06 METABOLIC MEDICINE 08 INFECTIOUS DISEASE 08.07 Protozoan infections 10 HAEMATOLOGY & ONCOLOGY 10.07 Platelet disorders
& ENDOCRINOLOGY • Amoebiasis • Cryptosporidiosis • Immune thrombocytopaenia
08.01 Bacterial infections • Cutaneous larva migrans 10.01 Haematological cancers • Thrombocytopaenia
06.01 Thyroid • Anthrax • Bacillus cereus • Giardiasis • Leishmaniasis • ALL • CLL • Hairy cell leukaemia • Haemophilia
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism • Malaria • Trypanosomiasis • AML • CML • Myelofibrosis • von Willebrand disease
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Schistosomiasis • Myelodysplastic syndrome • Neutropaenia
• Clostridiodes difficile • Diphtheria • Other mosquito-borne illnesses • Polycythaemia vera
06.02 Adrenals • Escherichia coli • Klebsiella 10.08 Blood products
• Cushing's disease • Enteric fever (typhoid/paratyphoid) 08.08 Genitourinary infections / STIs 10.02 Haematological cancers • Packed red cells • Platelets
• Adrenal insufficiency • Haemophilus influenza • Legionella • Bacterial vaginosis • Non-Hodgkin's lymphoma • CMV-ve and irradiated blood
• Hyperaldosteronism • Trichomonas vaginalis • Hodgkin's lymphoma • FFP & cryoprecipitate
• Phaeochromocytoma 08.02 Bacterial infections • Donovanosis • Genital warts • Multiple myeloma • Prothrombin complex
• Leptospirosis • Leprosy • Chlamydia • Syphilis • Cell saver devices
06.03 • Lyme disease • Ps. aeruginosa • Lymphogranuloma venereum 10.03 Primary immunodeficiencies • Warfarin – Mx of high INR
• Acromegaly • Prolactinoma • Mycoplasma pneumoniae • Q fever • Genital herpes • Chancroid • Neutrophilia / phagocytes • Blood product transfusion
• Hyperthyroidism & hypoparathyroidism • Staphylococci • MRSA • Gonorrhoea • Ulcers in STIs • T-cell disorders, incl DiGeorge's complications, including TACO, TRALI
• Multiple endocrine neoplasia • Toxic shock syndrome • B & T-cell disorders, incl SCID
• Tetanus • Other clostridia 08.09 Miscellaneous • Acute intermittent porphyria 10.09 Miscellaneous
06.04 Diabetes melitus • Animal & human bites • Cellulitis • Hereditary angioedema
• T1DM, T2DM 08.03 Bacterial infections & others • Sepsis • Necrotising fasciitis 10.04 Anaemia • Hyposplenism • Splenomegaly
© quackquackmed.com
• Drugs used in DM • Insulin • Streptococcus • Nematode infections • Threadworms • DDx chart + iron studies interpretation • Thymoma • Lymphadenopathy
• DVLA rules for diabetes - Scarlet fever (+ Centor criteria) • Lemierre's syndrome • Microcytic anaemia • Drugs – anticoagulants, antiplatelets,
• Complications of DM & sick day rules - Group B strep • Post-splenectomy sepsis tranexamic acid
• Notifiable disease • Pyrexia of unknown origin 10.05 Anaemia
06.05 • Influenza vaccination • Spinal epidural abscess • Normocytic anaemia ÷ non-haemolytic 10.10 Emergencies, organ transplants
• Diabetic ketoacidosis • Vaccination schedule • Side effects of antimicrobials and haemolytic anaemia • Neutropenic sepsis
• Hyperosmotic hyperglycaemic state • Tumour lysis syndrome
• Hypoglycaemia 08.04 Antibiogram 08.10 10.06 • Microcytic anaemia • Graft versus host disease (GVHD)
• Diabetes insipidus • Diarrhoea DDx • Methaemoglobinaemia • Superior vena cava syndrome
- Water deprivation test 08.05 Viral infections • Gastroenteritis – causes • Thrombophilia • Organ transplant & rejection
• Cytomegalovirus • Dengue fever - Bloody infectious diarrhoeas • Antiphospholipid syndrome
06.06 • Acid-base balance • Infectious mononucleosis • Ebola • Other infections in this book (list) • Thrombocytosis 10.11
• Hypercholesterolaemia • Herpes simplex • Measles • Common cancers • Tumour markers
• Mumps • Norovirus • Genetic conditions predisposing to
06.07 • Hyperkalaemia & hypokalaemia 09 DERMATOLOGY 09.04 • Eczema cancer
• Hypercalcaemia & hypocalcaemia 08.06 Viral infections • Psoriasis • Prescribing for palliative / end of life
• Hypomagnesaemia • Parvovirus B19 • Hand-foot-mouth 09.01 Dermatological emergencies • Rosacea care
