Week 6 & 7 Update
My second and third week of endocrine has gone well. In
clinic, I've seen a smorgasbord of diabetes, thyrotoxicosis, papillary thyroid
cancer, acromegaly, congenital adrenal hyperplasia (21-hydroxylase deficiency),
agranulocytosis 2/2 PTU, and a patient following up after recent thyrotoxicosis
periodic paralysis (which is much more common in Asians). For patients with
hyperthyroidism requiring radioactive iodine (RAI) ablation, the goal in much
of Thailand (with some exceptions) is to make the patient euthyroid rather than
hypothyroid. As I understand it, this is because many rural Thai patients
object to the prospect of daily levothyroxine. The drawback to this approach is
that a certain percentage of patients are still hyperthyroid after RAI and
require a second ablation. On rounds, we’ve had several interesting cases, the
most recent being a patient with limited access to healthcare who presented
with paroxysmal palpitations, diaphoresis, and according to family had a
cardiac arrest the prior year. His workup revealed dilated cardiomyopathy and
abdominal mass concerning for a paraganglioma.
Over the weekend I made a trip to Chiang Rai Province where
I visited the Mae Fa Luang district (Doi Tung and Tham Luang cave), and Golden
Triangle (Mae Sai, a brief crossing into Myanmar, and Opium Museum). Doi Tung
represents a successful development project by the royal family (particularly
the mother of Rama IX) to encourage alternatives to growing opium – primarily
coffee and macadamia. The Mae Fah Luang gardens are especially gorgeous.
In Mae Sai, I briefly crossed into Tachileik, Myanmar; a
peculiar crossing that required I forfeit my passport to immigration
authorities to ensure I wouldn’t venture any further. While there I visited
some temples and a highly regarded meditation center (Ngwe Taung Oo) where many
monks and nuns from various countries train in Vipassana.
Prior to returning to Chiang Mai, I stopped at the Opium
Museum which is ambitiously curated to cover the opium trade since ancient
Egyptian times but primarily focuses on the colonial opium wars and the
introduction of opium to Siam.
