Endocrine/Metabolic System



Endocrine/Metabolic System





3-A. Hypothermia

Congestive heart failure

Drugs and intoxicants



  • Alcohol


  • Anesthetics, general


  • Antidepressants


  • Antithyroid agents


  • Barbiturates


  • Benzodiazepines


  • Cancer chemotherapy


  • Clonidine


  • Hypnotics/sedatives


  • Lithium


  • Marijuana


  • Neuromuscular blockers


  • Opiates


  • Phenothiazines


  • Tranquilizers

Endocrine disorders



  • Adrenal insufficiency


  • Diabetic ketoacidosis


  • Hypoglycemia


  • Hypopituitarism


  • Hypothyroidism


Environmental exposure (especially in neonates; premature or low birth weight babies; the elderly; or persons who are mentally impaired, unconscious, immobilized, drugged, debilitated, under anesthesia, wearing inadequate clothing, or exhausted)



  • Accidental



    • Cold water immersion


    • Sports related


    • Occupational


    • Wet clothing


  • Iatrogenic



    • Administration of cold blood or intravenous fluids


    • Iced saline gastric lavage


    • Peritoneal dialysis

Hepatic failure

Increased cutaneous blood flow



  • Burns


  • Erythrodermas (including toxic epidermal necrolysis and psoriasis)

Malnutrition

Myocardial infarction

Neurologic disorders



  • Central [hypothalamic and central nervous system (CNS) dysfunction; note: the hypothermia may be paroxysmal]



    • Anorexia nervosa


    • Brain tumors


    • Cerebrovascular accidents, paralysis, paresis


    • Encephalopathy


    • Episodic spontaneous hypothermia with hyperhidrosis (including those with agenesis of the corpus callosum—Shapiro syndrome)


    • Head trauma


    • Other hypothalamic lesions (e.g., infarction, midbrain lesions, sarcoidosis)


    • Parkinson disease


    • Prolonged cardiopulmonary resuscitation


    • Seizure


    • Spontaneous periodic hypothermia (paroxysmal hypothermia—nearly always with evidence
      of injury to the preoptic area of the hypothalamus)


    • Wernicke encephalopathy


  • Peripheral



    • Diabetic autonomic neuropathy


    • Spinal cord transection above T1

Pancreatitis

Prolonged surgery

Respiratory failure

Sepsis

Shock

Uremia



References

1. Danzl DF. Hypothermia and frostbite, p. 122. See Bibliography, 1.

2. Yoder E. Disorders due to heat and cold, p. 628. See Bibliography, 5.


3-B. Weight Gain

Cessation of cigarette smoking

Congenital disorders (e.g., Prader-Willi syndrome and pseudohypoparathyroidism)

Depression

Disturbances of hypothalamic satiety centers



  • Encephalitis


  • Trauma


  • Tumors

Drugs



  • Antidepressants



    • Monoamine oxidase inhibitors


    • Selective serotonin uptake inhibitors


    • Tricyclic antidepressants


  • Antiepileptics



    • Carbamazepine


    • Gabapentin


    • Valproate


  • Antihistamines


  • Antihypertensives



    • Alpha-adrenergic blockers


    • Beta-adrenergic blockers


    • Clonidine



  • Antipsychotics



    • First-generation antipsychotics



      • Haloperidol


      • Loxapine


      • Phenothiazines


    • Second-generation (atypical) antipsychotics



      • Aripiprazole


      • Clozaril


      • Olanzapine


      • Quetiapine


      • Risperidone


  • Glucocorticoids (pharmacologic doses)


  • Highly active antiretroviral therapy


  • Hypoglycemic agents



    • Insulin


    • Meglitinides


    • Sulfonylureas


    • Thiazolidinediones


  • Megestrol acetate


  • Oral contraceptives


  • Progestational agents

Endocrine disorders



  • Acromegaly


  • Cushing syndrome


  • Hypothyroidism


  • Insulinoma


  • With treatment of diabetes mellitus


  • With treatment of thyrotoxicosis

Exogenous obesity

Increased body fluid (see 2-B)



Reference

1. Jensen MD. Obesity, pp. 1342-1343. See Bibliography, 5.


3-C. Weight Loss

Ankylosing spondylitis

Bilateral lesions of the lateral hypothalamus (hypothalamic anorexia)

