Multifocal fibrosclerosis

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Combined thyroxine and triiodothyronine for thyroid replacement therapy

Tablets containing 50mug. of thyroxine and 15mug. of triiodothyronine have been used to treat patients with hypothyroidism of varied aetiology. Following total thyroidectomy a daily dose of three tablets-that is, 150mug. of thyroxine and 45mug. of triiodothyronine-maintained patients in a euthyroid state and produced a protein-bound iodine level within the normal range. The preparation is preferable to dried thyroid because of uniformity of activity and speed of action, and when the patient is clinically euthyroid the P.B.I. falls within the normal range.

A case of mild hyperparathyroidism in childhood

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Familial multiple endocrine adenopathy (primary hyperparathyroidism and Zollinger-Ellison syndrome) in two siblings

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Thyroid carcinoma and its treatment

Thyroid cancer is a rare disease. Aetiological factors are increased secretion of TSH and exposure of the growing gland to ionizing radiation. Pathological classification is in two main groups: differentiated and undifferentiated. Differentiated is subdivided into papillary, follicular and medullary.

Papillary and medullary carcinomas occur in young patients, grow slowly, spread by lymphatics. Treatment is surgical excision of thyroid and affected nodes plus thyroid hormone replacement. Follicular carcinoma spreads by blood to lungs and bones. Treatment is total thyroidectomy and radioiodine therapy of the metastases followed by thyroid hormone replacement.

Undifferentiated tumours occur in old patients. They are identified by drill biopsy and treated with radiotherapy.