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Relation between hyperthyroidism and HCC

Marked elevations in serum thyroid-stimulating hormone, T4, T3, and free T4 are increased with tumour progression. The tumour also produced a substance stimulating thyroid-stimulating hormone synthesis and secretion with resultant inappropriate thyroid-stimulating hormone production and thyrotoxicosis.

Causes of discharge from skin overlying thyroid


. Malignancy !. "istula 3. #mproper surgery healing

Bruit on thyroid and 2 other bruits in the body causes

$ bruit is an audible vascular sound associated with turbulent blood flow detected by auscultation over the large and medium-si%ed arteries &e.g., carotid, brachial, abdominal aorta, femoral'

(auses )
Thyroid - sign of increased blood flow &hyperthyroidism' *eart - artherosclerosis, aneurysm $nterior abdominal wall - renal hypertension

Rx of thyrotoxicosis crises
+hould be treated in an #(, setting for close monitoring - stabili%ation. provide supplemental oxygen, ventilatory support, and intravenous fluids. .extrose solutions are the preferred intravenous fluids to cope with continuously high metabolic demand. (orrect electrolyte abnormalities. Treat cardiac arrhythmia (ontrol hyperthermia by applying ice packs and cooling blankets and by administering acetaminophen & / mg0kg orally or rectally every 4 h'. $ntiadrenergic drugs &eg, propranolol' to minimi%e sympathomimetic symptoms. (orrect the hyperthyroid state. $dminister antithyroid medications to block further synthesis of thyroid hormones &T*s' by high dose propylthiouracil $dminister iodine compounds &1ugol iodine or potassium iodide' orally or via a nasogastric tube to block the release of T*s &at least h after starting antithyroid drug therapy' $dminister glucocorticoids to decrease peripheral conversion of T4 to T3. This may also be useful in preventing relative adrenal insufficiency due to hyperthyroidism. Treat the underlying condition, if any, that precipitated thyroid storm and exclude comorbidities such as diabetic ketoacidosis and adrenal insufficiency. #nfection should be treated with antibiotics. 2arely, as a life-saving measure, plasmapheresis has been used to treat thyroid storm in adults

Complications of hyperthyroidism include:


$trial fibrillation

3lurred vision .ouble vision *eart failure *ypoparathyroidism Miscarriage 2apid heart rate 2ash 4eight loss

Radioactive uptake scan thyroid

$ radioactive iodine uptake &2$#,' test uses a radioactive tracer and a special probe to measure how much tracer the thyroid gland absorbs from the blood. The test can show how much tracer is absorbed by the thyroid gland and if it is evenly spread in the gland.

"indings) $ low uptake of tracer by the thyroid gland may mean that

hyperthyroidism is caused by inflammation of the thyroid gland &thyroiditis', taking too much thyroid medicine, or another rare condition. $ high uptake of tracer spread evenly in the thyroid gland may mean that hyperthyroidism is caused by conditions such as 5raves6 disease. $n uneven spread of tracer in the thyroid gland &with either low or high areas of uptake' may mean that hyperthyroidism is caused by a multinodular goiter or a noncancerous &benign' tumor called a toxic adenoma.

Why free

! and not

! measurement

"ree T4 - much more useful then total T4 &e.g. interested in unbound or active form' Total T4 is measured to see the bound and unbound levels of T4. The total T4 is less useful in cases where there could be protein abnormalities. The total T4 is less accurate due to the large amount of T4 that is bound

"cromegaly
$cromegaly is a hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood.

(linical picture
1arge bones of the face 1arge feet - hands 1arge glands in the skin &sebaceous glands' 1arge 7aw &prognathism' and tongue Thickening of the skin, skin tags 4idely spaced teeth

#nvestigatons *igh growth hormone level

*igh insulin-like growth factor &#5"- ' level +pine x-ray shows abnormal bone growth 8ituitary M2# may show a pituitary tumor 9chocardiogram may show an enlarged heart, leaky mitral valve, or leaky aortic valve "asting plasma glucose 5lucose tolerance test

Treatment +urgery to remove the pituitary tumor Transphenoidal or Transfrontal Medications


:ctreotide &+andostatin' or bromocriptine &8arlodel' may control growth hormone release in some people. 8egvisomant &+omavert' directly blocks the effects of growth hormone, and has been shown to improve symptoms of acromegaly.

Hypothyroidism

*ypothyroidism refers to any state in which thyroid hormone production is below normal

(auses

*ashimoto6s thyroiditis 1ymphocytic thyroiditis &which may occur after hyperthyroidism' Thyroid destruction &from radioactive iodine or surgery' 8ituitary or hypothalamic disease Medications +evere iodine deficiency

(linical 8icture
"atigue, somnolence, daytime sleepiness oligomenorrhea weight gain (old intolerance .ry, coarse hair (onstipation .ry skin Muscle cramps .ecreased concentration ;ague aches and pains +welling of the legs

#nvestigation T+*, T3 and T4


Condition hyroid hormone resistance &rimary hypothyroidism #H 2aised or normal 2aised $ree 2aised 1owered ! 2aised 1owered or normal $ree %

#econdary hypothyroidism

1owered or normal

1owered

1owered of normal

$nti-thyroid peroxidase &anti-T8:' antibodies or anti-thyroglobulin antibodies are found in <=-</> of patients with autoimmune thyroiditis. ,ntreated hypothyroidism may be associated with a raised (?, raised cholesterol and triglycerides and anaemia &normocytic or macrocytic'. These abnormalities usually resolve with treatment. #f the patient has an asymmetrical goitre then they may need imaging of their thyroid gland, eg ultrasonography to rule out neoplastic lesions

Treatment
2emove causes &drugs, etc' 1ifelong Thyroxine therapy

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