。 |
a*********d
发帖数: 2763 | 8 really good.
but even in the FSH LH elevated case, the patient might still need some
further work up including karyotype.
what kind education do you usually give patients?
There
【在 U********e 的大作中提到】
: If FSH and LH are increased with low testosterone level, then we start
: testosterone replacement. There is lots of patient education about the
: replacement including helping pt to put realistic goals and the possible
: infertility aftermath.
: The teaching part is my favorite part.
: If FSH and LH are normal or decreased, then we usually refer to Endo. There
: are more work up needed to be done including the pituitary function panel.
: Any comment?
|
|
U********e
发帖数: 20 | 9 Thanks for your comments.
Well, for the patient education regarding testosterone replacement:
1. may cause infertility. We have a pt who is 50s and has a serious
relationship with a young girl. We have to give him this warning.
2. may cause BPH. We usually screen AUA before starting replacement, and
follow up DRE and PSA afterwards.
3. where and how to apply the gel. make sure do not pass any testosterone to
kids/swimming pools and other women (specially pregnant women).
4. Realistic goals. The replacement may not reach the expectation that the
patients want.
5.The opposite--ask pt to give his partner a warning---may ask for more freq
than before.
6. make sure to follow up
-----------------
-----------------------------
【在 a*********d 的大作中提到】
: really good.
: but even in the FSH LH elevated case, the patient might still need some
: further work up including karyotype.
: what kind education do you usually give patients?
:
: There
|
f*****w
发帖数: 1451 | 10 学习了，，，听二位的谈话很长知识阿。。。。继续继续 |
|
|
a*********d
发帖数: 2763 | 11 very good indeed!
1. patient should see reproductive endocrinologist for fertility concerns,
and starting testosterone might not be a good idea for those who still
desire fertility.
2. true, also should screen prostate cancer,if any history or suspicion,
consult
urologist first.
3. true
4. always true
5. i am not quite sure what you mean
6. they always follow up, hehehe
other things should be mentioned include acnes, skin rashes, breast
tenderness. more importantly, patient should be evaluated and treated for
sleep apnea if clinically suspected. also follow HCT.
Well, for the patient education regarding testosterone replacement:
1. may cause infertility. We have a pt who is 50s and has a serious
relationship with a young girl. We have to give him this warning.
2. may cause BPH. We usually screen AUA before starting replacement, and
follow up DRE and PSA afterwards.
3. where and how to apply the gel. make sure do not pass any testosterone to
kids/swimming pools and other women (specially pregnant women).
4. Realistic goals. The replacement may not reach the expectation that the
patients want.
5.The opposite--ask pt to give his partner a warning---may ask for more freq
than before.
6. make sure to follow up
【在 U********e 的大作中提到】
: Thanks for your comments.
: Well, for the patient education regarding testosterone replacement:
: 1. may cause infertility. We have a pt who is 50s and has a serious
: relationship with a young girl. We have to give him this warning.
: 2. may cause BPH. We usually screen AUA before starting replacement, and
: follow up DRE and PSA afterwards.
: 3. where and how to apply the gel. make sure do not pass any testosterone to
: kids/swimming pools and other women (specially pregnant women).
: 4. Realistic goals. The replacement may not reach the expectation that the
: patients want.
|
b*******e
发帖数: 67 | 12
5. i am not quite sure what you mean - increased libido?
【在 a*********d 的大作中提到】
: very good indeed!
: 1. patient should see reproductive endocrinologist for fertility concerns,
: and starting testosterone might not be a good idea for those who still
: desire fertility.
: 2. true, also should screen prostate cancer,if any history or suspicion,
: consult
: urologist first.
: 3. true
: 4. always true
: 5. i am not quite sure what you mean
|
A*******s
发帖数: 9638 | 13 应该是这样。
【在 b*******e 的大作中提到】
:
: 5. i am not quite sure what you mean - increased libido?
|
a*********d
发帖数: 2763 | 14 oh i see, i would just tell patient not to say anyting, so it will turn out
to be a nice suprise.:) |
A*******s
发帖数: 9638 | 15 lol， are you sure it's going to be a surprise not a disaster? :)
out
【在 a*********d 的大作中提到】
: oh i see, i would just tell patient not to say anyting, so it will turn out
: to be a nice suprise.:)
|
