PART 2 OF 3—Click "Full Text" to view commentary from presenters on thyroid topics
In July 2011, the inaugural MEDS (Metabolic and Endocrine Disease Summit) was held in Orlando, Florida. The meeting focused exclusively on diabetes, thyroid disorders, and other common endocrine-related conditions and was designed for PAs and NPs in primary care, with presentations by their counterparts in endocrinology.
In 2012, two MEDS events are planned: July 26-28 in Orlando and August 9-11 in San Diego. Save the dates and keep checking www.MEDSummit.qhc.com for more information. In the meantime, read on for a recap of some of the presentations from the first MEDS, in the faculty’s own words.
Scott Urquhart, PA-C, DFAAPA
It’s been an absolute honor to put this meeting together and to work with an amazing group of colleagues who are not only experts in their field but really wonderful clinicians with great clinical experience. And then to have the opportunity to work with Quadrant HealthCom—they really made it possible. You know, I’m a PA with an idea and a passion for education, but I can’t make it happen without the resources of that team. And then to work with the great editorial board and staff of Clinician Reviews, helping us to really start the spark of recognition for endocrinology and for this meeting. The meeting is clearly more than I ever expected it to be. All the hard work that went into it was absolutely worth it.
The feedback that I’m receiving … it really humbles you to see how happy and respectful people are of the time we’ve put into this meeting. So the reward is really giving back to the professions, to the patients, to the recipients of the best quality care. This meeting without a doubt has definitely met that goal and surpassed my own personal goals and expectations. I was expecting a good meeting, don’t get me wrong, but to really see it come together and have the attendance be nearly double what we expected for our inaugural meeting is amazing.
Christine Kessler, MN, CNS, ANP, BC-ADM
Unraveling the Mystery Part 1: Thyroid Labs and Hypothyroidism
Overall, what we were trying to impart to the attendees is how to identify patients at risk for thyroid disease and how to simply and efficiently and effectively assess these individuals. Then, once we’ve identified the patient’s thyroid disorder(s), identifying the type—hyper-, hypo-, or nodular disease—sharing with providers how you can, in reality, treat these patients. Not necessarily algorithmically, but how we can look at how patients feel as well as certain laboratory data. And it’s not always what people would read in a book. What I hope to show is not only how to effectively identify these patients, but how to treat them in a way that is patient focused, patient based, and with a great deal of flexibility in thyroid hormone replacement. Looking at what’s out there, there are different kinds—not just the various thyroid preparations but also some of the ancillary ones. We want to give primary care providers more choices in their armament.
Chris Sadler, MA, PA-C, CDE
Unraveling the Mystery Part 2: Hyperthyroidism and Postpartum Thyroiditis
We had this discussion about hyperthyroidism. When there’s a low TSH, there are many different reasons for it. The most common one is autoimmune thyroid disease or Grave’s disease. So we really talked about the work-up for that, how the TSH was important for initial screening but you need to go deeper. You need to get a free T4 level and possibly a T3 level. Then you might think about thyroid scanning if it’s still not clear from there.
Occasionally, we’ll do other work-up based on whether there’s an isometric goiter, the way we might think there might be a nodule. There may be an indication for biopsy. If the scan is abnormal or shows a cold nodule, we may want to biopsy that because there are rare thyroid cancers that are found in patients with Grave’s Disease. That’s not very typical, though.
Chris Sadler, MA, PA-C, CDE
Unraveling the Mystery Part 3: Thyroid Nodules and Other Forms of Thyroiditis
Thyroid nodules can really be categorized based on their characteristics on ultrasounds. The ultrasound is extremely important. You can look at things like a simple cyst, which has a very low risk for malignancy, and then as you go up the scale you can see nodules that have increased vascualrity, nodules that have microcalcifications, nodules that have irregular margins or are more suspicious for thyroid cancers. None of these factors by themselves predict thyroid cancer, but they certainly help you differentiate which nodules need a fine-needle aspiration as opposed to which nodules you can just follow clinically. Large nodules should be sampled with fine-needle aspiration and then followed over time.
And then we did go into thyroid cancers. Fortunately, most thyroid cancers are slow growing and late to metastasize. You usually have time to figure these things out. Most of the time the patient’s prognosis is good, although there are some forms of aggressive thyroid cancer. But fortunately, these are rare.
Dwight Deter, PA-C, CDE
Hypercalcemia: Parathyroid Disease Or Not?
When a clinician receives a lab report with a high calcium, it may be a parathyroid disorder but there are numerous other causes of hypercalcaemia that need to be addressed and treated. Knowing the appropriate test to order and when is the best time to refer are really important issues that I hope the attendees were able to take home from my lecture. You know that every single person has seen a patient with a calcium disorder, and it’s always a puzzle. It may be something very mild, like vitamin D deficiency, or something very serious, like some sort of cancer or a tumor or ademona of the parathyroid gland. Knowing how to take that test result and work through the process of evaluating it and what test is appropriate and when is the best time to refer are all essential.
The MEDS attendees have all seen these patients before. Their questions revolved around either a patient with a parathyroid ademona or somebody who, it appeared, had kidney stones and a high calcium. How do they work up that patient? What is the difference between a serum calcium and an ionized calcium, and how do you use that in your decision making? Excellent questions, excellent attendees. Hopefully my lecture was well received.