Morning Rounds · Breast, Thyroid & Endocrine Surgery
Key NEET traps: Follicular carcinoma cannot be diagnosed on FNAC alone — capsular/vascular invasion is only seen on excision histology. Medullary carcinoma arises from C-cells (calcitonin-secreting, not follicular) — must screen for RET mutation and MEN 2. Papillary carcinoma spreads to lymph nodes but still carries the best prognosis.
The alpha-before-beta rule is the single most tested fact about phaeochromocytoma management. Phenoxybenzamine (irreversible non-selective alpha-blocker) is standard; prazosin/doxazosin are alternatives. Beta-blockade (propranolol) is added only after adequate alpha-blockade to prevent reflex tachycardia. Surgery: laparoscopic adrenalectomy; ligate adrenal vein early to prevent catecholamine surge.
Sequence of surgery in MEN 2A: phaeochromocytoma must be resected first — undiagnosed phaeochromocytoma during thyroid surgery causes fatal hypertensive crisis. Always screen MEN 2 patients for phaeochromocytoma before any elective operation. MEN 2B is the most aggressive — prophylactic thyroidectomy before 6 months of age.
Morning Rounds · Surgery Series · Round 04
Breast, Thyroid & Endocrine Lumps, Hormones & Hard Choices