By Amir H Sam; Karim Meeran
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Extra info for Lecture notes. Endocrinology and diabetes
Radio-iodine may occasionally cause transient thyroiditis and sialoadenitis. Radio-iodine therapy for hyperthyroidism does not increase the overall risk of malignancy. Follow-up Antithyroid drugs may need to be started shortly after radio-iodine treatment in those who develop a transient thyroiditis. A total of 10% of patients develop permanent hypothyroidism during the first year and 2–3% annually thereafter. Therefore 22 patients should be followed up with repeat thyroid function tests regularly in the first year and then annually.
Hypocortisolaemia is a weaker stimulus to ACTH secretion than hypoglycaemia, and thus the metyrapone test will detect partial ACTH deficiency that may be missed by the insulin tolerance test. to look for apical shadowing and adrenal calcification respectively. Abdominal computed tomography (CT) may show adrenal enlargement with or without calcification in patients with tuberculosis, infiltration or metastatic disease. In autoimmune adrenalitis, the adrenal glands are often small and atrophic. Other tests Other tests may be done depending on the suspected causes of adrenal insufficiency.
The antithyroid drug dose is titrated down at monthly follow-up visits, using the free T4/T3 levels as a guide. It takes longer (up to several months) for suppressed TSH levels to increase. Treatment is continued for 12–18 months with regular monitoring of thyroid function tests. In the block and replacement regimen, carbimazole 40 mg per day or PTU 400 mg per day is started, and T4 (usually 100 μg) is added when free T4 is in the normal range (usually after about 4 weeks). This regimen is given for 18 months and requires fewer follow-up visits.
Lecture notes. Endocrinology and diabetes by Amir H Sam; Karim Meeran