Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1426 Thrombophilia Thyroid Nodules and Cancer

■1–5 mg folate PO daily will decrease homocysteine levels by 25% –

even if levels are normal to start.

■0.5 mg B12 PO daily will further decrease homocysteine levels by 7%.

■Start treatment with 2–5 mg folate daily, then recheck fasting homo-

cysteine levels in 8 weeks. If no change, then add B12+/−B6.

follow-up

n/a

complications and prognosis

■Complications from anticoagulation include bleeding (1–7%),

heparin-induced thrombocytopenia (UFH > LMWH) and osteo-

porosis (UFH > LMWH).

■Platelet counts should be checked every few days while patients

are on UFH or LMWH to monitor for the development of heparin-

induced thrombocytopenia.

■Patients with active cancer and venous thromboembolism have an

increased risk of recurrence when treated with warfarin. LMWH

should be considered the treatment of choice for these individuals.

■Inferior vena cava (IVC) filters are recommended in patients who

have contraindication for anticoagulation or failed treatment with

oral anticoagulants. The long-term use of these filters is associated

with recurrent venous thrombosis for which anticoagulation should

be started when safe. More recently, removable IVC filters are been

used for short-term periods without the administration of anticoag-

ulation.

THYROID NODULES AND CANCER

LAWRENCE CRAPO, MD, PhD

history & physical

History

■Personal/family history of thyroid nodules or cancer

■Hypertension or pheochromocytoma

■Neck irradiation

Signs & Symptoms

■Thyroid mass: soft or firm, tender or not, mobile or fixed, large or

small

■Fever, sweats, chills