May 31, 2007

TSH effects: hyperTRICEPS

Since I'm on the topic of hyperthyroid, I thought I'd share a little mnemonic I just made about the steps of thyroid hormone synthesis that are affected by TSH stimulation.

HYPERplasia of the follicle cells

Autoimmune hyperthyroid, aka Grave's Disease, creates antibodies that resemble TSH and trigger all of these steps willy-nilly without any regulation! This makes your follicular cells very hungry for iodine and they start sucking out all of their stored colloid and dumping the hormones out into the system.

I'm not going to bore you with all of the nitty gritty details. For that, you can go to Boron & Boulpaep or my favorite, Guyton and Hall.

PHASED up hyperthyroid

I've talked about the exopthalmos you see in Grave's disease before.

Here's a way to remember a few of the signs of Hyperthyroid!
PHASED up thyroid
Heat intolerance
Emotions/energy lvl/Eyes

Patients who have hyperthyroid might be noticed by their weird-looking appearance. They have bulging eyes, a strange lumpy neck and they are always anxious. This disease is usually caused by an autoimmune disease that attacks and activates the thyroid gland located in the neck. Increased levels of thyroxine (T4) and T3 hormone lead to a high energy state, which can cause weight loss, muscle weakness, and the increased basal metabolic rate makes them feel hot and sweaty.

I know someone who had this. She told me about her diagnosis and I looked up a few of the symptoms and asked her about them. I remember thinking that she did look a little bit weird, but I couldn't quite place my finger on it. In retrospect, she did have an enlarged thyroid, she was very thin and her eyes were a little bit buggy. Now that she has had treatment (not sure if it was selectively radioactive iodine or medication)... she looks a lot better. I'm sure she feels a lot better too.

May 30, 2007

Portable ePaper

I'm waiting for the day that they invent ePaper. I'd like to be able to take notes on something thats flexible and portable, something that I could read hundreds of books on with the flip of a page, that requires very little power, and it has wireless access to the internet.

I think that having a device like this would greatly improve my own speed and productivity and more importantly, it would be TOTALLY RAD. A lot of docs these days have palm pilots or Treo phones with mini keypads and stuff like that, but they are so tiny! I rarely use my palm pilot because it makes a highpitched electronic sound that gives me a headache.

My tutorial group was talking about our proposed electronic purchases yesterday. One girl was displeased with her old Treo. Someone else commented on about getting a tablet PC.

And then, I saw this today on Geekologie.
Holy cow, this laptop is thinner than a penny is wide! It's almost as thin as the new Razr phones! And it uses flash memory (the same stuff that comes on jumpdrives and in digicams) so the battery life is >12 hours.

Whoa. I can't wait to buy this, jewelry and purse-looking straps be damned! It is a sweet device.

May 23, 2007


I've been staying up very late these past few weeks studying. I've been worried about the upcoming exams on gastroenterology (mouth to butt), endocrinology (hormones and such) and hematology (blood and immune cells). Our exams will cover our knowledge of common procedures and practices involved in the most common diagnoses of these fields, anatomy, histology (microscopic anatomy), pathology (Dana Scully autopsy work!), physiology, genetics, biochemistry, etc.

Whew. It's a chore just to try and list the topics that we are supposed to know about. I feel pretty confident about the most recent material since I've kicked my butt into high gear... but I'm VERY stressed out about older material.

Our ex-Secretary of Defense said it best:
The Unknown
As we know,
There are known knowns.
There are things we know we know.
We also know
There are known unknowns.
That is to say
We know there are some things
We do not know.
But there are also unknown unknowns,
The ones we don't know
We don't know.

—Feb. 12, 2002, Department of Defense news briefing

I'm at that stage where I don't really know what it is that I don't know. There's something different about feeling confident with material that doesn't quite cut it when you're faced with a blank page and you're told to "write the mechanism for diarrhea caused by E. coli."

The best way to face this stress is to study, I suppose. And the best way to prove to myself that I've been learning more material than I've been forgetting it is to apply it and start grinding away at mechanisms on scratch paper.

I noticed that I've stopped writing here in lieu of studying, when in fact, this is my best outlet for expressing myself, educating myself and conveying my thoughts in a coherent way that will pay off in the future. I plan on picking this blog up again. I'll use it less as an opportunity to teach and more as a way to figure out what the heck I'm going to do from where I am! :)

May 22, 2007


Every subunit in our curriculum, we are randomly assigned a new preceptor who we visit in the hospital, to learn more about the subject at hand. Currently, we are in the hematology unit, learning about blood diseases -- and I hear stories about other groups who visit the pathologists in hospitals to read blood smears, learn about leukemia and all sorts of cool things.

