22. Thyroid Disorders

Question 1

How can you image a thyroid gland?

Answer 1

Thyroid ultrasound
Radio-isotope scan
X-ray
CT scan

Question 2

What is myxoedema?

Answer 2

Hypothyroidism

Question 3

What are the symptoms of hypothyroidism?

Answer 3

Tiredness
Weight gain
Cold intolerance
Change in appearance
Depression
Psychosis
Joint/muscle ache
Dry hair/skin
Puffy eyes

Question 4

What are the signs of hypothyroidism?

Answer 4

Peri-orbital oedema
Loss of eyebrows
Dry, thin hair
Bradycardia
Slow-relaxing reflexes
Carpal tunnel syndrome
Cold peripheries

Question 5

What are the causes of hypothyroidism?

Answer 5

Auto-immune atrophic
Hashimoto’s thyroiditis
Post-partum thyroiditis
Dyshormonogenesis
Medication
Iodine deficiency

Question 6

What is the treatment for hypothyroidism?

Answer 6

Thyroxine replacement therapy

• levothyroxine (T4) for life
• starting dose depends on severity
• 100micrograms for young fit person

Question 7

What are the aims of treatment of hypothyroidism?

Answer 7

Resolution of symptoms
Normalisation of blood tests - takes 6-8 weeks
High TSH suggests under-replacement
Low TSH suggests over-replacement

Question 8

What is myxoedema coma?

Answer 8

Severe hypothyroidism usually in elderly - rare
Hypothermia and fluid overload in heart - pericardial effusion
50% mortality

Question 9

What are the symptoms of hyperthyroidism?

Answer 9

Weight loss
Irritability
Restlessness
Insomnia
Malaise
Itching
Sweating
Palpitations
Tremor
Muscle ache

Question 10

What are the signs of hyperthyroidism?

Answer 10

Tremor
Hyperkinesis
Tachycardia
Atrial fibrillation
Warm peripheries
Hypertension
Proximal myopathy
Lid lag

Question 11

What are the causes of hyperthyroidism?

Answer 11

Graves’ disease
Modular thyroid disease
Thyroiditis

Question 12

What is Graves’ disease?

Answer 12

Autoimmune mediated stimulation of TSH receptor

Question 13

What is thyroiditis?

Answer 13

Inflammation of thyroid

Release of thyroxine into circulation

Question 14

What can cause thyroiditis?

Answer 14

Viral infection
Postpartum
Medication - amiodarone

Question 15

What medication is given to treat hyperthyroidism?

Answer 15

Carbimazole or propylthiouracil
Beware of agranulocytosis (risk of infections) - neutropenia
Beta-blockers for symptoms control

Question 16

What are the 3 ways that hyperthyroidism can be treated?

Answer 16

Medication
Surgery
Radioactive iodine

Question 17

Why is surgery given in hyperthyroidism?

Answer 17

If side effects on medication or patient preference

Small risk of laryngeal nerve palsy and hypocalcaemia

Question 18

What is thyroid crisis or thyroid storm?

Answer 18

Rare condition with 10% mortality
Hyperpyrexia, tachycardia, cardiac failure, liver dysfunction
Needs urgent treatment on HDU

Question 19

Why can hyperthyroidism in pregnancy be bad?

Answer 19

In Graves’ disease antibodies can cross placenta

Baby can be born with hyperthyroidism

Question 20

What are the types of goitre?

Answer 20

Diffuse - simple goitre, autoimmune thyroid disease, thyroiditis
Modular - multinodular, solitary nodule (red flag symptoms)
Fibrotic - Riedels thyroiditis (rare)
Iodine deficiency

Question 21

What are the red flag symptoms of thyroid cancer in the history?

Answer 21

Very young or old patient
Rapid enlargement of lump in neck
Hoarse voice and dysphagia
Family history

Question 22

What are the red flag symptoms of thyroid cancer on examination?

Answer 22

Hard irregular thyroid mass
Fixed to surrounding structures
Cervical lymph nodes

Question 23

What is the investigation of suspected thyroid cancer?

Answer 23

Thyroid ultrasound
Fine needle aspiration
CT scan thorax and mediastinum