Thiazolidinediones are contraindicated in bladder cancer
Papillary thyroid cancer
Most common - 70%
Biopsy: Papillary + colloidal filled follicles with pale empty nuclei
Monitoring: Yearly thyroglobulin
The increased proinsulin:insulin ratio strongly suggests an insulinoma, a rare pancreatic neuroendocrine tumour secreting insulin.
The most appropriate next investigation is a supervised prolonged fast (up to 72 hours), which is the gold-standard diagnostic test for insulinoma.
C: Gitelman’s syndrome – Hypokalaemic metabolic alkalosis but normal/low BP.
D: Bartter’s syndrome – Childhood onset with normal BP.
E: Liddle’s syndrome – Causes hypertension and hypokalaemia but with low renin and low aldosterone.
De Quervain’s thyroiditis
Aetiology: Post-viral illness.
Course: Stage 1 - hyperthyroidism, painful goitre. Stage 2 - euthyroid. Stage 3 - Hypothyroid.
Scintigraphy: Globally reduced uptake of I131.
Mx: Conservative measures - NSAIDs, beta-blockers, consider steroids if severe