Decreased food intake/malnutrition



  • Abdominal angina


  • Anorexia of aging


  • Chronic/recurrent nausea/vomiting



  • Dementia/Alzheimer disease


  • Esophageal disease/dysphagia


  • Medications



    • Angiotensin-converting enzyme inhibitors (distortion of taste)


    • Antibiotics


    • Antidepressants


    • Digoxin


    • Levodopa


    • Metformin


    • Nonsteroidal anti-inflammatory agents


    • Sedatives


    • Theophylline


  • Obstructive disease (including pyloric obstruction due to chronic peptic ulcer disease)


  • Oral disease (e.g., loose dentures, poor or absent teeth)


  • Pain


  • Poor social situation


  • Postantrectomy (especially Billroth II) or gastrectomy


  • Poverty


  • Unpalatable diets

Endocrine disorders



  • Adrenal insufficiency


  • Diabetes mellitus


  • Diabetic neuropathic cachexia


  • Hypercalcemia


  • Panhypopituitarism


  • Pheochromocytoma


  • Thyrotoxicosis

Extensive exercise

Infection, especially:



  • Amebic abscess


  • Bacterial endocarditis


  • Chronic suppurative pleuropulmonary disease


  • Cryptosporidiosis


  • Fungal diseases


  • Giardiasis


  • Human immunodeficiency virus (HIV)


  • Mycobacterium avium pulmonary infections


  • Parasitic infestations


  • Paraspinal/epidural abscess


  • Tuberculosis


  • Visceral leishmaniasis


Maldigestion/malabsorption



  • Inflammatory bowel disease


  • Pernicious anemia

Malignancy, especially:



  • Biliary


  • Breast


  • Gastrointestinal


  • Glucagonoma


  • Hepatic


  • Leukemia


  • Lymphoma


  • Myeloma


  • Pancreatic


  • Pulmonary


  • Somatostatinoma

Myelofibrosis

Myotonic dystrophy

Neuromuscular disorders

Parkinson disease

Pink disease (mercury poisoning in children)

Psychiatric disease



  • Alcoholism


  • Anorexia nervosa


  • Anxiety disorders


  • Bulimia


  • Conversion disorders


  • Depression


  • Manipulative behaviors


  • Psychosis/paranoia


  • Schizophrenia


  • Substance abuse

Severe chronic organ failure



  • Heart failure (cardiac cachexia)


  • Hepatic disease


  • Pulmonary disease


  • Renal failure

Stroke

Systemic lupus erythematosus



References

1. Reife CM. Weight loss, p. 234. See Bibliography, 1.

2. Baron RB. Protein-energy malnutrition, p. 1315. See Bibliography, 5.



3-D. Thyrotoxicosis


Thyrotoxicosis with High or Normal Radioactive Iodine Uptake

Abnormal thyroid stimulator



  • Human chorionic gonadotropin (HCG)



    • Gestational transient thyrotoxicosis (typically in association with hyperemesis)


    • Tumors secreting HCG



      • Choriocarcinoma


      • Hydatidiform mole


      • Embryonal cell carcinoma of the testis


  • Thyroid-stimulating hormone (TSH)



    • Resistance to thyroid hormone (often tachycardic)


    • TSH-secreting pituitary adenoma


  • Thyroid-stimulating immunoglobulins



    • Amiodarone-induced thyrotoxicosis type I [usually the radioactive iodine (RAI) uptake is low]


    • Graves disease


    • Hashitoxicosis


    • Interferon-induced Graves disease


    • Interleukin-2-induced Graves disease


    • Neonate of mother with Graves disease

Autonomous thyroid function



  • Constitutive activation of TSH receptors (autosomal dominant)


  • Toxic adenoma


  • Toxic multinodular goiter

Infarction of a thyroid adenoma

Postaspiration thyrotoxicosis (after needle aspirate of thyroid cyst)

TSH hyperresponsiveness (autosomal dominant)


Thyrotoxicosis with a Low Radioactive Iodine Uptake

Excessive thyroidal production of thyroid hormone



  • Iodine-induced thyrotoxicosis (the “Jod-Basedow” phenomenon)



    • Amiodarone-induced thyrotoxicosis type I (rarely the RAI uptake may be normal or elevated)


    • Other iodine-containing drugs (including kelp tablets and certain cough preparations)


    • Iodine-containing x-ray contrast agents


Extrathyroidal sources of thyroid hormone



  • Ectopic thyroid tissue



    • Metastatic differentiated thyroid cancer (usually follicular carcinoma)


