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MBChB YR2 Endocrine > Disease Profiles: Thyroid Disorders > Flashcards

Disease Profiles: Thyroid Disorders Flashcards

1
Q

How would you manage hyperthyroidism in pregnancy?

A

Graves may settle as pregnancy suppresses autoimmunity

β-blockers if needed

LOW DOSE antithyroid drugs (wait as late as possible due to side effects on foetus) - propylthiouracil 1st trimester, carbimazole 2/3rd trimester

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2
Q

Describe the genetic factors linked to Graves disease

A

Increased incidence in family members

Susceptibility associated with certain HLA haplotypes, as well as polymorphisms in genes associated with immune regulation

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3
Q

Describe the management of acute severe hypercalcaemia

A

Fluids - rehydrate with 0.9% saline 4-6L in 24 hours

Consider loop diuretics once rehydrated (avoid thiazides)

Bisphosphonates - single dose will lower Ca2+ over 2-3 days, max. effect at 1 week

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4
Q

Describe the histology of minimally invasive follicular carcinoma

A

Follicular architecture well differentiated, may have part surrounding capsule, difficult to distinguish from adenoma

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5
Q

How would you differentiate between hyperemesis gravidarim and hyperthyroidism in pregnancy?

A

Hyperemesis gravidarim - ↑hCG, ↓TSH, no antibodies

HG should resolve by 20 weeks gestation

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6
Q

Which genetic syndrome results in patients who almost always develop a parathyroid adenoma with hypercalcaemia at a young age?

A

MEN1 and 2

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7
Q

Which forms of hyperparathyroidism can result in hypercalcaemia?

A

Primary and tertiary

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8
Q

Why is smoking cessation very important in a patient with Graves disease?

A

Graves eye disease is associated with smoking

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9
Q

Which type of differentiated thyroid cancer has a propensity for haematogenous spread?

A

Follicular carcinoma

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10
Q

What is pretibial myxoedema?

A

Infiltrative dermopathy caused by the accumulation of excess mucopolysaccharides, associated with Graves disease and occasionally seen in Hashimoto’s thyroiditis

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11
Q

Describe the management of thyroid lymphoma

A

Chemotherapy (R-CHOP), radiotherapy or steroids

(Does not respond to RAI)

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12
Q

Describe the pathophysiology of Graves disease

A

Involves auto-antibodies to TSH receptor, thyroid peroxisomes and thyroglobulin

The anti-TSH receptor antibodies stimulate the thyroid resulting in increased function

Some antibodies can inhibit function - may explain paradoxical episodes of hypofunction which can occur

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13
Q

Describe the clinical presentation of medullary thyroid carcinoma

A

Neck mass with local effects - dysphagia, hoarseness, airway compromise

Paraneoplastic syndromes - diarrhoea, Cushing’s

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14
Q

When would you treat subclinical hyperthyroidism?

A

If TSH <0.1%, or if co-existing osteoporosis/fracture or AF

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15
Q

What are β-blockers used for in the management of Graves disease?

A

Useful for immediate symptomatic relief of thyrotoxic symptoms

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16
Q

PTH increases urinary _____ excretion

A

Phosphate

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17
Q

Name 3 causes of hypocalcaemia

A

Chronic kidney disease, congenital absence (DiGeorge syndrome), destruction (surgery, radiotherapy, malignancy)

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18
Q

___ production by a medullary thyroid carcinoma causes diarrhoea

A

VIP

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19
Q

______ cases of medullary thyroid carcinoma result in a solitary nodule

A

Sporadic

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20
Q

Describe the management of hypercalcaemia secondary to malignancy

A

Treat underlying malignancy

Chemotherapy may reduce calcium in e.g. myeloma

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21
Q

Name two drugs which can cause hypercalcaemia

A

Vit. D, thiazides

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22
Q

Describe the management of advanced medullary thyroid carcinoma

A

May involve tyrosine kinase inhibitors

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23
Q

Why are patients with differentiated thyroid cancer after initial treatment given suppressive doses of levothroxane?

A

Aim is to suppress TSH below the normal range to minimise risk of recurrence

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24
Q

Describe the clinical presentation of thyroid lymphoma

A

Rapid onset mass in thyroid

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25
Q

Which genetic syndrome results in patients who develop an adenoma resulting in primary hyperparathyroidism?

