• Increase renal tubular reabsoption of calcium in distal tubule
• Activation of vitamin D (hydroxylation at 1 position)
• Increased phosphate excretion
• Promotes release of calcium and phosphate from bone (osteoblast --> RANKL --> osteoclast)

Synthesized from 7 dehydro-cholesterol and sunlight in skin; 25 hydorxylation in live; 1 hydroxylation in kidney (active form)

25(OH) D

Moans- malaise, fatigue

Groans - constipation, gastritis, pancreatitis

Bones- Osteitis fibrosa cystica, osteoporosis

Stones- renal stones

1. Hemorrhage, scarring, and eventual calcification due to follicular rupture.
2. No papillations

Follicular carcinoma lacks the nuclei changes associated with papillary carcinoma (longitudinal nuclear grooves and "Annie eye" nuclei)

Follicular carcinoma invades the blood, while papillary invades the lymph

• Injury to the recurrent laryngeal nerve (hoarseness)
• Accidental removal of parathyroid glands (hypocalcemia)

• Increase catecholamine effect (lipolysis, glycogenolysis, gluconeogenesis)
• Increae mitochondrial action, respiratory enzymes, Na-K ATPase
• Increase oxygen consumption, basal metabolic rate

• Oxidization of iodine and coupling of iodotyrosines to form T3/T4; anti-TPO seen in Hashimoto's thyroiditis (90%) and Graves (60%)
• Substance in colloid which provides scaffold for T3/T4; after thyroidectomy to remove cancer, presence in circulation suggests relapse

Large excess of iodine ingested inhibits organification of iodine for 2-3 days. Large bolus of iodine is given to patients experiencing thyroid storm

.

T3 resin uptake measure how many binding sites for T3 and T4 are available.

• Low in high TGB (euthyroid), hypothyroidism
• High in low TGB (euthyroid), hyperthyroidism

Prolonged hypothyroidism, precipitated by cold exposure, sepsis or other stressful conditions. Characterized by low T4, T3, T3R, and high cholesterol and TSH.

SES will have low T4 and T3, but with high T3R and low TSH.

Extensive lymphocytic infiltrate, with well-developed germinal centers. Hurthle cells (eosinophilic, metaplastic epithelial cells) are abundant

Note: Hurthle cells also found in follicular adenomas

Patient typically experience a viral upper respiratory infection just before onset of thyroiditis, inducing an immune response. Patient experiences tranient hyperthyroidism followed by transient hypohtyroidism. Recovery occurs in 6-8 weeks.

Multinucleate giant cells enclosing pools of colloid

Grossly, Graves is more likely to be diffuse. Microscopically, goiters lack the papillations found in Graves.

Follicular adenomas are encapsulated.

For prolactinoma, primary treatment is with dopamine/bromocriptine (unless acidophil stem cell adenoma)

Surgeyr is the ultimate therapy.

• MEN-1 will most likely present with pituitary, parathyroid and pancreatic abnormalities (peptic ulcers from gastrin, diarrhea from VIP, hypoglycemia from insulin overproduction)
• Carney complex will present with cardiac myxoma, naevi and neural tumors.

Estrogen and TRH stimulate prolactin, while dopamine inhibits its release. Prolactin decreases gonadotropin levels.

Prozac can induce prolactin secretion, thereby indirectly inhibit FSH/LH

Reduced sensitivity of calcium receptor, meaning high levels of calcium are required to induce secretion of PTH.

Patient will have high serum calcium, normal serum PTH and low urinary calcium excretion (primary hyperPTH has high calcium excretion)

Lithium

1. Hydrate (replace volume lost, increase water/sodium, calcium to DCT and LoH, furosemide)
2. Decrease resorption of bone: palmidronate, alendronate
3. Salmon calitonin
4. Glucocoriticoids
5. Oral phossphate
6. Dialysis

• Phosphorous levels (high = hypoparathyroidism, PTH deficiency or resistance; low = vitD problem)
• Magnesium levels (low = PTH secretion problems)

Patient is given 2L saline over 4 hrs or salt tables for 5 days. Positive test is a serum aldosterone >15 ng/mL.

Primary hyperaldosteronism has low renin.