Hyper/hypo thyroid

Question 1

What is the commonest cause of a hypo/hyper thyroid?

Answer 1

Autoimmune thyroid disease

Question 2

Are primary or secondary causes more common?

Answer 2

Primary

Question 3

What does subclinical hypothyrodism look like, biochemically?

Answer 3

Normal T3/4 and raised TSH

Question 4

What hormones are measured for thyroid issues?

Answer 4

TSH
T4
T3

Question 5

In overt hyperthyroidism, describe the patterns of TSH and T3/4

Answer 5

TSH will be low.
T3/T4 will be high.
TSH low so negative feedback doesn’t turn off

Question 6

Why is secondary pituitary gland failure different to primary in terms of hormone balance?

Answer 6

If TSH is high then T3/T4 are high e.g in TSHoma.

Question 7

What is pre-tibial myxoedema?

Answer 7

Non-pitting oedema with discolouration over lateral malleoli.
Associated with Grave’s disease.

Question 8

In which sex is hypothryoidism more common?

Answer 8

Females

Question 9

What are the three types of primary hypothryoidism?

Answer 9

Goitrous
Non-goitrous
Self limiting

Question 10

What kind of drugs can induce a goitrous hypothyroidism?

Answer 10

Amiodarone, stavudine(HIV)

lithium

Question 11

A deficiency in what mineral can cause hypothyroidism?

Answer 11

Iodine

Question 12

True or False

Hypothyroidism cannot be placentally transmitted

Answer 12

False.

Antithyroid agents or iodides can be transmitted

Question 13

What is the main cause of primary goitrous hypothryroidism?

Answer 13

Hashimotos thyroiditis

Question 14

What is the main cause of primary non- goitrous hypothryroidism?

Answer 14

Atrophic thyroiditis

Question 15

True or False

Postpartum thyroiditis is transient

Answer 15

True

Question 16

If Hashimotos thyroiditis is suspected which antibodies are present in blood?

Answer 16

Thyroid Peroxidase Ab

anti-TPO

Question 17

What would be seen on microscopy with Hashimotos thyroiditis?

Answer 17

T cell infiltrate and inflammation

Question 18

What signs can be seen on the skin in hypothyroidism?

Answer 18

Pale, cool skin
Hypercarotenaemia
Vitiligo
Pitting oedema

Question 19

What changes are seen in hair?

Answer 19

Coarse and sparse hair

Question 20

What CVS changes may be present?

Answer 20

Hyperlipidaemia
Reduced HR
Cardiac dilatation
Pericardial effusion

Question 21

Is weight gain or weight loss more common in hypothryoidism?

Answer 21

Weight gain

Question 22

True or False

Macroglossia is a sign of hypothyroidism

Answer 22

True

Question 23

True or False

Carpal Tunnel syndrome may present in hypothryoidism

Answer 23

True

Question 24

Which nerve is affected in carpal tunnel syndrome?

Answer 24

Median

Question 25

What gynae changes may be present in hypothyroidism?

Answer 25

Menorrhagia | Oligo/amenorrhoea

Question 26

What will the TSH be like in hypothyroidism?

Answer 26

High

Question 27

What will the T4/3 levels be like in hypothryoidism?

Answer 27

Low

Question 28

What is macrocytosis?

Answer 28

Large RBC. | MCV >100

Question 29

What other changes may be seen in bloods?

Answer 29

Elevated CK Elevated LDL HYPOnatraemia HYPERprolactinaemia

Question 30

True or False | Younger patients with hypothyroidism should be started on lower doses of thyroxine

Answer 30

False. | Younger patients should be started on 50-100 micrograms

Question 31

How long after starting thyroxine should TSH levels be checked?

Answer 31

2 months. | 4 weeks in elderly

Question 32

When should thyroxine be taken?

Answer 32

Before breakfast

Question 33

What consideration should be taken regarding thyroxine in pregnancy?

Answer 33

Dose should go up by half

Question 34

What is a myxoedema coma?

Answer 34

Occurs in severe hypothyroidism. | precipitated by stroke, MI, infection

Question 35

What signs are common in myxoedema coma?