A

Familial isolated hyperparathyroidism

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26
Q

Describe the clinical presentation of a differentiated thyroid cancer

A

Majority present with palpable nodules

Small percentage are chance findings on histological section of thyroidectomy tissue

Approx. 5% present with local or disseminated metastases

Local effects e.g. hoarseness, dysphagia, cough suggest advanced disease

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27
Q

What is fibrosa cystica?

A

Osteoporosis, brown tumours and osteitis caused by overproduction of PTH and continued osteoclasis in hyperparathyroidism

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28
Q

Why should you alert neonatologist if you find TRAb antibodies in a pregnant woman?

A

TRAb antibodies can cross the placenta and cause neonatal transient hyperthyroidism

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29
Q

Which investigations would you perform in suspected differentiated thyroid cancer?

A

US scan, TSH

Confirm with US-FNA, may need excisional biopsy of lymph node

Pre-operative laryngoscopy if vocal cord palsy suspected clinically

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30
Q

Describe the pathophysiology of a goitre

A

Reduced T3/T3 production causes a rise in TSH, stimulating gland enlargement

May maintain euthyroid state or if compensation fails there will be goitrous hypothyroidism

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31
Q

What is scintiscan used for in investigating a patient with hyperthyroidism?

A

Used in patients who are antibody negative to look for toxic nodular disease

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32
Q

How would you manage a ‘low risk’ thyroid cancer?

A

Thyroid lobectomy + biopsy, thyroidectomy following biopsy results if needed

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33
Q

What is pseudo-pseudohypoparathyroidism?

A

Describes the phenotypic defects of pseudohypoparathyroidism (Albright’s herditary osteodystrophy) but without any abnormalities in calcium metabolism

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34
Q

Describe the chronic clinical features of hypercalcaemia

A

Myopathy

Fractures

Osteopenia

Depression

Pancreatitis

Duodenal ulcers

Hypertension

Renal calculi

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35
Q

Which differentiated thyroid cancer has been associated with activation of the MAP kinase pathway, rearrangements of RET or NTKR1, activating point mutation in BRAF and ras mutations?

A

Papillary carcinoma

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36
Q

How would you be able to tell if a nodule on the throat is in the thyroid?

A

Moves on swallowing - invested in pretracheal fascia

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37
Q

___ production by a medullary thyroid carcinoma causes Cushing’s

A

ACTH

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38
Q

Name three causes of medullary thyroid carcinoma

A

Adults - sporadic, familial non-MEN

Children - MEN2a

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39
Q

Name 3 causes of thyrotoxicosis not associated with hyperthyroidism

A

Thyroiditis e.g. drug-induced

Exogenous thyroid hormones

Ectopic thyroid tissue

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40
Q

Name the three components of fibrosa cystica

A

Osteoporosis, brown tumours and osteitis

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41
Q

How would you investigate a follicular adenoma?

A

US scan, FNA, serum TSH, thyroid surgery + biopsy

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42
Q

How would you monitor a patient with differentiated thyroid cancer after initial treatment?

A

Measure TSH and Tg every 6 months for first 5 years, then annually for next 5 years, consider discharge after 5 years if low risk

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43
Q

What is a diffuse goitre?

A

Diffusely enlarged thyroid

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44
Q

Describe the clinical presentation of post-partum thyroiditis

A

Small, diffuse, nontender goitre

Hyperthyroid then hypothyroid

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45
Q

Describe histology of papillary carcinoma

A

Can be multifocal

Often cystic

May be calcified - psammoma bodies

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46
Q

What is a follicular adenoma?

A

Benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous capsule

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47
Q

What causes primary hyperparathyroidism?

A

Due to a benign adenoma, hyperplasia or rarely a malignant neoplasia within the parathyroid glands

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48
Q

How can hypomagnesaemia cause hypocalcaemia?

A

Calcium release from cells is dependent on magnesium - in magnesium deficiency intracellular calcium is high so PTH release will be inhibited

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49
Q

Describe the management of primary hyperparathyroidism

A

Parathyroidectomy if indicated

Cinacalcet (calcium mimetic) - can be useful if need treatment but unfit for surgery

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50
Q

What is a multi-nodular goitre?

