Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

640 Goiter Gonorrhea

specific therapy

■Levothyroxine: may be useful to suppress small diffuse goiters, esp.

if recent onset and TSH slightly elevated or in upper normal range;

may prevent further enlargement of multinodular goiters given in

dose that completely suppresses the serum TSH level

■Thyroidectomy: suspected malignancy or large long-standing goi-

ters with compressive symptoms

■I-131: occasionally useful to shrink goiter, esp. if I-123 uptake

increased

■Iodine repletion: useful only for iodine deficiency

follow-up

During Treatment

■After thyroidectomy: treat with levothyroxine and follow free T4 and

TSH; check serum calcium

■After levothyroxine and I-131: follow free T4, TSH, goiter size

complications and prognosis

Complications

■Hypothyroidism: after thyroidectomy, I-131

■Hyperthyroidism: after levothyroxine

■Hypoparathyroidism: after thyroidectomy (permanent in 5% of

cases)

■Recurrent laryngeal nerve injury: after thyroidectomy (5% of cases)

Prognosis

■Benign goiter: excellent, may eventually require thyroidectomy

■Lymphoma: good

■Anaplastic cancer: poor

Gonorrhea.........................................

SARAH STAEDKE, MD

history & physical

History

■Neisseria gonorrhoeaeis a gram-negative diplococcus that infects

non-cornified epithelial cells of the urogenital tract, rectum, phar-

ynx, and conjunctivae.

■Risk factors: young age, race/ethnicity (highest reported rates in

African-Americans), sexual preference (recent increase in men who