• Rabies • Yellow fever • Rubella • Acute urticaria & angioedema
06.08 • Hyponatraemia (DDx) • Human immunodeficiency virus • Steven-Johnson's & TEN 09.05 Dermatological infections 10.12 Breast
- SIADH • Eczema herpeticum • Impetigo • Folliculitis • Breast Ca • Fibroadenoma
• Hypernatraemia • Staph scalded skin syndrome • Cellulitis & erysipelas • Fibrocystic breast changes
• Necrotising fasciitis • Head lice • Scabies • Fat necrosis • Lipoma
• Phyllodes tumour • Galactocele
07 RENAL MEDICINE & UROLOGY 09.02 Melanocytic lesions and mimickers 09.06 Dermatological infections • Mammary duct ectasia
• Melanoma & differentials • Tinea / dermatophyte infections • Duct papilloma • Lump description
07.01 • Acute kidney injury (AKI) 07.04 • Urinary tract stones • Seborrhoeic keratosis • Benign naevi • Candida • Viral warts
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia • Dermatofibroma • Molluscum contagiosum
- Renal replacement therapy • Erectile dysfunction • Pyoderma gangrenosum
09.07 Dermatological infections
07.02 • Acute tubular necrosis 07.05 09.03 • Varicella / chickenpox
• Acute interstitial nephritis • Urological cancers: renal cell • Non-melanoma skin cancers • Herpes zoster / shingles
• Diabetic nephropathy carcinoma, bladder Ca, prostate Ca - BCC & SCC • Pityriasis rosea
• Lupus nephritis • Misc urology: circumcision, vasectomy, • Acne vulgaris • Hidradenitis suppurativa
• ANCA glomerulonephritis priapism
• Myeloma kidney 09.08 Miscellaneous
07.06 Testicular lumps • Pemphigus • Bullous pemphigoid
07.03 Infections of the urinary tract • Inguinal hernia • Hydrocele • Insect bites • Skin lesions
• Infectious cystitis including UTI • Varicocele • Epididymal cyst
• Pyelonephritis • Epididymitis • Epididymo-orchitis
• Prostatitis • Balanoposthitis • Testicular torsion • Testicular tumour
, Hypothyroidism Mx (cont) Hyperthyroidism Thyroid cancers
• Goal is to normalise TSH level – aim for
D: clinical disorder 2/2 ↓T3 and T4 D: clinical state 2/2 ↑T3 and ↑T4
0.5-2.5 mU/L
Toxic multinodular goitre Papillary carcinoma (70%)
• In pregnancy, increase dose by ≥25-50
• Thyrotoxicosis is an interchangeable = multiple autonomously functioning • F>M (3:1), young, good prognosis
mcg, monitor TSH
term thyroid nodules • cancer of epithelial follicular cells, seldom
Causes of primary hypothyroidism • Levothyroxine SE
• Scan: patchy uptake encapsulated
• Hashimoto's (autoimmune) - hyperthyroidism
- ↓bone mineral density: may need Causes • Mx: antithyroid drug (eg carbimazole) – • mets: usually via LN, rare haematologically
- anti-thyroid peroxidase and anti-
• Graves' disease (most common) trial for ≥2 years as first-line
thyroglobulin antibodies supplementing with calcium + D
• Toxic nodular goitre - Radioiodine or surgery are secondary Follicular adenoma
- a/w other autoimmune disorders - worsening of angina - AF
• In amiodarone-induced ↓T, continue • Postpartum thyroiditis options • benign encapsulated tumour of the thyroid
• Subacute thyroiditis (de Quervain's)
- thought to occur after viral infxns amiodarone + give levothyroxine • Gestational hyperthyroidism gland; usually presents as solitary thyroid
- 4 phases: 1st phase (3-6w) with ↑T, ❗️
© quackquackmed.com
Interactions with levothyroxine • TSH-producing pituitary adenoma Thyroid storm nodule
painful goitre and ↑ESR; 2nd phase - iron and calcium carbonate will ↓ • Thyroid cancers (don't usually cause aka thyrotoxic crisis, life-threatening • Requires histology to r/o malignancy
euthyroid; 3rd phase ↓T; 4th phase absorption of levothyroxine – give hyper or hypothyroidism) hyperthyroidism
normal ≥4h apart • Iodine-induced ↑T (2/2 diet, contrast, • Precipitated by surgery, trauma, infxn Follicular carcinoma (20%)
- scan will show ↓uptake of iodine-131 • Levothyroxine is safe in bfding drugs eg amiodarone) or acute illness, acute iodine overload • malignant transformation of follicular
- usually self-limiting (eg contrast) adenoma; capsular invasion of tumour
