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  <head>
    <title>024-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Thyroid, adrenal, calcium, and bone foundations">
      <outline text="Thyroid hormone synthesis and action">
        <outline text="Sodium-iodide symporter concentrates iodide"/>
        <outline text="Thyroid peroxidase oxidises and attaches iodide">
          <outline text="Coupling forms thyroxine and triiodothyronine"/>
        </outline>
        <outline text="Colloid stores hormone until proteolysis"/>
        <outline text="Mostly thyroxine secreted">
          <outline text="Deiodinases make active or inactive forms"/>
        </outline>
        <outline text="Free hormone binds nuclear receptors"/>
        <outline text="Stimulating hormone and negative feedback"/>
      </outline>
      <outline text="Hypothyroidism">
        <outline text="Primary: autoimmunity, treatment, iodine, drugs"/>
        <outline text="Paired stimulating hormone and free thyroxine">
          <outline text="Primary: high stimulating hormone, low thyroxine"/>
          <outline text="Central: inappropriately low or normal"/>
        </outline>
        <outline text="Levothyroxine dose individualised">
          <outline text="Iron, calcium, food reduce absorption"/>
        </outline>
        <outline text="Myxoedema coma: severe decompensation">
          <outline text="Urgent hormone, glucocorticoid cover, triggers"/>
        </outline>
      </outline>
      <outline text="Thyrotoxicosis and structural thyroid disease">
        <outline text="Excess tissue exposure to thyroid hormone">
          <outline text="Graves disease stimulates the receptor"/>
          <outline text="Toxic nodules secrete autonomously"/>
          <outline text="Thyroiditis releases stored hormone"/>
          <outline text="Exogenous hormone bypasses synthesis"/>
        </outline>
        <outline text="Radionuclide uptake separates cause">
          <outline text="High uptake: active synthesis"/>
          <outline text="Low uptake: thyroiditis or exogenous hormone"/>
        </outline>
        <outline text="Thionamides inhibit synthesis">
          <outline text="Agranulocytosis: fever or sore throat is urgent"/>
        </outline>
        <outline text="Storm: block adrenergic effects to trigger"/>
        <outline text="Nodules: ultrasound risk and needle sampling"/>
      </outline>
      <outline text="Adrenal cortical organisation">
        <outline text="Glomerulosa: aldosterone via angiotensin, potassium"/>
        <outline text="Fasciculata: cortisol via adrenocorticotropic hormone"/>
        <outline text="Reticularis: adrenal androgens"/>
        <outline text="Cortisol supports vascular tone and gluconeogenesis"/>
        <outline text="Aldosterone acts on principal cells">
          <outline text="Sodium reabsorption, potassium secretion"/>
        </outline>
        <outline text="Renin: low perfusion, macula densa, sympathetic"/>
      </outline>
      <outline text="Adrenal insufficiency and crisis">
        <outline text="Primary: cortex destroyed">
          <outline text="Cortisol and aldosterone deficiency"/>
        </outline>
        <outline text="Central: aldosterone usually preserved"/>
        <outline text="Chronic glucocorticoids suppress the axis"/>
        <outline text="Pigmentation, salt craving, hyperkalaemia in primary"/>
        <outline text="Hyponatraemia in both forms"/>
        <outline text="Crisis: shock, vomiting, hypoglycaemia">
          <outline text="Do not delay treatment for testing"/>
          <outline text="Hydrocortisone, isotonic fluid, glucose"/>
        </outline>
        <outline text="Sick-day dosing, identification, rescue injection"/>
      </outline>
      <outline text="Cortisol excess">
        <outline text="Cushing syndrome most often iatrogenic"/>
        <outline text="Dependent: pituitary or ectopic secretion"/>
        <outline text="Independent: adrenal lesion"/>
        <outline text="Screening: suppression, free cortisol, nadir">
          <outline text="Confirm and exclude exogenous before localising"/>
        </outline>
        <outline text="Treat source; temporary replacement after cure"/>
      </outline>
      <outline text="Aldosterone disorders and adrenal masses">
        <outline text="Primary aldosteronism: hypertension, low renin">
          <outline text="Potassium may remain normal"/>
          <outline text="Aldosterone-renin screening, then localise"/>
          <outline text="Unilateral surgery, bilateral receptor blockade"/>
        </outline>
        <outline text="Catecholamine tumours: headache, sweating, palpitations">
          <outline text="Alpha blockade before beta blockade"/>
        </outline>
      </outline>
      <outline text="Calcium regulation">
        <outline text="Ionised calcium drives excitability and clotting">
          <outline text="Total calcium varies with albumin and pH"/>
        </outline>
        <outline text="Parathyroid hormone rises as calcium falls">
          <outline text="Renal calcium reabsorption, phosphate excretion"/>
        </outline>
        <outline text="Vitamin D: skin or diet, liver, kidney"/>
        <outline text="Magnesium needed for parathyroid function">
          <outline text="Severe deficiency: resistant hypocalcaemia"/>
        </outline>
      </outline>
      <outline text="Hypercalcaemia and hypocalcaemia">
        <outline text="Mostly hyperparathyroidism or malignancy"/>
        <outline text="Measure parathyroid hormone early">
          <outline text="High or normal: parathyroid dependent"/>
          <outline text="Suppressed: investigate other causes"/>
        </outline>
        <outline text="Severe: volume, antiresorptive, monitoring"/>
        <outline text="Hypocalcaemia: tingling, tetany, long QT">
          <outline text="Intravenous calcium with cardiac monitoring"/>
        </outline>
      </outline>
      <outline text="Bone remodelling and osteoporosis">
        <outline text="Osteoclasts resorb, osteoblasts form, osteocytes sense">
          <outline text="Excess resorption weakens architecture"/>
        </outline>
        <outline text="Silent vertebral, disabling hip fractures"/>
        <outline text="Exercise, falls prevention, calcium, vitamin D"/>
        <outline text="Antiresorptive versus anabolic drugs">
          <outline text="Some agents rebound: plan an exit"/>
        </outline>
      </outline>
    </outline>
  </body>
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