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Monthly archives: November, 2017

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  • Monthly archives: November, 2017

  • Listen

    Frequent urination? Increased thirst? Increased hunger? Increased fatigue? Altered level of consciousness with advanced cases

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  • Listen

    Appetite/weight changes? Hot or cold intolerance? Change in energy, mood, or behavior? Palpitations? Increased fatigue? Bowel-related changes? Constipation/diarrhea Skin-related changes? Dry/oily

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  • Recognize

    Ensure that patient undergoes thyroid function tests prior to first dose, every 12 weeks while on PD-1 therapy and q3 weeks with ipilimumab High TSH with low free T4 consistent with primary hypothyroidism DDX: secondary hypothyroidism due to hypophysitis, low TSH and low free T4 Occasionally thyroiditis with transient hyperthyroidism (low TSH and high free

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  • Look

    Does the patient appear unwell? Changes in weight since last visit Appear heavier? Thinner? Changes in hair texture/thickness? Appearing hot/cold? Does the patient look fatigued?

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  • Look

    Does the patient appear fatigued? Does the patient look listless? Does the patient look ill? Does the patient look uncomfortable?

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  • Recognize

    Low levels of hormones produced by pituitary gland (ACTH, TSH, FSH, LH, GH, prolactin) Brain MRI with pituitary cuts: enhancement and swelling of the pituitary gland DDX adrenal insufficiency: low cortisol and high ACTH DDX primary hypothyroidism: low free T4 and high TSH

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  • Listen

    Does the patient report: Change in energy? Headache? Dizziness? Nausea/vomiting? Altered mental status? Visual disturbances? Fever?

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  • Listen

    Change in energy level? Change in skin color? Yellowing? Change in stool color (paler)? Change in urine color (darker/tea colored)? Abdominal pain: specifically, right upper quadrant pain? Bruising or bleeding more easily? Fevers? Change in mental status? Increased sweating?

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  • Recognize

    Elevation in LFTs AST/SGOT ALT/SGPT Bilirubin (total/direct) Alteration in GI function Symptoms such as abdominal pain, ascites, somnolence, and jaundice Other potential causes (viral, drug toxicity, disease progression)

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  • Look

    Does the patient appear fatigued or listless? Does the patient appear jaundiced? Does the patient appear diaphoretic? Does the patient have any ascites?

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