• Riedel thyroiditis Subclinical hypothyroidism
S/smx of hyperthyroidism • S/smx: ↳ vascular invasion usually
- chronic inflammation and fibrosis of = ↑TSH but normal T3, T4 • General: wt loss, sweating, heat - Fever (>38.5ºC) ↳ multifocal disease rare
thyroid gland intolerance, tremor, irritability - CNS dysfunction (agitation, delirium,
+ no obvious smx psychosis, lethargy++, seizure, coma)
• Post-thyroidectomy or post-radioiodine • Palpitations ± AF
treatment
• Possible in pts who are non-compliant
• GI: diarrhoea - ↑HR ± AF - HF Medullary carcinoma (5%)
with levothyroxine • malignancy of the parafollicular C cells derived
• Post-partum thyroiditis • Gynae: oligomenorrhoea - GI dysfunction (NVD, abd pain,
from neural crest
unexplained jaundice)
• Drug therapy (eg lithium, amiodarone, Mx
• See below for features specific to
• Ix: TSH receptor antibodies (TRAbs), ± ↳ secretes calcitonin
and anti-thyroid drugs) Graves' • a/w MEN2 (familial genetic disease accounts
• If TSH >10 mU/L on 2 separate technetium scan of thyroid gland if
• Iodine deficiency (diet) occasions 3mo apart (and T3 T4 normal for ~20%)
TRAbs -ve
Causes of 2ndary hypothyroidism range), consider offering levoT Graves' disease • nodal disease a/w very poor prognosis
• Mx
↳ causes that don't directly affect the • If TSH 5.5-10 mU/L on 2 separate
occasions 3mo apart (and T3 T4 normal
= autoimmune thyroid condition a/w
hyperthyroidism
☝🏻
- β-blockers: IV propranolol
thyroid gland Anaplastic carcinoma (1%)
• Down's syndrome • Pituitary range + smx of hypothyroidism ↳ abs to TSH receptor (90%) and abs - Antithyroid drugs, eg propylthiouracil
or methimazole • aka undifferentiated thyroid carcinoma
• Turn's syndrome
• Coeliac disease
adenomas + <65yo
→ consider 6mo trial of levothyroxine
to anti-thyroid peroxidase (75%)
• R: FHx, F>M (6:1), tobacco use
- Dexamethasone ❗ blocks the • highly aggressive; very poor prognosis
conversion of T4 to T3 • most common in elderly females
• If TSH 5.5-10 mU/L in older people, • Features specific to Graves'
- Lugol's iodine • Mx: resection where possible, palliation via
Note: amiodarone can cause both hyper and watch and wait - Eyes (30%): exophthalmos &
- Other smx treatment isthmusectomy and radiotherapy
ophthalmoplegia [→05.05]
hypothyroidism • If TSH 5.5-10 mU/L + asmx, observe - Treat precipitating event ↳ chemo not effective
and repeat TFT in 6mo ↳ smoking ↑risk for eye disease
S/smx: [body slows down] - Pretibial myxoedema (scaly and lumpy
• General: wt gain, lethargy, cold skin on shins; non-pitting) Anti-thyroid drugs Thyroid lymphoma (rare)
intolerance Sick euthyroid syndrome • MOA: inhibits thyroid peroxidase • a/w Hashimoto's
= non-thyroidal illness where ↓TSH,
- Thyroid acropachy
• Ix before starting: FBC, LFTs • Primary thyroid lymphoma – lymphoma affects
• Skin: dry, cold skin; non-pitting oedema
(on hands/face - can show up as peri- ↓T3, ↓T4 ◊ Digital clubbing
◊ Soft tissue swelling of hands and •❗️ STOP if pt develops agranulocytosis thyroid first → LN → other organs
orbital oedema); dry, coarse scalp hair, • Most of the time TSH is roughly in
feet (and warn pt to be careful with infxns) ↳ B-cell lymphoma most common
loss of lateral aspect of eyebrows normal range Carbimazole • 2ndary thyroid lymphoma – lymphoma affects
• GI: constipation ↳ "inappropriate" since TSH should be ◊ Periosteal new bone formation
• Ix: thyroid scintigraphy scan – diffuse, • SE: Teratogenic. Pancreatitis. LN → other organs → thyroid
• Gynae: menorrhagia (↑bleeding) high if T3 and T4 are low
homogenous, ↑uptake of iodine 131 Propylthiouracil (PTU)
• Neuro: carpal tunnel syndrome • Usually result of systemic illness • 2nd-line; given if pt cannot tolerate
• Mx
• No tx needed if it reverses upon carbimazole, pregnant (or planning to
- Propranolol for smx control + = neck swelling ∵ thyroid issue
recovery be), and PMH of pancreatitis
Ix: TFTs ± TPO antibodies endocrine referral • 5-12% malignant. Usually benign and asmx.
