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CASE 2

CASE 2 . 42 yo man HIV+ 1992 Presented with PCP CD4 33. CASE 2. CASE 2 . Hypothyroidism Late 90’s → TSH   - L-T4 initiated 2005-2007 → increasing requirement for L-T4 up to 0.25 mg/d with Lopinavir based therapy Despite this….TSH  8-9 u/ml. CASE 2 . 2008

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CASE 2

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  1. CASE 2 • 42 yo man • HIV+ 1992 • Presented with PCP • CD4 33

  2. CASE 2

  3. CASE 2 Hypothyroidism • Late 90’s → TSH - L-T4 initiated • 2005-2007 → increasing requirement for L-T4 up to 0.25 mg/d with Lopinavir based therapy • Despite this….TSH  8-9 u/ml

  4. CASE 2 2008 • TSH suddenly <0.05 on LT4 0.25 mg/d • Subsequent lowering of dose to nil with persistent TSH <0.05 and escalating signs/symptoms of hyperthyroidism

  5. CASE 2 2008 • Thyroid Iodine uptake scan → Homogenous increased uptake in a slightly enlarged gland • TSH Receptor Antibodies 214 u/l (N=<10)

  6. CASE 2 Diagnosis…GRAVES DISEASE!!! • Propranolol/Tapazole initiated with normalization of FT3/FT4 in one month and TSH over a few months

  7. CASE 2 2009-2010 • 1.5 yrs of Tapazole with attempted tapering revealed recrudescent hyperthyroidism from both a biochemical/clinical perspective • CD4 800-850 VL <50

  8. CASE 2 JAN. 2011 • Radioactive Iodine ablation of thyroid gland

  9. CASE 2 APR. 2011 • TSH 73.67.. tapering Tapazole • Will need lifelong L-T4 replacement as of now

  10. CASE 2 APR. 2011 • Interestingly CD4 now 370 (was 800-850) with stable % CD4 and CD4/CD8 ratio as c/w previous ?Cause

  11. CASE 2 APR. 2011…Crestor 10 mg x 3 yrs ? Increase Crestor WHY OR WHY NOT?

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