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