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