A

Irregular enlarged thyroid due to nodule formation

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51
Q

Which patient group is most likely to develop a sporadic diffuse goitre?

A

Females, usually occurs in puberty/YA

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52
Q

What is the first line antithyroid drug in the management of Graves disease?

A

Carbimazole

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53
Q

How would a brown tumour appear on x-ray?

A

Lytic lesion

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54
Q

Name two conditions associated with subclinical hyperthyroidism

A

Osteoporosis and atrial fibrillation

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55
Q

Describe the clinical presentation of pseudohypoparathyroidism

A

Bone abnormalities (McCune Albright)

Obesity

Subcutaneous calcification

Learning disability

Brachydactyly (shortened 4th metacarpal)

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56
Q

What is subclinical hyperthyroidism?

A

↓TSH, normal fT4/3

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57
Q

Describe the clinical presentation of a multi-nodular goitre

A

Multiple nodules - thyroid feels bumpy on palpation

Mass effects

Can be inactive or toxic

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58
Q

If a patient has a solitary thyroid nodule which is firm, hard and immobile with cervical lymphadenopathy and associated hoarseness, is it more likely to be benign or malignant?

A

Malignant

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59
Q

Describe the management of anaplastic thyroid carcinoma

A

Total thyroidectomy if resectable +/- adjuvant radiochemotherapy as needed

(Do not respond to RAI)

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60
Q

Describe the management of a diffuse goitre

A

Treat underlying cause if appropriate

Usually no further treatment needed (unless causing obstructive symptoms - surgery)

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61
Q

How are thyroid nodules which have undergone USS-FNA classified?

A

FNA Bethesda classification - Thy1-5

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62
Q

How would you manage a hypothyroid patient who becomes pregnant?

A

Increase thyroxine dose by 25mcg as soon as pregnancy suspected, check TFTs regularly and increase thyroxine appropriately

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63
Q

Name two classes of disease which can cause hyperparathyroidism

A

Granulomatous disease e.g. sarcoid, TB

Disease of high turnover e.g. thyrotoxic, Pagets (especially if bedridden)

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64
Q

How would you investigate a multi-nodular goitre?

A

As for thyroid nodule - thyroid function test, US, FNA, thyroid isotope scan

CT scan may detect retrosternal extension and tracheal compression in patients with a very large goitre or clinical symptoms

Flow volume loops if considering other potential causes of breathlessness

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65
Q

What is a toxic thyroid nodule?

A

Thyroid gland contains autonomously functioning thyroid nodule(s), with resulting hyperthyroidism

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66
Q

Describe the prognosis of anaplastic thyroid carcinoma

A

Rapid growth and involvement of neck structures and death

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67
Q

What causes a sporadic diffuse goitre?

A

Most cases have no clear cause

Some associated with ingestion of substances limiting T3/T4 production or dyshormonogenesis

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68
Q

Describe the biochemistry usually seen in primary hyperparathyroidism

A

High calcium, usually high serum PTH, normal or low phosphate

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69
Q

Name an autoimmune disease associated with the development of papillary carcinoma

A

Hashimotos

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70
Q

Describe the clinical presentation of primary hyperparathyroidism

A

Hypercalcaemia - fatigue, depression, bone pain, myalgia, nausea, thirst, polyuria, renal stones, osteoporosis

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71
Q

Describe the management of a thyroid storm

A

High dose carbimazole

β-blockers (propranolol)

Potassium iodide

Hydrocortisone

IV fluids +/- inotropes

Treat precipitating cause e.g. MI, infection, PE

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72
Q

What is pseudohypoparathyroidism?

A

Genetic defect of the Gs⍺-protein causing end organ resistance to PTH → hypocalcaemia

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73
Q

Which patient group is most likely to develop follicular carcinoma?

