Patient scenario in family medicine NP

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-Below 30 male presents for physical exam. TSH LEVEL IS ELEVATED. 6 point something.

Next step? And should patient be started on THYROID MED.

other Questions: Do you All Check male TSH annually??? If yes why if no why not??

-Does anybody have a good reference/PowerPoint/ with how to manage diabetic medications. Just how and when to add things, when to refer to endeocrine.

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Specializes in Neurology, Psychology, Family medicine.

These seem straight from a textbook to be honest. If your in school both of these should be covered pretty thoroughly. Try checking out a primary care guideline book/ family practice etc. None of us should be doing your hw. These are all pretty simple questions. Good luck

In addition after noticing your previous created topic I'm slightly confused. You are a new solo provider but need help managing Tsh levels and diabetic meds?

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And yet NPs are clamoring for independent practice...

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Your response sounded rude. And to answer you Yes I am A solo provider. Even with guideline books one can still bounce things off each other to come up with best treatment/management plan for a patient. Let's not act like that's not something that takes place in Medical settings frequently. I am doing more to make sure when I see patients my plan of care/treatment approach is the best. This can help me or someone else long term. I am out of school, so this not a case of homework whatsoever.

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Putting down your fellow NP does nothing to lift them up. But I appreciate your rude words as well. Your not perfect, and we all don't know everything. It's normal to seek information. So I will not allow you to make me think otherwise.Thank you.

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Specializes in Neurology, Psychology, Family medicine.
Putting down your fellow NP does nothing to lift them up. But I appreciate your rude words as well. Your not perfect, and we all don't know everything. It's normal to seek information. So I will not allow you to make me think otherwise.Thank you.

Fair statements. No one is trying to pretend collaboration does not occur in medical settings. I was merely making the point that these kind of questions are put frankly belong in a student/learning/different posting category. So let me expand. If you came to the APN forum asking benefits of GLP-1 vs SGLT2 then thats an APN conversation. But asking for a vague how to manage a diabetic patient is not. Sample resources include ADA, epocrates, uptodate, dynamed, pubmed, the list goes on. Next the TSH is simple and a TSH gets run annually. So seeing a solo provider not know what to do with a 6, regarding having it rechecked vs a more expanded lab vs treatment is frightening.

Seeking additional information / learning / collaborating is always encouraged. But there has to be a hard stop at some point that the knowledge brought to the table is not starting at the beginning.

Lastly, no one would expect you to change your mind regarding one person's online rebuttal to a question. I would always encourage continued learning as my history has shown. But, I stand by what I've said in the past that standards need to be increased.

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Another problem with the NPs being mass produced - they aren't aware they are clinically lacking and no one will convince them otherwise.

The clinical scenario you suggested is exceedingly straight forward. You cant even tell us the first step with an elevated TSH? That's a problem. Like the poster above said, this is not an NP level question.

Your feelings were hurt by our comments? Go over to the medical forum and ask this question and see how they respond.

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Specializes in Family Nurse Practitioner.
Another problem with the NPs being mass produced - they aren't aware they are clinically lacking and no one will convince them otherwise.

The clinical scenario you suggested is exceedingly straight forward. You cant even tell us the first step with an elevated TSH? That's a problem. Like the poster above said, this is not an NP level question.

Your feelings were hurt by our comments? Go over to the medical forum and ask this question and see how they respond.

To be perfectly honest I thought this poster was punking us. Horrifying to learn otherwise.

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There are different modifications depending on patient scenario. All the time you took to type your expanded reasoning you could have taken more time to understand what was going on. Or just referred to proper chat. If you knew what I knew or where my questions falls you wouldn't be focused on writing a paragraph of aiming to put anyone down. Your not better than anybody, again, if it's such a question you don't think it's appropriate, leave it alone. My feelings are not hurt because what you write behind a keyboard. Sorry. I am confident in asking what I ask and you are not doing nothing to that. Thank you for your long paragraph.

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Since you know it all, and are perfect, when your ready to assist, be assistant , and also find out more about scenarios or what this person may need for their better, everything else your saying is not bothering me. Putting people down because you believe your better only gives you excitement. Thanks for your cooperation and assistance.

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The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults.

Just to throw you a bone, if the patient is asymptomatic I personally would not treat a TSH of 6. I would run the labs again as the recommendations are to treat if symptomatic and two TSH panels show abnormalities.

For future reference I would use uptodate.com to answer your questions or the US preventive task force website if you have basic questions that you would like answered anonymously.

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Specializes in Neurology, Psychology, Family medicine.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in nonpregnant, asymptomatic adults.

Just to throw you a bone, if the patient is asymptomatic I personally would not treat a TSH of 6. I would run the labs again as the recommendations are to treat if symptomatic and two TSH panels show abnormalities.

For future reference I would use uptodate.com to answer your questions or the US preventive task force website if you have basic questions that you would like answered anonymously.

So then to figure out the scenario which you provided little information about I would need to know

Why was the TSH run?

Describe to me his currently medical conditions.

Does he currently have any symptoms

Is he current taking any medications or has has any surgeries / hospitalizations

Does he have any family history of autoimmune or thyroid dysfunction

Does he live in USA where iodine is not a problem to obtain

Are the rest of his labs in check and only abnormality was the TSH.

Do he have a goiter, nodule, dysphagia etc.

Differentials because of the lack of details can be extensive or minor. If the answer lyes within the scenario then it should be provided and we should not need to actively search for it.

Differentials could be

medication induced

subclinical

hashimoto

hypothyroid secondary or tertiary

thyroiditis

primary hypothyroid

Next at a 6 you never up front prescribe a medication regarding TSH. Always requires further evaluation. At a 6 you are near baseline, can not determine etiology if you put him on a medication right away, especially if it was transient.

Next you should draw a secondary TSH and panel.

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