Endocrine - Thyroid Disease

Question 1

what are the types of thyroid cancer?

Answer 1

papillary
follicular
anaplastic
MTC

Question 2

what is MTC associated with?

Answer 2

MEN 2

Question 3

features of thyroid cancer?

Answer 3

nodule
hoarseness
dysphagia

Question 4

what is a risk factor for follicular thyroid cancer?

Answer 4

iodine deficiency

Question 5

what type of thyroid cancer has associations with hashimoto’s?

Answer 5

papillary

Question 6

Ix for thyroid cancer?

Answer 6

TFTs 
TPO (for hashimoto's)
US FNA
radioactive iodine scan (cold nodule)
CT/MRI to stage

Question 7

Tx for thyroid cancer?

Answer 7

surgery

+ levothyroxine

Question 8

what causes primary and secondary hypothyroid?

Answer 8

primary: low T3 and 4
secondary: low TSH

Question 9

features of hypothyroidism?

Answer 9

cold sensitivity 
constipated
wt gain
depression
infertility
menorrhagia
hyperlipidaemia
carpal tunnel

Question 10

skin features of hypothyroid?

Answer 10

loss of lateral 1/3rd eyebrow
diffuse alopecia
dry skin

Question 11

what are iatrogenic causes of hypothyroid?

Answer 11

radiotherapy
sarcoidosis
lithium
amiodarone (if iodine rich)

Question 12

bloods for hypothyroid and results?

Answer 12

TSH high
T4 low
FBC (may be anaemic)
LDL (may be high)

Question 13

tx for hypothyroid?

Answer 13

levothyroxine

Question 14

what blood is used to monitor hypothyroid?

Answer 14

T4

Question 15

extreme hypothyroidism can result in?

Answer 15

myxoedema coma (emergency)

Question 16

features of grave’s disease?

Answer 16

wt loss
diarrhoea
amenorrhoea 
tremor
palpitations
sweating 
irritable

Question 17

examination findings of hypothyroidism?

Answer 17

bradycardia
deep voice
delayed reflexes
non tender goitre

Question 18

examination findings of hyperthyroidism?

Answer 18

goitre
pretibial myxedema
thyroid acropachy

Question 19

what are features of thyroid eye disease?

Answer 19

exopthalmos
lid retraction
gritty eyes
loss of colour vision
diplopia

Question 20

Ix and results for graves disease?

Answer 20

T4 (high)
TSH (low)
TRAb present

Question 21

tx for graves disease?

Answer 21

carbimazole for 18months, bloods rechecked

PTU in pregnancy

propranolol/CCB for tremor

steroids for eye disease

radioiodine

surgery

Question 22

risk of thyroid surgery?

Answer 22

recurrent laryngeal nerve damage
PTH damage
hypothyroid

Question 23

rules for radioiodine?

Answer 23

no pregnancy for 6 months

stay away from kids/pregnant women fro 3 weeks

Question 24

side effects of carbimazole?

Answer 24

agranylocytosis

autoimmune hepatitis

Question 25

when does a thyroid storm often occur?

Answer 25

after infection/surgery

Question 26

what is the Tx for a thyroid storm?

Answer 26

lugol's iodine
glucocorticoid (beclamethasone, hydrocortisone etc..)
PTU
Bb
fluids

Question 27

what occurs in hashimoto’s?

Answer 27

transient phase of hyperthyroid then hypothyroid

Question 28

risk factors for hashimoto’s?

Answer 28

excess iodine
postnatal
Li
autoimmune disease

Question 29

Ix for hashimoto’s and results?

Answer 29

TSH (high)
T4 (low)
TPO antibodies

Question 30

Tx for hashimoto’s?

Answer 30

monitor to see if resolves
levothyroxine

(Bb/CCB if during hyperthyroid phase)

Question 31

what occurs in a multinodular goitre?

Answer 31

multiple nodules causing hyperthyroidism

Question 32

Tx for a multinodular goitre?

Answer 32

radioiodine
surgery
propranolol/CCB for tremor

Question 33

who gets de quervains? how does it present?

Answer 33

women after an URTI

hyperthyroid + sore thyroid

Question 34

what is iodine uptake like on a scan of someone with de quervains?

Answer 34

reduced iodine uptake

Question 35

what does medullary thyroid cancer secrete? what does this hormone do?

Answer 35

calcitonin

reduce Ca

Question 36

blood results in sick euthyroid?

Answer 36

low TSH

low T3/4