large pedunculated fibroid

42 year old lady with a fungating breast lesion X 5 months duration. Extensive matted LN in right Axillary and Lymphedema in the right UL. Supraclav LN present as well. IDC - grade 3. TNBC. Metastasis to lungs, liver. Let's discuss the management. It is sad to see such advanced cases.

MANAGEMENT OF HYPERTHYROIDISM IN PREGNANCY : 1. Maternal monitoring should include pulse,blood pressure and thyroid size. Serum FT3 & FT4 TSH should be done every 2-4 weeks. Dosage of anti thyroid drugs should be changed accordingly. 2.In first trimester, propyl thiouracil is preferred to methimazole. 3.The treatment should consist of lowest dose of anti thyroid drugs to maintain serum TSH concentrations between 0.1 - 0.4 mIU /L.Patient may remain slightly hyperthyroid. 4. Frequent antenatal check ups every 2 weeks. 5.If TSH receptor antibody titre is positive in early pregnancy, fetal thyrotoxicosis should be ruled out. 6.If TSH receptor antibody titre is positive in late pregnancy, neonatal thyrotoxicosis should be looked for. 7.Beta blockers like propranolol may be needed before surgeries like caesarean section. 8.Thyroid storm is a serious complication which occurs in labour and may cause maternal mortality. 9. The postpartum period should be carefully monitored as patient may worsen and drugs may need to be started again or dose may need to be increased. 10. Surgery is indicated if patient is not able to tolerate anti thyroid drugs or very high doses are needed.

HAPPY NEW YEAR--- THANKS TO CUROFY N ALL CUROFIANS.

it's my pleasure to be honoured with this. this was achieved with your continuous support.

42 year old lady underwent surgery for breast cancer and she was unable to pass urine in the post op period and she required catheterisation. Greenish urine came out after catheterisation. Let's see who can guess the cause for this kind of urine after breast surgery