- Antithyroid drugs, eg carbimazole • Both hyper and hypothyroidism can cause
Goitre
Myxoedema coma - Definitive therapy: radioiodine (used if "Block and replace" – give levothyroxine goitre.
Mx: levothyroxine = extremely decompensate hypoT if hypothyroidism develops after tx
antithyroid drugs unlikely to achieve
- Start 1.6 mcg/kg/day (nearest 25 mcg) • S/smx: confusion, hypothermia remission), or surgery (esp if concerns Dx - establish whether mass is intra or extra
- If ≥65yo with IHD, start with 25 mcg • Mx: - IV thyroid replacement about compression, malignancy, or thyroidal - US + exam. Evaluate LN also.
OD and slowly titrate up - IV corticosteroids (due to possibility of other tx not suitable)
• With dose ↑ or ↓ , check TFTs after
Thyroid will move with swallowing.
8-12w
coexisting adrenal insufficiency) ↳ Radioiodine CI in pregnancy
- IV fluids - correct electrolytes
06.01 Metabolic & Endocrine – Thyroid updated 13/09/2025
& ENDOCRINOLOGY • Amoebiasis • Cryptosporidiosis • Immune thrombocytopaenia
08.01 Bacterial infections • Cutaneous larva migrans 10.01 Haematological cancers • Thrombocytopaenia
06.01 Thyroid • Anthrax • Bacillus cereus • Giardiasis • Leishmaniasis • ALL • CLL • Hairy cell leukaemia • Haemophilia
• Hypothyroidism • Hyperthyroidism • Campylobacter • Botulism • Malaria • Trypanosomiasis • AML • CML • Myelofibrosis • von Willebrand disease
• Thyroid cancers • Goitre • Cat scratch disease • Cholera • Schistosomiasis • Myelodysplastic syndrome • Neutropaenia
• Clostridiodes difficile • Diphtheria • Other mosquito-borne illnesses • Polycythaemia vera
06.02 Adrenals • Escherichia coli • Klebsiella 10.08 Blood products
• Cushing's disease • Enteric fever (typhoid/paratyphoid) 08.08 Genitourinary infections / STIs 10.02 Haematological cancers • Packed red cells • Platelets
• Adrenal insufficiency • Haemophilus influenza • Legionella • Bacterial vaginosis • Non-Hodgkin's lymphoma • CMV-ve and irradiated blood
• Hyperaldosteronism • Trichomonas vaginalis • Hodgkin's lymphoma • FFP & cryoprecipitate
• Phaeochromocytoma 08.02 Bacterial infections • Donovanosis • Genital warts • Multiple myeloma • Prothrombin complex
• Leptospirosis • Leprosy • Chlamydia • Syphilis • Cell saver devices
06.03 • Lyme disease • Ps. aeruginosa • Lymphogranuloma venereum 10.03 Primary immunodeficiencies • Warfarin – Mx of high INR
• Acromegaly • Prolactinoma • Mycoplasma pneumoniae • Q fever • Genital herpes • Chancroid • Neutrophilia / phagocytes • Blood product transfusion
• Hyperthyroidism & hypoparathyroidism • Staphylococci • MRSA • Gonorrhoea • Ulcers in STIs • T-cell disorders, incl DiGeorge's complications, including TACO, TRALI
• Multiple endocrine neoplasia • Toxic shock syndrome • B & T-cell disorders, incl SCID
• Tetanus • Other clostridia 08.09 Miscellaneous • Acute intermittent porphyria 10.09 Miscellaneous
06.04 Diabetes melitus • Animal & human bites • Cellulitis • Hereditary angioedema
• T1DM, T2DM 08.03 Bacterial infections & others • Sepsis • Necrotising fasciitis 10.04 Anaemia • Hyposplenism • Splenomegaly
© quackquackmed.com
• Drugs used in DM • Insulin • Streptococcus • Nematode infections • Threadworms • DDx chart + iron studies interpretation • Thymoma • Lymphadenopathy
• DVLA rules for diabetes - Scarlet fever (+ Centor criteria) • Lemierre's syndrome • Microcytic anaemia • Drugs – anticoagulants, antiplatelets,