What did my group have to look forward to for these past few weeks?

Lets see... we visited two patients who had lung cancer. Another patient who had colon cancer. Another patient who had carcinoid syndrome (which is actually quite interesting in terms of manifestation of cancer.) So yes, there was a lot of cancer. It can be a sobering and sad subject, especially when we reach that awkward point in the Q&A when the patient probes us about what they think the future will hold. Hoo boy... that's rough.

Soured by this experience, I found myself complaining today about how our preceptor is a "fallback" guy. Basically, my theory was that if the school couldn't find enough doctors, they picked him up since he was in previous units as well.

In retrospect, those were harsh words. As I printed out my history and physical write-up to present to my preceptor tomorrow, it came out upside down on the back page. I saw the scenario unfolding in my mind -- he carefully reads the page, much to my surprise and flips it over, remarking that the back page is upside down. In my mind's eye, I had two different replies:
Honestly, I thought you weren't even going to read it.
Sorry, I had trouble figuring out the instructions for backside printing at school. You'd think by now I'd get the hang of it, by now...
The first one shocked me. I couldn't believe that I'd think of saying that to a doctor! Did I really have that little respect for him? He's not a bad doctor; he's just very dull. And to top it off, he doesn't have any patients relevant to the topics we are learning about.

Sometimes it can be difficult to muster up gratitude. He does deserve it though. I imagine that he doesn't get the best treatment from medical students, even though he went out of his way and volunteered to help teach us about hematology when no one else would. I'm glad that he let us visit the blood bank to learn about their lab procedures and techniques last week.

We've had opportunities to shadow doctors, who all have different styles for teaching and presenting. I don't know how he responds to feedback, but I hope that our suggestions are met with gratitude. In much the same way that he's helped us to learn, I hope we can help him teach future students.

I spoke too soon. We had an excellent session today with him -- and we had the opportunity to meet with an elderly gentleman who had the misfortune of being diagnosed with multiple myeloma. It was a good learning experience for us, it was something heme-related and much to our surprise and joy, we got out early!

[edit #2]
Upon further consideration, I recall my mother used to tell me when I was young: "complaining about something being boring just means you're not thinking enough to make it interesting." I started asking more questions and getting more engaged in my preceptorship and this attitude shift really paid off. I felt as though I made a good connection with the doctor and I learned a lot.

May 09, 2007

Pet food scare

Perhaps you've heard about "melamine" in regards to contaminated pet food that's causing renal failure in pets across the country. Have you ever wondered what that chemical actually is? I certainly did and my ears perked up when I heard about it via TerraSigillata at (via the Knight Science Journalism Tracker at MIT.)

David Brown at the Washington Post ... does a terrific job of explaining how the modestly toxic substance, melamine, can cause renal failure when combined with cyanuric acid. Not widely reported in the press is the fact that cyanuric acid, another nitrogen-rich compound, has also been found to contaminate some wheat gluten and wheat flour from China.
What do a dead cat in Ontario and a motel swimming pool in Phoenix have in common?

In certain circumstances, they both contain melamine-cyanuric acid crystals.

Gout works in much the same way, when foods rich in purine are consumed and inadequately excreted from the body via the kidneys. Uric acid crystallizes in the joints, usually in the big toe for some reason and causes immense pain aka tophus. It makes sense, since needle-like crystals are spontaneously forming there.

May 05, 2007

A Grave Disease

From OverMyMedBody!
This just ain’t right. This guy must have some sort of malformation of his orbital ridge, or something, cause I have no idea how he’s getting his globe (eyeball) so far out. I think it’s real–you can see the lateral rectus muscle as the camera pans to the side…

I think this person has Grave's opthalmopathy. I don't know much about medicine yet, especially about the eyeball, but if you have a condition known as autoimmune hyperthyroidism aka Grave's disease, your eyes bug out like crazy! This happens because your body attacks the tissue behind your eyes and this triggers inflammation and an increase in glycosaminoglycan (GAG) production. It happens in the pretibial (shin) area as well. Here's a funny video I found on YouTube:

Grave's disease is typified by restlessness, irritability, hyperactivity, weight loss, muscle weakness, heart palpitations, eye problems, sweating and heat intolerance. For a clinical assessment of orbitopathy, click here. Pages 11-16 have some crazy pics of red, swollen eyes and stuff like that too.
Dickinson, A.J. Controversies in the clinical evaluation of active thyroidassociated
orbitopathy: use of a detailed protocol with
comparative photographs for objective assessment. Clinical Endocrinology (2001) 55, 283-303