Hyperthyroidism

Question 1

Thyrotoxicosis

Answer 1

Abnormal + xs TH

Question 2

Organ affected in 1ry hyperthyroidism

Answer 2

Thyroid gland

Question 3

Aetiology of 2ry hyperthyroidism

Answer 3

Xs thyroid due to overstimulation by TSH

Question 4

Graves causes 1ry hyperthyroidism due to antibodies formed against what receptor

Answer 4

TSH

Question 5

Most common cause of hyperthyroidism

Answer 5

Graves

Question 6

In toxic multi nodular goitre (plummer’s disease), nodules lead to hyperthyroidism through

Answer 6

• xs thyroid production

- independent of feedback mechanism

Question 7

Exophthalmus is caused by

Answer 7

Graves

Question 8

Histological finding in a tissue of pre-tibial myxoedema

Answer 8

Deposits of mucin in pre-tibial area

Question 9

Presentation of pre-tibial myxoedema

Answer 9

• discoloured
• wacky
• oedematous

Question 10

Cause of pretibial myxoedema

Answer 10

Reaction to TSH receptors antibodies (Graves)

Question 11

Universal hyperthyroidism features

Answer 11

• anxiety & irritability
• fatigue
• sexual dysfunction

Question 12

Temperature control in hyperthyroidism

Answer 12

Sweating & heat intolerance

Question 13

HR in hyperthyroidism

Answer 13

Tachycardia

Question 14

Weight changes in hyperthyroidism

Answer 14

Weight loss

Question 15

Stool changes in hyperthyroidism

Answer 15

Loose (diarrhoea)

Question 16

What causes the unique features of Graves

Answer 16

Reaction to TSH receptor antibodies

Question 17

Goitre characteristic in Graves

Answer 17

Diffuse

Question 18

Features of Graves (3)

Answer 18

• graves eye disease
• exophthalmus
• pretibila myxoedema

Question 19

Goitre features in toxic multinodular goitre

Answer 19

Goitre + firm nodules

Question 20

Patient ages in toxic multinodular goitre

Answer 20

> 50

Question 21

2nd most common cause of thyrotoxicosis

Answer 21

TMG

Question 22

Nodule in solitary toxic thyroid nodule

Answer 22

• single abnormal nodule

- release thyroid

Question 23

Cause of solitary toxic thyroid nodule

Answer 23

Benign adenoma

Question 24

Tx solitary toxic thyroid nodule

Answer 24

Surgical

Question 25

Aetiology of De Quervain’s thyroiditis

Answer 25

- hyper then hypothyroidism | - -ve feedback —> TSH fall

Question 26

Cause of De Quervain’s thyroiditis

Answer 26

Viral infection

Question 27

Presentation of De Quervain’s thyroiditis

Answer 27

- hyperthyroidism | - viral symptoms

Question 28

Thyroid storm

Answer 28

Presentation of hyperthyroidism

Question 29

1st line management of hyperthyroidism

Answer 29

Carbimazole

Question 30

What is given in the “block+replace” stage of managing hyperthyroidism if the “titration-block” stage causes hypothyroidism

Answer 30

Levothyroxine

Question 31

Remission takes … with carbimazole

Answer 31

18 months

Question 32

2nd line drug in treating hyperthyroidism which has serious hepatic side effects and can lead to death

Answer 32

Propylthiouracil

Question 33

How long does remission take with iodine

Answer 33

16 months

Question 34

Contraindications of radioactive iodine

Answer 34

Pregnancy

Question 35

When to use beta blockers

Answer 35

Block adrenaline symptoms —> thyroid storm

Question 36

Lifetime … is required if surgery is used to treat hyperthyroidism

Answer 36

Levothyroxine

Question 37

Very important side effect of carbimazole which requires stopping the medication

Answer 37

Sore throat (BM suppression —> agranulocytosis)

Question 38

what does nuclear scintigraphy reveal in toxic multinodular goitre

Answer 38

patchy uptake

Question 39

what does nuclear scintigraphy reveal in grave's

Answer 39

- diffuse enlargement of both lobes | - uniform uptake throughout

Question 40

what does nuclear scintigraphy reveal in solitary adenoma

Answer 40

small focus of uptake