Goitre- Diffuse
- Nodular
- Multilobular
Hyperthyroidism - 80% Graves
- Eye signs
- Onycholysis
- Acropatchy (clubbing)
- Vitiligo
- Dermopathy (cauliflower feet)
- 15% toxic multinodular goitre
- Can get toxic nodules which selectively raise T3
- Make sure patients are euthyroid before surgery
- Give steroids when there's eye disease
Thyroid tumours- Papillary
- Follicular
- Anaplastic
- Medullary thyroid carcinoma
- MEN2 association
- 70% inherited
- Check relatives
- Prophylactic thyroidesctomy by age 2
- Rapid mets => Bone, Lung
- Can release calcitonin
- Lymphoma
Hypothyroidism- Peaches and cream
- Thyroxine can cause tachycardia
- Check for angina and do an ECG
- Amiodarone binds iodine and can cause hypothyroidism
- Don't stop the amiodarone, just replace thyroxine
- Type I vs Type II
- Type 1 is failure of the thyroid gland to produce sufficient amounts of thyroid hormones
- Type 2 is peripheral resistance to thyroid hormones - T4, TSH are normal
Hypoadrenalism - 99% of cases come from suddenly stopping steroids
- MUST taper if taking for >20 days
- May also manifest during stress, when a really big response is required
- Adrenals take up to a year to wake up again
- Be careful of removing a hyper-secreting gland
Pituitary apoplexy - Bleed
- Same signs as ICH
- Also hormone loss
- DI, Addisonian crisis, etc
Pheochromocytoma - Associations
- MENII
- Von Hippel-Lindau
- Neurofibromatosis
- Treatment
- Phenoxybenzamine + beta blockers BEFORE surgery
- Surgery can cause massive release of stuff
- Scan
Notes - Mechanical ophthalmoplegia, from pressure
- Avoid aspirin in thyroid storm - releases thyroid hormones from TBG
- Cortisol is the killer
- Addison's also causes mucosal pigmentation
- Replace cortisol first before fucking around with the thyroid
- Dexamethosone does not interfere with the synacthan test so can be used while you're waiting
- COCP interferes with synacthan test
- Hyperthyroidism is the gland; Thyrotoxicosis could be e.g. from exogenous thyroxine
- Somatostatin
- General inhibitor of stuff
- Octreotide = Synthetic mimic
- Can give just glucocorticoids initially in Addison's - have mineralocorticoid properties at high doses
- Dexamethosone suppression test should lower cortisol to <50 the next day
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