Ossicle/Oncology
< Ossicle
Head and Neck Oncologic Surgery
[edit | edit source]THYROID DISEASE
[edit | edit source]Medullary Thyroid Carcinoma produces calcitonin
- Amyloid and leukocytic infiltrate on path
- Associated with RET-protooncogene and MEN IIa and IIb
Thyroid Binding Globulin
- Increases with estrogens, BCP's, pregnanacy
- Decreases with androgens
- High TBG = High T4, Low T3RU (T3RU inversely proportional to # unoccupied T3 binding sites)
- High T3RU with hyperthyroidism, alternate ligands - salicylate, clofibrate
- Low T3RU with hypothyroidism, increased TBG
T1 + T1 => T2, PLUS ADD'L T2 => T4 => T3 + T1
- T4 => T3 blocked in periphery by propylthiouracil
- Tyr => Iodotyrosine blocked by thiouracil
- T3 much more active than T4, half life 30h
- T4 less active, half life 7 days
- Serum T4 = Bound + Free (free T4 is active)
Hypothyroidism - Low T4, Low T3RU
Hyperthyroidism - High T4, High T3RU
Grave's Ophthalmopathy - decompress orbits into ethmoids and maxillary sinus
Thyroiditis
- Acute Suppurative - (rare), hi WBC, nl ESR; Staph, Strep, Pneumococcus
- Subacute (DeQuervan's) - (common), Decr T3RU, High T3 & T4; Rx steroids, ASA
- Fibrous (Reidel's) - (rare), Rx debulking, steroids, cyclophosphamide
- Chronic Lymphocytic (Hashimoto's) - (common), α-microsomal and α-TBG antibodies; Rx: thyroxine
- Chronic non-suppurative - (rare)