Endo II - Thyroid Disorders

Question 1

bradycardia, HTN
cold intolerance
constipation
anaemia
carpel tunnel syndrome
dry skin, delayed DTR
myxoedema

Answer 1

hyperthyroidism

Question 2

TSH high
fT4 low
fT3 low/n

Answer 2

primary hypothyroidism (thyroid gland)

Question 3

TSH low
fT4 low
T3 low

Answer 3

secondary / tertiary hypothyroidism (pituitary)

Question 4

TSH normal
T4 normal
T3 decreased
associated with acute illness

Answer 4

Euthyroid sick syndrome
T4 not converted to T3
associated with cytokines; IL-1, IL-6, TNF-a, IFN-b

Question 5

child
iodine deficiency
thyroid hypoplasia
pale, puffy face
protruding umbilicus
poor brain development
protuberant tongue
pot bellied

Answer 5

congenital hypothyroidism - Cretinism

Question 6

hashimotos thyroiditis is type ____ hypersensitivity

Answer 6

type 4 HS

Question 7

What are the 3 phases of hashimitos thyroiditis

Answer 7

thyrotoxic phase
hypothyroid phase
euthyroid phase

Question 8

damage to follicular cells, release colloid
increased T3, T4
decreased TSH

Answer 8

Thyrotoxic phase - hashimoto thyroiditis

Question 9

last 2-8 weeks
permanent subacute granulomatous thyroiditis
low T3, T4
high TSH

Answer 9

hypothyroid phase - hashimoto thyroiditis

Question 10

what antibodies are seen in hashimoto thyroiditis

Answer 10

thyroid peroxidase (TPOAb)
thyroglobulin (TgAb)
antimicrosomal Ab

Question 11

low T3
high TSH
anti-TPOAb (+)
anti-TgAb (+)
painless diffuse thyroid enlargement
lymphocytic infiltration
Hurthle cells

Answer 11

hashimoto thyroiditis

Question 12

complications of hashimoto thyroiditis

Answer 12

hashitoxicosis
increased risk B cell lymphoma
myxoedema coma

Question 13

severe hypothyroidism
Decreased CNS
Hypothermia
Bradycardia
Hyponatraemia
Hypoglycaemia
Hypotension
Precipitating illness

Answer 13

myxoedema coma
(hypothyroidism)

Question 14

iodine induced hypothyroidism
excess iodine - inhibited organification
normal thyroid function
escape phenomena present

Answer 14

Wolf-Chaikoff effect

Question 15

iodine induced hyperthyroidism
iodine deficient hypothyroidism
increased iodine exposure - excessive hormone sythesis
not occur in euthyroid individuals

Answer 15

Jod-Basedown phenomenon

Question 16

tremor, tachycardia, anxiety, HTN, weight loss
hyperdefecation
warm, smooth skin
hyperpigmentation
heat intolerance, normo-anaemia, oligo-amenorrhoea
madarosis (eyebrows)

Answer 16

hyperthyroidism

Question 17

low/absent
Radioactive iodine uptake seen in:

Answer 17

hasimoto thyroiditis
thyroid drug ingestion

Question 18

high/normal
radioactive iodine uptake seen in:

Answer 18

Graves disease
toxic adenoma
toxic multinodular goiter

Question 19

focal, high uptake RIU

Answer 19

toxic adenoma

Question 20

diffuse high uptake RIU

Answer 20

Graves disease

Question 21

female
diffuse goitre
exophthalmos
dry eyes, lig lag
myxoedema

Answer 21

graves disease

Question 22

Graves disease is type ____ hypersensitivity

Answer 22

type 2 HS

Question 23

what is the pathogenesis of Grave disease

Answer 23

autoimmune
auto-AB (IgG) against TSH receptor

Question 24

haplotypes HLA-B8 and DR3 associated with

Answer 24

Graves disease

Question 25

diffuse symmetric enlarged meaty appearance thyroid gland

Answer 25

Graves disease

Question 26

pseudopapillary infolding scalloping of colloid hyperplastic follicular cells

Answer 26

Graves disease

Question 27

process behind exophthalmos

Answer 27

activated B/T cell infiltrate --> TNF-a, IFN-y inflammatory response --> fibroblast proliferation, adipocyte differentiation --> production hyaluronic acid & GAG --> increased volume intraorbital fat & muscle tissue --> exophthalmous

Question 28

hyperthyroidism goitre dysphagia, dyspnoea multinodular arely assoc. eye signs

Answer 28

toxic multinodular goitre

Question 29

female 30-50yo following viral infection or drug use (lithium/amiodorone) transient pathcy inflammation of thyroid gland

Answer 29

subacute thyroiditis

Question 30

2 types of subacute thyroiditis

Answer 30

subacute granulomatous thyroiditis (de Quervains) subacute lymphocytic thyroidits

Question 31

treatment of subacute thyroiditis

Answer 31

NSAIDS steriods if severe

Question 32

follows viral URTI CD8 T cells damage follicles colloid leakage & macropahe infiltrate severe neck pain - radiate to ear/jaw inflammatory infiltrate - multinucleated giant cells, disruptive follcies

Answer 32

de Quervains subacute granulomatous thyroiditis

Question 33

inherited HLA-DR3, HLA-DR5 painless, silent lymphocytic infiltration sparse germinal centres

Answer 33

subacute lymphocytic thyroiditis

Question 34

thyroid dysfunction within first year post-partum

Answer 34

post-partum thyroiditis

Question 35

goitre - iron collar stony hard fibrosis tan-grey woody thyroid fibrosclerotic changes pathcy lymphocytic & eosinophilic infiltration

Answer 35

Riedel syndrome

Question 36

what thyroid condition can mimic anaplastic carcinoma

Answer 36

Riedel syndrome

Question 37

acute onset aggitation, delirium fever, coma diarrhoea, Afib, high output HF upregulation B1-adrenergic receptors low TSH, high T3/T4 recent stresor - infection, surgery, withdrawal antithyroid drugs

Answer 37

thyroid storm life threatening hypermetabolic state