A

Higher incidence in female, higher incidence at 40-50 years

Incidence slightly higher in regions of iodine deficiency

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74
Q

Describe the clinical presentation of anaplastic thyroid carcinoma

A

Thyroid nodule

Features of local infiltration/compression

Cervical lymphadenopathy

Signs of distant metastases

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75
Q

Name a genetic mutation associated with medullary thyroid carcinoma

A

Germline RET mutations

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76
Q

Name the 4 types of benign thyroid nodule

A

Cyst

Colloid nodule

Benign follicular adenoma

Hyperplastic nodule

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77
Q

Define thyrotoxicosis

A

The clinical, physiological, and biochemical state arising when the tissues are exposed to excess thyroid hormone

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78
Q

Describe the reproductive features of hyperthyroidism

A

Menstrual cycle changes, including lighter beeling and less frequent periods

79
Q

Describe the pathophysiology of a multi-nodular goitre

A

Variation of response of follicular cells to external stimuli - recurrent hyperplasia and involution

Mutations of TSH signalling pathway

There will be a varying degree of fibrosis, haemorrhage and calcification

80
Q

Describe the long term management of hypocalcaemia

A

Calcium supplement

Vitamin D supplement or cholecalciferol depot injection

81
Q

A patient presents with hypercalcaemia. PTH levels are undetectable. What must be investigated for?

A

Malignancy

82
Q

Describe the clinical presentation of hypocalcaemia

A

Paraesthesia - fingers, toes, perioral

Muscle cramps, tetany

Muscle weakness

Fatigue

Bronchospasm or laryngospasm

Fit

83
Q

Describe the clinical presentation of a diffuse goitre

A

Entire thyroid gland swells and is smooth to the touch

Usually euthyroid, may be S+S of hyper/hypothyroidism

Mass effects

In children dyshormonogenesis may cause cretinism

84
Q

Which thyroid cancers are derived from follicular epithelium?

A

Papillary and follicular carcinoma

85
Q

How would you investigate a diffuse goitre?

A

Thyroid function tests - T3/T4 normal, TSH high or upper limit of normal

86
Q

What is rhTSH used for in whole-body iodine scanning?

A

Increase TSH to ensure sensitivity

87
Q

What is familial hypocalciuric hypercalcaemia?

A

Autosomal dominant deactivating mutation in the calcium sensing receptor which results in decreased sensitivity of the receptor to calcium

88
Q

Describe the hair and skin features of hyperthyroidism

A

Hair change (thin, brittle hair)

Rapid fingernail growth

89
Q

How would you manage a patient with recurrent differentiated thyroid cancer?

A

Whole-body scan to determine ability to take up iodine with a view to RAI

If negative whole-body scan - systemic anti-cancer therapy

90
Q

Hypo- and hyperthyroidism causes anovulatory cycles, resulting in reduced _______

A

Fertility

91
Q

What thyroid hormone results would you expect in a patient with primary hyperthyroidism e.g. in Graves disease?

A

TSH low, free T4/T3 high

92
Q

Which autoantibody is found in 70-100% of patients with Graves disease?

A

TSH receptor antibody (stimulating)

93
Q

PTH increases the synthesis of active forms of _______ __

A

Vitamin D

94
Q

What causes secondary hyperparathyroidism?

A

Physiological response to low calcium or vitamin D resulting in overproduction of PTH, can also be caused by chronic kidney disease

95
Q

How can malignant disease cause hypercalcaemia?

A

Metastatic bone destruction

PTHrp from solid tumours

Osteoclast activating factors produced by tumours

96
Q

How would you manage a ‘high risk’ thyroid cancer?

A

Subtotal/total thyroidectomy

Consider radioactive iodine

97
Q

How would you manage severe Graves eye disease?

A

Steroids, radiotherapy, surgery

98
Q

Describe the management of a multi-nodular goitre

A

Most can leave alone

Antithyroid drugs if toxic

Radioactive iodine if significant hyperthyroid

Surgery if structural problem or significant retrosternal extension

99
Q

What are differentiated thyroid cancers?

A

Refers to papillary and follicular variants

100
Q

What is thyroid bruit?

A

Bruit when auscultating over the thyroid, associated with the formation of large goitres in Graves disease

Reflective of hypervascularity of thyroid

101
Q

Name 5 causes of hypomagnesemia

A

Alcohol, drugs, GI illness with diarrhoea, pancreatitis, malaborption

102
Q

Define hashitoxicosis

A

Transient hyperthyroidism caused by inflammation associated with Hashimoto’s thyroiditis, patient will then develop hypothyroidism

103
Q

What is a thyroid storm?

A

Rapid deterioration of hyperthyroidism with typically seen in hyperthyroid patient with an acute infection/illness or recent thyroid surgery

104
Q

When would you treat subclinical hypothyroidism?