    • Struma ovarii


  • Hormone ingestion



    • “Hamburger thyrotoxicosis”


    • Iatrogenic


    • Thyrotoxicosis factitia

Inflammation of the thyroid



  • Drug-induced thyroiditis



    • Amiodarone-induced thyrotoxicosis type II


    • Interferon-α


    • Interleukin-2


  • Postpartum thyroiditis


  • Radiation thyroiditis


  • Silent (painless) thyroiditis


  • Subacute (De Quervain, granulomatous) thyroiditis

Postparathyroidectomy thyrotoxicosis (transient—2 weeks)



References

1. Burman KD. Hyperthyroidism, p. 416. See Bibliography, 2.

2. Braverman LE, Utiger RD. Introduction to thyrotoxicosis, p. 454. See Bibliography, 4.


3-E. Hypothyroidism


Primary Hypothyroidism

Destruction of the thyroid gland



  • External-beam radiation therapy to the head/neck


  • RAI (may be transient)


  • Replacement of thyroid tissue



    • Infiltrative diseases



      • Amyloidosis


      • Cystinosis


      • Hemochromatosis


      • Kaposi sarcoma


      • Lymphoma of the thyroid


      • Metastases to the thyroid


      • Riedel thyroiditis


      • Sarcoidosis and other granulomatous diseases


      • Scleroderma


  • Surgery (total or subtotal thyroidectomy) (may be transient)



  • Thyroiditis



    • Acute (suppurative) thyroiditis [bacterial, mycobacterial, fungal, parasitic, gummatous, Pneumocystis carinii infection in acquired immunodeficiency syndrome (AIDS)]


    • Chronic



      • Atrophic thyroiditis


      • Hashimoto thyroiditis (including after Graves disease)


    • Due to drug therapy



      • Amiodarone


      • Interferon-α


      • Interleukin-2


      • Lymphokine-activated killer cell therapy


    • Transient



      • Postpartum thyroiditis


      • Silent (painless) thyroiditis


      • Subacute (De Quervain, granulomatous) thyroiditis

Generalized resistance to thyroid hormone

Inhibition of thyroid hormone synthesis or accelerated disappearance from the circulation



  • Exposure to exogenous goitrogens (see 3-I)


  • Inherited defects of thyroid hormone synthesis


  • Iodine deficiency


  • Multiple hepatic hemangiomas (infants)


  • Selenium deficiency (usually with concomitant iodide deficiency)


  • Thalidomide


  • Thyroid agenesis, dysgenesis, or ectopy

Thyroid growth-blocking antibodies

Transplacental passage of antithyroid drugs, chemicals, or agents

TSH hyporesponsiveness



  • Pseudohypoparathyroidism type Ia


  • TSH receptor abnormalities


  • TSH receptor-blocking antibodies


Secondary (Pituitary) or Tertiary (Hypothalamic) Hypothyroidism

After withdrawal of thyroid hormone therapy in euthyroid patients (transient)

Pituitary/hypothalamic disease (see 3-T)

Thyroid-releasing hormone deficiency or insensitivity


TSH synthetic defect

Treatment with bexarotene and other retinoid X receptor-selective ligands


Increased Requirement for Oral Levothyroxine

Decreased gastrointestinal absorption of levothyroxine tablets



  • Drugs that interfere with levothyroxine absorption



    • Aluminum hydroxide-containing antacids


    • Bile acid sequestrants


    • Calcium


    • Ciprofloxacin


    • Ferrous sulfate and ferrous fumarate


    • Raloxifene


    • Sodium polystyrene sulfonate


    • Sucralfate

Increased levothyroxine metabolism



  • Carbamazepine


  • Phenobarbital


  • Phenytoin


  • Rifampin

Increased levothyroxine requirement by an unknown mechanism



  • Lovastatin


  • Sertraline

Levothyroxine malabsorption



  • Celiac disease and other malabsorption syndromes


  • Large quantities of fiber, bran, or soy



References

1. Shapiro LE, Surks MI. Hypothyroidism, p. 446. See Bibliography, 2.

2. Braverman LE, Utiger RD. Introduction to hypothyroidism, p. 698. See Bibliography, 4.


3-F. Serum Thyroxine


Elevated Total Thyroxine but Normal Free Thyroxine

Increased affinity of serum binding proteins for thyroxine (T4)