• Complications of DM & sick day rules - Group B strep • Post-splenectomy sepsis tranexamic acid
• Notifiable disease • Pyrexia of unknown origin 10.05 Anaemia
06.05 • Influenza vaccination • Spinal epidural abscess • Normocytic anaemia ÷ non-haemolytic 10.10 Emergencies, organ transplants
• Diabetic ketoacidosis • Vaccination schedule • Side effects of antimicrobials and haemolytic anaemia • Neutropenic sepsis
• Hyperosmotic hyperglycaemic state • Tumour lysis syndrome
• Hypoglycaemia 08.04 Antibiogram 08.10 10.06 • Microcytic anaemia • Graft versus host disease (GVHD)
• Diabetes insipidus • Diarrhoea DDx • Methaemoglobinaemia • Superior vena cava syndrome
- Water deprivation test 08.05 Viral infections • Gastroenteritis – causes • Thrombophilia • Organ transplant & rejection
• Cytomegalovirus • Dengue fever - Bloody infectious diarrhoeas • Antiphospholipid syndrome
06.06 • Acid-base balance • Infectious mononucleosis • Ebola • Other infections in this book (list) • Thrombocytosis 10.11
• Hypercholesterolaemia • Herpes simplex • Measles • Common cancers • Tumour markers
• Mumps • Norovirus • Genetic conditions predisposing to
06.07 • Hyperkalaemia & hypokalaemia 09 DERMATOLOGY 09.04 • Eczema cancer
• Hypercalcaemia & hypocalcaemia 08.06 Viral infections • Psoriasis • Prescribing for palliative / end of life
• Hypomagnesaemia • Parvovirus B19 • Hand-foot-mouth 09.01 Dermatological emergencies • Rosacea care
• Rabies • Yellow fever • Rubella • Acute urticaria & angioedema
06.08 • Hyponatraemia (DDx) • Human immunodeficiency virus • Steven-Johnson's & TEN 09.05 Dermatological infections 10.12 Breast
- SIADH • Eczema herpeticum • Impetigo • Folliculitis • Breast Ca • Fibroadenoma
• Hypernatraemia • Staph scalded skin syndrome • Cellulitis & erysipelas • Fibrocystic breast changes
• Necrotising fasciitis • Head lice • Scabies • Fat necrosis • Lipoma
• Phyllodes tumour • Galactocele
07 RENAL MEDICINE & UROLOGY 09.02 Melanocytic lesions and mimickers 09.06 Dermatological infections • Mammary duct ectasia
• Melanoma & differentials • Tinea / dermatophyte infections • Duct papilloma • Lump description
07.01 • Acute kidney injury (AKI) 07.04 • Urinary tract stones • Seborrhoeic keratosis • Benign naevi • Candida • Viral warts
• Chronic kidney disease (CKD) • Benign prostatic hyperplasia • Dermatofibroma • Molluscum contagiosum
- Renal replacement therapy • Erectile dysfunction • Pyoderma gangrenosum
09.07 Dermatological infections
07.02 • Acute tubular necrosis 07.05 09.03 • Varicella / chickenpox
• Acute interstitial nephritis • Urological cancers: renal cell • Non-melanoma skin cancers • Herpes zoster / shingles
• Diabetic nephropathy carcinoma, bladder Ca, prostate Ca - BCC & SCC • Pityriasis rosea
• Lupus nephritis • Misc urology: circumcision, vasectomy, • Acne vulgaris • Hidradenitis suppurativa
• ANCA glomerulonephritis priapism
• Myeloma kidney 09.08 Miscellaneous
07.06 Testicular lumps • Pemphigus • Bullous pemphigoid
07.03 Infections of the urinary tract • Inguinal hernia • Hydrocele • Insect bites • Skin lesions
• Infectious cystitis including UTI • Varicocele • Epididymal cyst
• Pyelonephritis • Epididymitis • Epididymo-orchitis
• Prostatitis • Balanoposthitis • Testicular torsion • Testicular tumour
, Hypothyroidism Mx (cont) Hyperthyroidism Thyroid cancers
• Goal is to normalise TSH level – aim for
D: clinical disorder 2/2 ↓T3 and T4 D: clinical state 2/2 ↑T3 and ↑T4
0.5-2.5 mU/L
Toxic multinodular goitre Papillary carcinoma (70%)