A

TSH > 10 or if patient is pregnant

105
Q

Which patient group is most likely to develop thyroid lymphoma?

A

Background of auto-immune hypothyroidism

Females aged 70-80 years

106
Q

Which form of differentiated thyroid cancer more commonly spreads to the lungs, bone or brain?

A

Follicular carcinoma

107
Q

Serum alkaline phosphatase is raised in hypercalcaemia of _________

A

Malignancy

108
Q

Describe the musculoskeletal features of hyperthyroidism

A

Fine tremor of the outstretched fingers

Muscle weakness, especially in thighs and upper arms

109
Q

Which antithyroid drug is given instead of carbimazole during 1st trimester of pregnancy?

A

PTU

110
Q

Describe the management of localised medullary thyroid carcinoma

A

Total thyroidectomy - curative

111
Q

PTH increases reabsorption of _____ by renal tubules

A

Calcium

112
Q

Describe the prognosis of post-partum thyroiditis

A

After delivery, the mother develops transient over-active thyroid, classically at around 6 weeks, and then at around 3 months has an underactive thyroid

Hypothyroid phase associated with neonatal depression

Can persist up to 1 year postpartum

25-50% will have persistent hypothyroidism beyond 1 year

113
Q

How would you describe a ‘high risk’ differentiated thyroid cancer?

A

Stage Thy3 or higher on FNA (atypical)

114
Q

Name 2 medications which can cause hypomagnesemia

A

Thiazide, PPIs

115
Q

When would you perform a thyroidectomy in a hyperthyroid patient?

A

Relapsed Graves’ disease and nodular thyroid disease when radioiodine is contraindicated e.g. pregnancy

116
Q

Describe the acute clinical features of hypercalcaemia

A

Thirst

Dehydration

Confusion

Polyuria

117
Q

Describe the ophthalmological features of hyperthyroidism

A

Lid retraction

Double vision

Graves ophthalmopathy in Graves disease

118
Q

What causes Graves eye disease?

A

Results from autoimmune inflammation of the extra-ocular muscles as orbital fat and connective tissue have TSH receptors

119
Q

Describe the histology of medullary thyroid carcinoma

A

Composed of spindle or polygonal cells arranged in nests, trabeculae or follicles

Associated amyloid deposition (abnormally folded calcitonin)

120
Q

Which differentiated thyroid cancer has been associated with mutations in PI3K/AKT pathway, ras mutations and translocation involving Pax8 and PPAR𝛾1?

A

Follicular carcinoma

121
Q

Describe the management of a follicular adenoma

A

Lobectomy with biopsy

122
Q

Describe the biochemistry usually seen in tertiary hyperparathyroidism

A

High calcium, high PTH

123
Q

Name the 4 types of malignant thyroid nodule

A

Papillary thyroid carcinoma

Medullary thyroid carcinoma

Lymphoma

Anaplastic

124
Q

Which patient group is most likely to develop Graves disease?

A

Females, 20-40 years

125
Q

Name the most common cause of hyperthyroidism (85%)

A

Graves disease

126
Q

Which form of differentiated thyroid cancer more commonly spreads to cervical lymph nodes?

A

Papillary carcinoma

127
Q

Describe the biochemistry usually seen in familial hypocalciuric hypercalcaemia

A

Mild hypercalcaemia, reduced urine calcium excretion, (marginally) elevated PTH

128
Q

Describe the cardiovascular features of hyperthyroidism

A

Increased pulse rate

Palpatations, AF

Rarely cardiac failure

129
Q

How would you investigate underlying malignancy in a patient with hypercalcaemia?

A

X-ray, CT, MRI, PET

Isotope bone scan

130
Q

Name two genes implicated in < 20% of follicular adenomas

A

< 20% have a mutant ras or PIK3CA

131
Q

What causes tertiary hyperparathyroidism?

A

Parathyroid becomes autonomous after many years of overactivity e.g. renal failure

132
Q

What causes a diffuse goitre?

A

Physiological (e.g. pregnancy)

Autoimmune thyroid disease

Endemic (iodine deficiency)

Inflammation (de Quervain’s thyroiditis

Sporadic

133
Q

How would you describe a ‘low risk’ differentiated thyroid cancer?

A

Age <50 years, tumour <4 cm

134
Q

What classification of thyroid nodule on ultrasound would prompt further investigation (USS-FNA)?

