Lecture notes. Endocrinology and diabetes by Amir H Sam; Karim Meeran

By Amir H Sam; Karim Meeran

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ACTH secretion is suppressed by glucocorticoid therapy. Thus blood samples for ACTH must be drawn before starting glucocorticoids. In patients who are already on hydrocortisone, the test should be done at least 24 hours after the last dose of hydrocortisone, and longer after long-acting glucocorticoids such as dexamethasone if this is thought to be safe clinically. Prolonged ACTH stimulation test A prolonged ACTH stimulation test may be used to distinguish primary from secondary adrenal insufficiency.

The incidence of thyroid cancer has increased since 1980, partly due to an increase in the sensitivity of diagnostic methods. Aetiology Environmental factors 30 Goitre, thyroid nodules and cancer Chapter 4 Patients usually present with a rapidly enlarging neck mass. The spread is haematogenous, and distant metastases are found in 15–50% of patients at initial disease presentation. Thyroid lymphoma (a) Thyroid lymphoma may be part of a systemic disease or may primarily involve the thyroid gland.

Lymph node status should be assessed by neck ultrasound scans, and regional neck dissection is carried out in cases of central or lateral nodal involvement. TSH suppression After initial surgery, all patients should receive thyroxine to prevent hypothyroidism and to minimize potential TSH stimulation of tumour growth. 1 mU/L. Most patients require 175–200 μg daily. A lower level of TSH suppression may be appropriate in those with heart disease or low bone mineral density. 31 Chapter 4 Goitre, thyroid nodules and cancer Radio-iodine Thyroid follicular cells can take up radio-iodine (131I), which causes cell death by the emission of beta rays.

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