  • Increased affinity of albumin for T4



    • Familial dysalbuminemic hyperthyroxinemia (total T4 and free T4 index elevated, but free T4 normal) (note: a familial dysalbuminemic hypertriiodothyroninemia has also been described)



  • Increased affinity of transthyretin for T4



    • Familial increase in transthyretin binding (autosomal dominant) (total T4 and free T4 index elevated, but free T4 normal)

Increased serum concentration of binding proteins for T4



  • Increased thyroid-binding globulin (TBG) concentration



    • Estrogens (oral but not transdermal)


    • Drugs (small increases in TBG)



      • Clofibrate


      • Fluorouracil


      • Heroin


      • Methadone


      • Perphenazine


      • Raloxifene (very little effect)


      • Tamoxifen (small effect)


    • Increased endogenous estrogen production



      • Estrogen-secreting adrenal or testicular tumors


      • Pregnancy


    • Inherited increase in TBG


    • Liver disease



      • Chronic active hepatitis


      • Primary biliary cirrhosis


      • Infectious hepatitis


  • Increased T4 binding to autoantibodies to T4


Elevated Total and Free Thyroxine

Thyrotoxicosis (see 3-D)

Iatrogenic (excessive doses of oral levothyroxine)

Amphetamines (large doses)

Antibodies that interfere with the thyroid hormone assay



  • Autoantibodies to T4 and triiodothyronine (T3)


  • Human antimouse antibodies

Generalized resistance to thyroid hormone

High altitude

Inhibition of binding of T4 to thyroid-binding proteins (increases free T4 but not total T4)



  • Enoxaparin


  • Heparin

Inhibition of peripheral conversion of T4 to T3



  • 5′-Deiodinase inhibition


  • Amiodarone


  • Neonatal period


  • Nonthyroidal illness (including acute psychiatric illness)



Decreased Total Thyroxine but Normal Free Thyroxine

Decreased levels of serum thyroid-binding proteins



  • Acromegaly


  • Cirrhosis


  • Cushing syndrome


  • Drugs



    • Androgens and anabolic steroids


    • Asparaginase


    • Chlorpropamide


    • Colestipol combined with niacin


    • Danazol


    • Large doses of adrenocorticotropic hormone (ACTH) or glucocorticoids (chronic)


    • Salsalate


    • Sulfonamides


  • Inherited decrease in serum levels of TBG


  • Malnutrition


  • Protein loss (e.g., nephrotic syndrome)


  • Nonthyroidal illness


  • Testosterone-secreting adrenal or ovarian tumors

Decreased affinity of serum-binding proteins for T4



  • Decreased affinity of TBG for T4



    • Inherited TBG that has decreased affinity for T4


    • Nonthyroidal illness


  • Decreased affinity of transthyretin for T4



    • Familial amyloid polyneuropathy


    • Nonthyroidal illness

Displacement of T4 from serum-binding sites



  • Drugs



    • Furosemide (oral doses >100 mg or large intravenous doses)


    • Salicylates (in high doses)


Decreased Total and Free Thyroxine

Hypothyroidism (see 3-E)

Increased hepatic metabolism of T4 (TSH usually remains normal)



  • Carbamazepine


  • Phenobarbital


  • Phenytoin


  • Rifampin


Severe nonthyroidal illness

Ingestion of T3 alone



References

1. Toft AD, Beckett GJ. Measuring serum thyrotropin and thyroid hormone and assessing thyroid hormone transport, pp. 335-340. See Bibliography, 4.

2. Weiss RE, Wu SY, Refetoff S. Diagnostic tests of the thyroid. See Bibliography, 6.


3-G. Serum Thyroid-Stimulating Hormone


Elevated Serum Thyroid-Stimulating Hormone

Primary hypothyroidism (see 3-E)



  • Overt (low free T4)


  • Subclinical (normal free T4)

Addison disease

Drugs



  • Domperidone (acutely)


  • Metoclopramide (acutely)

Heterophile antibodies interfering with the TSH assay

Pulsatile TSH secretion, nocturnal TSH surge

Recovery from nonthyroidal illness

Resistance to thyroid hormone

TSH-secreting pituitary tumors


Low Serum Thyroid-Stimulating Hormone

Thyrotoxicosis (see 3-D)



  • Overt (low free T4)


  • Subclinical (normal free T4)


  • T3 toxicosis (with normal free T4)

After treatment of thyrotoxicosis, before the axis recovers from suppression

Drugs



  • Bromocriptine (acutely)


  • Dopamine


  • Glucocorticoids (acutely)

Nonthyroidal illness

Secondary (pituitary) and tertiary (hypothalamic) hypothyroidism (see 3-E)




References

1. Toft AD, Beckett GJ. Measuring serum thyrotropin and thyroid hormone and assessing thyroid hormone transport, pp. 336, 338, 341. See Bibliography, 4.

