Clinical Presentations

Question 1

Clinical presentations of thyroid pathology

Answer 1

1. Goitre - enlargement of thyroid gland
   - diffuse
   - localised swelling/nodule
2. Functional Derangement
   - hyperthyroidism
   - hypothyroidism

Question 2

Symptoms of hyperthroidism (6)

Answer 2

• Weight: loss, thin
• Temp: heat intolerant
• Menstrual: oligo
• Bowel: diarrhea
• Mental state: irritable
• Appetite: increased

Question 3

Symptoms of hypothyroidism (6)

Answer 3

• Weight: gain, mildly obese
• Temp: cold intolerant
• Menstrual: menorrhagia, oligo
• Bowel: constipation
• Mental state: slowness
• Appetite: may be poor

Question 4

Signs of hyperthyroidism (4)

Answer 4

1. Face
   - staring gaze
   - lid lag (excessive symp stim of levator palpebrae superioris)
   - exophthalmos
2. Skin
   - warm, sweaty, flushed
3. CVS
   - tachycardia, AF
4. LL
   - proximal myopathy (increased muscle catabolism)
   - pretibial myxedema

Question 5

Signs of hypothyroidism (4)

Answer 5

1. Face
   - peaches & cream skin
2. Skin
   - cool, dry, pale
3. CVS
   - bradycardia
   - pericardial effusion (leading to decreased CO)
4. LL
   - proximal myopathy (decreased metab)

Question 6

Hyper vs hypothyroidism (biochemical) (5)

Answer 6

1. Total thyroxine (T4): high vs low
2. Free T4: high vs low
3. T3: high vs not useful
4. TSH: low (primary) vs high (pri), low (sec)
5. Autoantibodies: Graves, early Hashimoto vs Hashimoto