A Synopsis of Endocrinology and Metabolism by David G. Ferriman

By David G. Ferriman

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See p . 41. 6. —Probably due to aggravation of a latent diabetes. — 1. BMR elevated in hyperthyroidism. Method unreliable. 38 DISEASES OF T H E THYROID Hyperthyroidism—Diagnosis, continued. 2. THYROIDAL 132 I AND 131 I UPTAKES and 48-hour PBI 1 3 1 high. Forty-eight-hour 131 I excretion low. 3. T3 SUPPRESSION TEST useful when 132 I or 131 I uptakes in border-line range, and in cases presenting with proptosis with absence of signs and symptoms due to the overproduction of thyroxine. 131 4. I SCAN OF THYROID shows uptake confined to nodule in toxic adenoma.

Sporadic goitre of unknown aetiology—the usual type found in communities where iodine supplies are satisfactory. 3. Dietary goitrogens and drugs. 4. Auto-immune thyroiditis. 5. Genetic enzyme defects. Studies in iodine-deficiency areas have shown two types of case. One with high 132 I uptake, thyroidal turnover rate, and 48-hour P B I 1 3 1 level; glands contain more iodothyronines than iodotyrosines. The other with low 132 I uptake, thyroidal turnover rate, and 48-hour P B I 1 3 1 level; glands contain more iodotyrosines than iodothyronines.

1. Put to bed. 2. —500 mg. , followed by 500 mg. 6-hourly by mouth. 3. —100 mg. , followed by 15 mg. 6hourly by mouth. 4. —Sodium amytal 2-400 mg. , repeated as often as necessary. Chlorpromazine with hypothermie as well as sedative action advocated; hypotensive action undesirable and dose should not exceed 25-50 mg. by mouth 6-8-hourly. Morphine 10 mg. or pethidine 50 mg. useful in exceptional cases. 42 DISEASES OF T H E THYROID Thyrotoxic Crisis—Treatment, continued. 5. REDUCTION OF F E V E R by tepid sponging, or by covering in wet blanket and use of a fan in hyperpyrexia.

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