A

U3 (atypical) and above

135
Q

Describe the clinical features of a thyroid storm

A

Hyperpyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction

136
Q

Name two genetic features associated with anaplastic thyroid carcinoma

A

p53 and β-catenin mutations (+ genetic features associated with DTCs)

137
Q

What thyroid hormone results would you expect in a patient with secondary hyperthyroidism?

A

TSH high, free T4/T3 high (or ‘normal’)

138
Q

What is a thyrotropinoma?

A

TSH secreting pituitary adenoma, very rare cause of hyperthyroidism

139
Q

What ECG finding is consistent with hypocalcaemia?

A

QT prolongation

140
Q

Describe the management of hypomagnesemia

A

Magnesium supplementation, calcium supplementation if needed

141
Q

PTH activates ________ which results in increased bone reabsorption and releases calcium

A

Osteoclasts

142
Q

Describe the biochemistry usually seen in pseudohypoparathyroidism

A

Calcium will be low but PTH concentrations are elevated due to PTH resistance

143
Q

How would you investigate anaplastic thyroid carcinoma?

A

TSH, US

Confirmation: US-FNA or biopsy

144
Q

Which type of differentiated thyroid cancer tends to spread via lymphatics?

A

Papillary carcinoma

145
Q

Describe the biochemistry usually seen in secondary hyperparathyroidism

A

Low calcium, high PTH

146
Q

Define subclinical thyroid disease

A

Abnormal TSH with normal thyroid hormone

147
Q

What is a goitre?

A

Enlarged palpable thyroid gland, which moves on swallowing

148
Q

What is Trousseau’s sign?

A

Sign of hypocalcaemia - inflation of the sphygmomanometer cuff above systolic pressure for 3 min induces tetanic spasm of the fingers and wrist

149
Q

Maternal thyroxine important for neonatal development (especially ___)

A

CNS

150
Q

Which patient group is most likely to develop a follicular adenoma?

A

Higher incidence in women, increases in incidence in increasing age

Increased incidence in regions of iodine deficiency

151
Q

Describe the neuropsychiatric features of hyperthyroidism

A

Increased nervousness and excessively emotional

Sleep disturbance

Depression

Insomnia

152
Q

What is Chovestek’s sign?

A

Sign of hypocalcaemia - gentle tapping over the facial nerve causes twitching of the ipsilateral facial muscles

153
Q

What is thyroid arcropachy?

A

Specific sign of Graves disease involving thickening of the extremities manifested by digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation

154
Q

Which patient group is most likely to develop a benign thyroid nodule?

A

Females

155
Q

Describe the pathophysiology of post-partum thyroiditis

A

In the postpartum phase there is exacerbation of all autoimmune diseases

156
Q

______ cases of medullary thyroid carcinoma result in bilateral/multicentric disease

A

Familial

157
Q

Describe the clinical signs of hypomagnesemia

A

Positive Chvostek sign and Trousseau sign

Cardiac arrhythmias

158
Q

Which investigations would you perform in suspected medullary thyroid carcinoma?

A

Neck USS and FNA

Measure serum base calcitonin - 24-hour urinary metanephrines

Further imaging to detect localised/advanced disease

Check genetics for MEN

159
Q

Which investigations would you perform in hypomagnesemia?

A

Serum magnesium (low)

Measure other electrolytes, particularly K+ and Ca2+

160
Q

Which investigation would you perform in suspected thyroid lymphoma?

A

Core biopsy

161
Q

Describe the management of acute severe hypocalcaemia

A

IV calcium gluconate 10 ml, 10% over 10 mins (in 50ml saline or dextrose)

Calcium infusion (10ml 10% calcium gluconate in 100ml infusate, at 50 ml/h)

162
Q

How are thyroid nodules seen on ultrascan classified?

A

USS classification - U2-U5

163
Q

Describe the features of Graves eye disease

A

Autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, erythema, conjunctivitis, and bulging eyes (exophthalmos)

164
Q

Which differentiated thyroid cancer is associated with ionising radiation?

A

Papillary carcinoma

165
Q

When would you use a whole body iodine scanning (I-131) in a patient with differentiated thyroid cancer?

A

Patients who have undergone sub-total or total thyroidectomy to determine incomplete incision or present of occult metastases

166
Q

Which nerve is most at risk of damage during a thyroidectomy?