• In pregnancy, increase dose by ≥25-50
• Thyrotoxicosis is an interchangeable = multiple autonomously functioning • F>M (3:1), young, good prognosis
mcg, monitor TSH
term thyroid nodules • cancer of epithelial follicular cells, seldom
Causes of primary hypothyroidism • Levothyroxine SE
• Scan: patchy uptake encapsulated
• Hashimoto's (autoimmune) - hyperthyroidism
- ↓bone mineral density: may need Causes • Mx: antithyroid drug (eg carbimazole) – • mets: usually via LN, rare haematologically
- anti-thyroid peroxidase and anti-
• Graves' disease (most common) trial for ≥2 years as first-line
thyroglobulin antibodies supplementing with calcium + D
• Toxic nodular goitre - Radioiodine or surgery are secondary Follicular adenoma
- a/w other autoimmune disorders - worsening of angina - AF
• In amiodarone-induced ↓T, continue • Postpartum thyroiditis options • benign encapsulated tumour of the thyroid
• Subacute thyroiditis (de Quervain's)
- thought to occur after viral infxns amiodarone + give levothyroxine • Gestational hyperthyroidism gland; usually presents as solitary thyroid
- 4 phases: 1st phase (3-6w) with ↑T, ❗️
© quackquackmed.com
Interactions with levothyroxine • TSH-producing pituitary adenoma Thyroid storm nodule
painful goitre and ↑ESR; 2nd phase - iron and calcium carbonate will ↓ • Thyroid cancers (don't usually cause aka thyrotoxic crisis, life-threatening • Requires histology to r/o malignancy
euthyroid; 3rd phase ↓T; 4th phase absorption of levothyroxine – give hyper or hypothyroidism) hyperthyroidism
normal ≥4h apart • Iodine-induced ↑T (2/2 diet, contrast, • Precipitated by surgery, trauma, infxn Follicular carcinoma (20%)
- scan will show ↓uptake of iodine-131 • Levothyroxine is safe in bfding drugs eg amiodarone) or acute illness, acute iodine overload • malignant transformation of follicular
- usually self-limiting (eg contrast) adenoma; capsular invasion of tumour
• Riedel thyroiditis Subclinical hypothyroidism
S/smx of hyperthyroidism • S/smx: ↳ vascular invasion usually
- chronic inflammation and fibrosis of = ↑TSH but normal T3, T4 • General: wt loss, sweating, heat - Fever (>38.5ºC) ↳ multifocal disease rare
thyroid gland intolerance, tremor, irritability - CNS dysfunction (agitation, delirium,
+ no obvious smx psychosis, lethargy++, seizure, coma)
• Post-thyroidectomy or post-radioiodine • Palpitations ± AF
treatment
• Possible in pts who are non-compliant
• GI: diarrhoea - ↑HR ± AF - HF Medullary carcinoma (5%)
with levothyroxine • malignancy of the parafollicular C cells derived
• Post-partum thyroiditis • Gynae: oligomenorrhoea - GI dysfunction (NVD, abd pain,
from neural crest
unexplained jaundice)
• Drug therapy (eg lithium, amiodarone, Mx
• See below for features specific to
• Ix: TSH receptor antibodies (TRAbs), ± ↳ secretes calcitonin
and anti-thyroid drugs) Graves' • a/w MEN2 (familial genetic disease accounts
• If TSH >10 mU/L on 2 separate technetium scan of thyroid gland if
• Iodine deficiency (diet) occasions 3mo apart (and T3 T4 normal for ~20%)
TRAbs -ve
Causes of 2ndary hypothyroidism range), consider offering levoT Graves' disease • nodal disease a/w very poor prognosis
• Mx
↳ causes that don't directly affect the • If TSH 5.5-10 mU/L on 2 separate
occasions 3mo apart (and T3 T4 normal
= autoimmune thyroid condition a/w
hyperthyroidism
☝🏻
- β-blockers: IV propranolol
thyroid gland Anaplastic carcinoma (1%)