2. Weiss RE, Wu SY, Refetoff S. Diagnostic tests of the thyroid, pp. 1924-1925. See Bibliography, 6.


3-H. Radioactive Iodine Uptake


Factors Causing Increased Uptake

Reflecting increased hormone synthesis



  • Certain types of thyrotoxicosis (see 3-D)


  • Excessive hormone losses



    • Chronic diarrhea states


    • Nephrosis


    • Soybean ingestion


  • Response to glandular hormone depletion



    • Rebound after suppression of TSH


    • Recovery phase of silent, subacute, or other transient destructive thyroiditis


    • Rebound phase after withdrawal of iodide or other antithyroid drugs (if TSH is elevated)

Not reflecting increased hormone synthesis



  • Iodine deficiency



    • Dietary


    • Excessive loss



      • Dehalogenase defect


      • Pregnancy (RAI contraindicated)


    • Hashimoto thyroiditis (if TSH is elevated)


    • Inherited disorders of thyroid hormone synthesis (except for iodide-trapping defects)


    • Lithium administration


Factors Causing Decreased Uptake

Reflecting decreased hormone synthesis



  • Primary hypofunction



    • Drugs



      • Major effect



        • Glucocorticoids (in large doses, acutely)


        • Para-aminobenzoic acid


        • Perchlorate


        • Salicylates (>5 g/day)


        • Sulfonamides



        • Sulfonylureas


        • Thalidomide


        • Thiocyanate


        • Thionamides



          • Carbimazole


          • Methimazole


          • Propylthiouracil


      • Minor effect (small increases in TSH)



        • Aminoglutethimide


        • Ethionamide


        • Resorcinol (topical)


    • Hashimoto thyroiditis (end stage)


    • Some hormone biosynthetic defects (especially defects in iodide trapping)


    • Status post thyroidectomy, radioiodine, or external radiotherapy to the head/neck


    • Transient thyroiditis (active phase)



      • Postpartum thyroiditis (RAI contraindicated if breast feeding)


      • Silent (painless) thyroiditis


      • Subacute (De Quervain, granulomatous) thyroiditis


  • Secondary hypofunction



    • Exogenous thyroid hormone


    • Secondary (pituitary) or tertiary (hypothalamic) hypothyroidism

Not reflecting decreased hormone synthesis



  • Certain types of thyrotoxicosis (see 3-D)


  • Increased nonradioactive iodide exposure



    • Cardiac or renal failure with iodide retention


    • Increased dietary iodide


    • Pharmacologic iodide exposure



      • Amiodarone


      • Other iodine-containing drugs (e.g., kelp tablets, certain cough preparations, topical)


      • Iodine-containing x-ray contrast agents


    • Rapid hormone release due to very severe hyperthyroidism (rare)



References

1. McDougall R. In vivo radionuclide tests and imaging, p. 314. See Bibliography, 4.

2. Weiss RE, Wu SY, Refetoff S. Diagnostic tests of the thyroid, p. 1902. See Bibliography, 6.



3-I. Goiter/Neck Mass


Diffuse Goiter

Euthyroid or hypothyroid



  • Cigarette smoking (thiocyanate)


  • Increased intrinsic growth potential


  • Exposure to thyroid growth factors



    • Excess TSH



      • Chemicals



        • Cobalt


        • Flavonoids (polyphenols) (e.g. topical resorcinol)


        • Organochlorines


      • Cytokines (e.g., insulin-like growth factor-1, epidermal growth factor)


      • Defects in thyroid hormone synthesis (inherited)


      • Drugs



        • Amiodarone


        • Aminoglutethimide


        • p-Aminosalicylic acid


        • Antithyroid drugs



          • Carbimazole


          • Methimazole


          • Propylthiouracil


        • Ethionamide


        • Iodine excess (long term)


