A Synopsis of Endocrinology and Metabolism by David G. Ferriman

By David G. Ferriman

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1. Cover with blanket and nurse in warm room. Active rewarming is dangerous. 2. Tri-iodothyronine is given for rapid effect but in small doses (5 μg. intravenously at 8-hour intervals). Cardiac muscle is affected by myxoedematous change and indirectly by grossly atheromatous coronary arteries. Larger doses of T3 may precipitate acute cardiac failure and death. HYPERTHYROIDISM 35 3. Oral thyroxine 0*1 mg. is given daily from onset. This will exert its full effect in about 1 week, when T3 can be discontinued.

Partial Thyroidectomy is preferable for the majority of patients. b. Antithyroid Drugs can be given to patients with small goitres and relatively mild thyrotoxicosis ; 2 out of 3 such patients will be found to have gone into remission on discontinuance of therapy. Indicated in patients with associated auto-immune thyroiditis. c. 131 1 Therapy useful in elderly patients, and in mentally disturbed patients who refuse surgery and who are capricious in their taking of antithyroid drugs. d. Either antithyroid drugs or 131 I for those who refuse surgery, for thyrocardiac patients who cannot be made fit for surgery, or who are in relapse after previous surgery.

Loss of this diurnal rhythm may be the earliest sign of overactivity. —Cortisol is bound to transeortin (an a-globulin), and isotope studies show it to have a half-life of about 1J hours. Normal values—plasma 11-hydroxycorticosteroid, 5-25 μg. per 100 ml. Aldosterone is weakly bound to protein ; plasma levels are around 0-007 μg. , and it has a half-life of 20 min. F. Hypothalamus Pituitary CORTISOL CORTICOTROPHIN Adrenals Fig. —The hypothalamo-pituitary-adrenal control mechanism. —Steroids are mainly metabolized in the liver, formed into glucuronides and sulphates which are watersoluble, and thence excreted into the urine.

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