Answer 35

Hypothyroid, hypoglycaemic, hypothermic, bradycardia

Question 36

What changes are present on ECG in myxoedema coma?

Answer 36

Low voltage complexes ?heart block T wave inversion QT elongation

Question 37

What respiratory changes would you be worried about in myxoedema coma?

Answer 37

Type 2 resp failure with hypoxia, hypercarbia --> acidosis

Question 38

What cardiac changes are present in HYPERthryoidism?

Answer 38

Palpitations | AF

Question 39

What nervous system changes are present in hyperthyroidism?

Answer 39

Irritability Nervousness Anxiety

Question 40

What GI changes are present in hyperthyroidis?

Answer 40

Frequent loose stools

Question 41

What is the bulging of eyes called?

Answer 41

Exopthalmus Proptosis Exorbitism

Question 42

What changes are present in hair and skin in hyperthyroidism?

Answer 42

Brittle and thinning hair | Fast growing nails

Question 43

What is the autoimmune causation for hyperthryoidism called?

Answer 43

Graves disease

Question 44

What age does Graves disease normally affect?

Answer 44

20-50

Question 45

In which sex is Graves disease more common?

Answer 45

Female

Question 46

Is there a genetic link in Grave's disease?

Answer 46

Yes

Question 47

Which antibody is positive in Graves?

Answer 47

TRAbs

Question 48

What are the thyroid hormone patterns in Graves?

Answer 48

High T3/4 | low TSH

Question 49

How is the goitre described in Graves?

Answer 49

Smooth Symmetrical High uptake

Question 50

What is chemosis?

Answer 50

Conjuctival swelling

Question 51

True or False | Smoking is a recommended treatment for proptosis

Answer 51

true | Eye disease may improve

Question 52

In who does nodular thyroid affect?

Answer 52

Older patients

Question 53

What are the test results for nodular thyroid disease?

Answer 53

High T3/4 low TSH Ab neg Assymetrical goitre w high uptake

Question 54

Which eponymously annoyingly named condition is a subacute thyroiditis and may be associated with viral symptoms?

Answer 54

De Quervains

Question 55

What is the treatment for De Quervains?

Answer 55

No treatment. Will resolve in 18 months

Question 56

When does a thyroid storm occur?

Answer 56

Severe hyperthyroidism | Underlying infection

Question 57

What are the symptoms of a thyroid storm?

Answer 57

Resp and cardiac collapse Hyperthermia Exaggerated reflexes

Question 58

What is the Tx for thyroid storm?

Answer 58

``` Lugols iodine steroids PTU B blockers Fluids ```

Question 59

How is hyperthyroidism treated?

Answer 59

Carbimazole | Propylthiouracil (PTU)

Question 60

What drug can be given for the sympathomimetic symptoms?

Answer 60

Beta blockers specifically propanolol

Question 61

How does radio-iodine work?

Answer 61

Radioactivity destroys thryoid gland over a few weeks and then pee it out.

Question 62

What precautions need to be taken with radio-iodine?

Answer 62

No sharing bed Not pregnant No contact with pregnant women

Question 63

When is surgery indicated in hyperthroidism?

Answer 63

Only after drugs and radioiodine have failed

Question 64

In Graves disease which is the best antibody to check?

Answer 64

TSH receptor antibody

Question 65

When is scintigraphy used?

Answer 65

In hyperthyroid only

Question 66

What test is done at 5 days after birth?

Answer 66

Guthrie's test

Question 67

What is Guthrie's test for?

Answer 67

Heel prick test to check TSH/ T4

Question 68

What symptoms would be present in newborns with congenital thyroid disease?

Answer 68

Delayed jaundice Poor feeding but normal weight gain Hypotonia

Question 69

What is cretinism?

Answer 69

Developmental delay due to absence of thyroxine

Question 70

What is the normal range for TSH?

Answer 70

0.4-4.0

Question 71

What is the normal range for T3?

Answer 71

9.9-22

Question 72

What is the normal range for T4?

Answer 72

0.9-2.6

Question 73

What side effect of carbimazole means the medication must stop?

Answer 73

Agranylocytosis.

Question 74

What is agranylocytosis and how might it present?

Answer 74

Lack of granulocytes in blood leading to infection | Cough or sore throat