• Down's syndrome • Pituitary range + smx of hypothyroidism ↳ abs to TSH receptor (90%) and abs - Antithyroid drugs, eg propylthiouracil
or methimazole • aka undifferentiated thyroid carcinoma
• Turn's syndrome
• Coeliac disease
adenomas + <65yo
→ consider 6mo trial of levothyroxine
to anti-thyroid peroxidase (75%)
• R: FHx, F>M (6:1), tobacco use
- Dexamethasone ❗ blocks the • highly aggressive; very poor prognosis
conversion of T4 to T3 • most common in elderly females
• If TSH 5.5-10 mU/L in older people, • Features specific to Graves'
- Lugol's iodine • Mx: resection where possible, palliation via
Note: amiodarone can cause both hyper and watch and wait - Eyes (30%): exophthalmos &
- Other smx treatment isthmusectomy and radiotherapy
ophthalmoplegia [→05.05]
hypothyroidism • If TSH 5.5-10 mU/L + asmx, observe - Treat precipitating event ↳ chemo not effective
and repeat TFT in 6mo ↳ smoking ↑risk for eye disease
S/smx: [body slows down] - Pretibial myxoedema (scaly and lumpy
• General: wt gain, lethargy, cold skin on shins; non-pitting) Anti-thyroid drugs Thyroid lymphoma (rare)
intolerance Sick euthyroid syndrome • MOA: inhibits thyroid peroxidase • a/w Hashimoto's
= non-thyroidal illness where ↓TSH,
- Thyroid acropachy
• Ix before starting: FBC, LFTs • Primary thyroid lymphoma – lymphoma affects
• Skin: dry, cold skin; non-pitting oedema
(on hands/face - can show up as peri- ↓T3, ↓T4 ◊ Digital clubbing
◊ Soft tissue swelling of hands and •❗️ STOP if pt develops agranulocytosis thyroid first → LN → other organs
orbital oedema); dry, coarse scalp hair, • Most of the time TSH is roughly in
feet (and warn pt to be careful with infxns) ↳ B-cell lymphoma most common
loss of lateral aspect of eyebrows normal range Carbimazole • 2ndary thyroid lymphoma – lymphoma affects
• GI: constipation ↳ "inappropriate" since TSH should be ◊ Periosteal new bone formation
• Ix: thyroid scintigraphy scan – diffuse, • SE: Teratogenic. Pancreatitis. LN → other organs → thyroid
• Gynae: menorrhagia (↑bleeding) high if T3 and T4 are low
homogenous, ↑uptake of iodine 131 Propylthiouracil (PTU)
• Neuro: carpal tunnel syndrome • Usually result of systemic illness • 2nd-line; given if pt cannot tolerate
• Mx
• No tx needed if it reverses upon carbimazole, pregnant (or planning to
- Propranolol for smx control + = neck swelling ∵ thyroid issue
recovery be), and PMH of pancreatitis
Ix: TFTs ± TPO antibodies endocrine referral • 5-12% malignant. Usually benign and asmx.
- Antithyroid drugs, eg carbimazole • Both hyper and hypothyroidism can cause
Goitre
Myxoedema coma - Definitive therapy: radioiodine (used if "Block and replace" – give levothyroxine goitre.
Mx: levothyroxine = extremely decompensate hypoT if hypothyroidism develops after tx
antithyroid drugs unlikely to achieve
- Start 1.6 mcg/kg/day (nearest 25 mcg) • S/smx: confusion, hypothermia remission), or surgery (esp if concerns Dx - establish whether mass is intra or extra
- If ≥65yo with IHD, start with 25 mcg • Mx: - IV thyroid replacement about compression, malignancy, or thyroidal - US + exam. Evaluate LN also.
OD and slowly titrate up - IV corticosteroids (due to possibility of other tx not suitable)
• With dose ↑ or ↓ , check TFTs after
Thyroid will move with swallowing.
8-12w
coexisting adrenal insufficiency) ↳ Radioiodine CI in pregnancy
- IV fluids - correct electrolytes
06.01 Metabolic & Endocrine – Thyroid updated 13/09/2025
