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12.12.19 Endocrine teaching

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
    • MIBG

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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