        • Lithium carbonate


        • Nicardipine


        • Para-aminobenzoic acid


        • Perchlorate


        • Tumor necrosis factor-α


  • Infiltration



    • Amyloidosis


    • Thyroiditis



      • Acute (suppurative) thyroiditis


      • Hashimoto thyroiditis


      • Riedel thyroiditis


      • Silent (painless) thyroiditis


      • Subacute (De Quervain, granulomatous) thyroiditis


    • Sarcoidosis


  • Ingestion of goitrogens (these rarely cause goiter unless patient is iodine deficient)



    • Brassica genus (broccoli, brussels sprouts, cabbage, cauliflower, kale, rape, rutabagas, swedes, turnips)



    • Cyanoglucosides (bamboo shoots, cassava, lima beans, maize, sweet potatoes)


    • Kelp


    • Soybean milk/soybean flour


  • Iodine deficiency


  • Neonatal



    • Maternal antithyroid drug therapy


    • Maternal iodine therapy


  • Pregnancy


  • Protein calorie malnutrition


  • Resistance to thyroid hormone


  • Selenium deficiency (usually with concomitant iodine deficiency)


  • Thyroid growth immunoglobulins

Hyperthyroid



  • Excessive stimulation by HCG



    • Gestational transient thyrotoxicosis (usually with hyperemesis)


    • Tumors secreting HCG



      • Choriocarcinoma


      • Embryonal cell carcinoma of the testis


      • Hydatidiform mole


  • Graves disease


  • Hashitoxicosis


  • Neonatal (mother with Graves disease)


  • Resistance to thyroid hormone (tachycardia)


  • Silent (painless) thyroiditis


  • Subacute thyroiditis


  • TSH-secreting pituitary tumor


Multinodular Goiter

Multiple adenomas

Nontoxic nodular goiter (same causes as euthyroid or hypothyroid; see 3-I)

Toxic multinodular goiter


Nongoiter Neck Masses

Branchial cleft cyst

Cystic hygroma

Thyroglossal duct cyst




References

1. Davis PJ, Davis FB. Nontoxic goiter, pp. 367-369. See Bibliography, 2.

2. Hermus AR, Huysmans DA. Pathogenesis of nontoxic diffuse and nodular goiter. pp. 873-877. See Bibliography, 4.

3. Hegedüs L, Gerber H, Bonnema SJ. Multinodular goiter, pp. 2115-2118. See Bibliography, 6.


3-J. Solitary Thyroid Nodule


Thyroid Lesions

Colloid nodule (also called hyperplastic nodule or adenomatous nodule)

Ectopic normal or tumoral tissue within the thyroid



  • Parathyroid


  • Thymic

Follicular adenoma (including Hurthle cell adenoma)

Focal or asymmetric thyroiditis



  • Acute (suppurative) thyroiditis (including Pneumocystis carinii infection in AIDS)


  • Hashimoto thyroiditis (asymmetric)


  • Riedel struma


  • Subacute (De Quervain, granulomatous) thyroiditis

Malignancy



  • Anaplastic carcinoma


  • Carcinosarcoma


  • Follicular carcinoma


  • Hemangioendothelioma


  • Lymphoma


  • Malignant form of histiocytosis X


  • Malignant hemangioendothelioma


  • Medullary carcinoma


  • Metastases to the thyroid from other primaries


  • Mixed papillary-follicular carcinoma


  • Papillary carcinoma


  • Paraganglioma


  • Sarcoma, angiosarcoma, fibrosarcoma


  • Squamous cell carcinoma

Miscellaneous



  • Agenesis of one lobe


  • Asymmetric multinodular goiter


  • Compensatory hyperplasia after hemithyroidectomy



  • Focal granulomatous disease (e.g., sarcoidosis)


  • Hematoma

Simple cyst


Nonthyroid Lesions

Branchial cleft cyst and other epithelial cysts

Carotid aneurysm

Cystic hygroma

Dermoid

Fibrosis (including postradiation)

Hemangioma

Laryngocele/bronchocele

Lipoma

Lymph node

Parathyroid adenoma

Parathyroid cyst

Teratoma

Thyroglossal duct cyst



References

1. Kaplan MM. Clinical evaluation and management of solitary thyroid nodules, p. 997. See Bibliography, 4.

2. Pacini F, DeGroot LJ. Thyroid neoplasia, pp. 2148, 2156. See Bibliography, 6.


3-K. Hypercortisolism

Acute or chronic physical illness

Alcoholism

Apparent hypercortisolism due to interference with testing

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Jun 19, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Endocrine/Metabolic System

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