hall to sit in a chair facing the audience and then began telling her very sad story. She had noted a lump in her central neck that she hadn’t noted before and, being a good physician, felt it needed evaluation, even though she had no other symptoms. She talked to an endocrine fellow whom she knew as a friend who suggested an I131 thyroid scan as the first diagnostic test (yes, the first mistake and the first teaching point). As J. V. H. unraveled her family history, it became evident that her 28-year-old brother had died the year before of uncontrolled hypertension during induction of general anesthesia for an inguinal herniorrhaphy (Wow, that hit home! 28 years old—the second teaching point.). Now, those in the know in the audience became a bit squeamish. When she asked J. V. H. to see her, he, of course, obtained all the appropriate history (as yet unearthed by the endocrine fellow, of course, and the third teaching point), and after the baseline thyroid function tests (T4 thyroid-stimulating hormone—the fourth lesson), proceeded directly to a fine-needle aspiration of the mass (the fifth lesson), which showed medullary carcinoma. This fine-needle aspiration had been done the day before this grand rounds, and she still had the bandage on her neck as proof! Now, we were all worried about her because of the specter of multiple endocrine neoplasia and the somewhat bleak prognosis of medullary carcinoma that this entailed for our beloved resident colleague (I, personally, was sick, worried, sad, etc.). And, yes, her total thyroidectomy was planned for later next week after her urinary collections to rule out a pheochromocytoma (the sixth lesson). The lecture ended with a brief discussion of the spectrum J. V. H.: What a unique teacher
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Dec 1, 2004
Edgar J Schoen + 3
Open Access