A

Recurrent laryngeal nerve

167
Q

Describe the clinical presentation of a follicular adenoma

A

Discrete solitary mass in an otherwise normal thyroid gland

May be incidental finding

Patients with larger tumours may present with local symptoms e.g. dysphagia

168
Q

Most differentiated thyroid cancers take up _____ and secrete _______

A

Iodine, thyroglobulin

169
Q

If a patient has a solitary thyroid nodule that is tender, soft, smooth, and mobile with associated hormonal disturbance is it more likely to be benign or malignant?

A

Benign

170
Q

What percentage of solitary thyroid nodules are benign?

A

95%

171
Q

‘Bones, stones, moans, and groans’ refers to what?

A

General S+S of hypercalcaemia - bone pain, gallstones, abdominal pain and psychiatric disturbances

172
Q

Describe the histology of widely invasive follicular carcinoma

A

More solid architecture, less follicular architecture, more mitotic activity

173
Q

How does a multi-nodular goitre develop?

A

Develops from a long-standing simple sporadic goitre

174
Q

What is the 1st choice treatment for relapsed Graves’ disease and for nodular thyroid disease?

A

Radioactive iodine

175
Q

What are brown tumours?

A

Osteoporotic bone prone to fracture - associated haemorrage elicits macrophage reaction and processes of organisation and repair which results in a mass of reactive tissue

176
Q

When would you use RAI ablation in a patient with differentiated thyroid cancer?

A

To destroy occult microfoci left behind after thyroidectomy, and to remove residual thyroid tissue which may be a source of Tg and therefore confound the levels during follow-up

177
Q

What is a medullary thyroid carcinoma?

A

Tumour of the parafollicular cells which secrete calcitonin (C-cells)

178
Q

Why is thyroid surgery with biopsy is required for treatment and definitive diagnosis of a follicular adenoma?

A

FNA cannot distinguish between follicular adenoma and follicular carcinoma

179
Q

Functioning follicular adenomas have an activating mutation in which signalling pathway?

A

TSHR

180
Q

Describe clinical presentation of familial hypocalciuric hypercalcaemia

A

Usually benign/asymptomatic

181
Q

Define hyperthyroidism

A

Refers to conditions in which overactivity of the thyroid gland leads to thyrotoxicosis

182
Q

Which patient group is most likely to develop a papillary/follicular carcinoma?

A

Can affect any age group

In females, rates increase from 15-40 then plateaus

In males rates steadily increase with age

183
Q

Describe the management of post-partum thyroiditis

A

No treatment for hyperthyroid phase, if symptomatic hypothyroid treat with thyroxine

Should eventually be able to stop thyroxine but if the patient is still on thyroxine after a year it is likely they will need it long term

184
Q

Which investigations would you perform in diagnosing a solitary thyroid nodule?

A

Thyroid function tests

US scan

USS-FNA

Thyroid scan (scintigraphy)?

185
Q

Describe the symptoms of hypomagnesemia

A

Anorexia

N+V

Muscle weakness, lethargy

Fits

186
Q

What percentage of follicular adenomas are toxic (functioning)?

A

1%

187
Q

What is anaplastic thyroid carcinoma?

A

Undifferentiated and aggressive tumours derived from follicular epithelium

188
Q

Name the three thyroid autoantibodies associated with Graves disease

A

Anti-TPO antibody, anti-thyroglobulin antibody, TSH receptor antibody (stimulating)

189
Q

Which patient group is most likely to develop an anaplastic thyroid carcinoma?

A

Usually older patients, may occur in people with a history of differentiated thyroid cancer

190
Q

What is subclinical hypothyroidism?

A

↑TSH, normal fT4/3

191
Q

Which hormone drives the development of differentiated thyroid cancers?

A

TSH

192
Q

Describe the general symptoms associated with hyperthyroidism

A

Weight loss despite increased appetite

Frequent, loose bowel movements

Sweating and heat intolerance

Goitre

193
Q

What medication can be used for immediate symptomatic relief of thyrotoxic symptoms when β-blockers are contraindicated?

A

CCBs

194
Q

How would you manage mild Graves eye disease?

A

Topically e.g. lubricants

MBChB YR2 Endocrine (23 decks)

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