Hypo/hyperthyroidism

Question 1

Give 2 secondary causes of hypo/hyperthyroidism?

Answer 1

hypothalamic

pituitary

Question 2

What would you want to measure if you thought a patient has hyperthyroidism?

Answer 2

thyroid function tests

also do ECG in case of AF

Question 3

What is pretibial myoxoedema? When is it seen?

Answer 3

accumulation of mucopolysaccharides in ground substance of dermis on skin of shins
Grave’s disease

Question 4

What is thyrotoxicosis?

Answer 4

hyperthyroidism

Question 5

When does myoexedema occur?

Answer 5

Either refers to severe hypothyroidism eg myoexedema coma

OR pretibial myoxoedema in Grave’s disease - on skin

Question 6

In areas of high iodine intake, is hypo or hyper more common?

Answer 6

hypo

Question 7

What are the goitrous causes of primary hypothyroidism?

Answer 7

Chronic thyroiditis (Hashimotos)
Iodine deficiency

Question 8

What are the non goitrous causes of hypothyroidism?

Answer 8

atrophic thyroiditis
post ablative/radiotherapy
congenital

Question 9

Most common cause of thyroiditis?

Answer 9

hashimoto’s

Question 10

In Hashimotos, what is seen in blood?

Answer 10

thyroid peroxidase antibodies

Question 11

In Hashimotos, what is seen on microscopy?

Answer 11

T cell infiltrate and inflammation

Question 12

What type of hair can be seen in hypothyroidism?

Answer 12

sparse, coarse

Question 13

What are other signs of hypothyroidism?

Answer 13

dull expressionless face
periorbital puffiness
pale cool skin, doughy to touch
vitiligo
hypercarotenaemia/yellowing
fluid retention, pitting oedemia

Question 14

Can vitiligo be associated with hypo or hyper?

Answer 14

hypo

Question 15

What happens to heart rate in hypo?

Answer 15

reduced

Question 16

What happens to lipids in hypo?

Answer 16

hyperlipidaemia

Question 17

What respiratory signs may occur with hypo

Answer 17

deep hoarse voice, macroglossia, obstructive sleep apnoea

Question 18

What GI symptoms may occur with hypo?

Answer 18

constipation

Question 19

What is carpal tunnel more likely in, hypothyroid or hyperthyroid?

Answer 19

hypo

Question 20

What can hypothyroidism do to periods?

Answer 20

menorrhagia

later oligo/amenorrhoea

Question 21

What does hypothyroid do to prolactin?

Answer 21

increases

Question 22

What happens to thyroid hormones in hypothyroid?

Answer 22

TSH high

T4/3 low

Question 23

What happens to sodium in hypothyroidism?

Answer 23

low

Question 24

Once stabilized, how often should TSH be checked?

Answer 24

every 12-18 months

Question 25

What is the main treatment of hypothy.

Answer 25

thyroxine

Question 26

Is there any benefit of combined T4 and T3 therapy?

Answer 26

no

Question 27

When is T4 preferabnly taken?

Answer 27

before breakfast

Question 28

Is T3 therapy used much in hypo?

Answer 28

no

Question 29

Who does myxoedema coma tend to affect?

Answer 29

elderly women with longstanding but untreated hypothyroidism

Question 30

Is there a high mortality in myxoedema coma?

Answer 30

yes

Question 31

What are the ECG findings of myxoedema coma?

Answer 31

bradycardia, low voltage complexes, varying degrees of heart block, t wave inversion, prolongation of QT interval

Question 32

Which drug can cause thyroid dysfuction?

Answer 32

amiodarone

Question 33

Is it more likely to get hypo or hyper on amiodarone?

Answer 33

hypo

Question 34

Cardiac signs of hyperth?

Answer 34

``` palpatations/AF cardiac failure (rare) ```

Question 35

What CNS symptoms may occur in hyperth?

Answer 35

anxiety, irritability, insomnia

Question 36

What GI symptoms may occur in hyperth?

Answer 36

frequent loose bowel movements

Question 37

What may happen to vision in hyperth?

Answer 37

lid retraction double vision eyes that bulge out

Question 38

What hair changes occur in hyperthyroidism?

Answer 38

brittle thinning hair

Question 39

What happens to nail growth in hyperthyroid?

Answer 39

rapid

Question 40

What happens to periods in hyperthyroidism?

Answer 40

lighter bleeding/less frequent

Question 41

What happens to muscles in hyperth?

Answer 41

weakness, especially in thighs and upper arms

Question 42

What happens to metabolism in hyper?

Answer 42

increased appetite but weight loss

Question 43

What are nodular thyroid causes of hyperthyroid?

Answer 43

``` multi nodular goiter toxic nodule (adenoma) ```

Question 44

What are inflammatory types of hyperthyroid?

Answer 44

subacute | post-partum

Question 45

What is seen on thyroid function tests in Grave's?

Answer 45

high T3/4, low TSH

Question 46

What is Graves antibody positive for?

Answer 46

TRAbs

Question 47

What is seen on ultrasound in graves?

Answer 47

smooth symmetrical goitre

Question 48

In whom does nodular thyroid disease occur more?

Answer 48

older patients

Question 49

Are nodular thyroid disease patients antibody TRAbs positive?

Answer 49

NO

Question 50

What type of goiter is seen in in nodular thyroid disease?

Answer 50

assymetrical

Question 51

What is De Quervains?

Answer 51

sub acute thyroiditis

Question 52

What happens to T4 in sub acute thyroiditis?

Answer 52

high then low then normal

Question 53

What happens to TSH in sub acute thyroiditis?

Answer 53

low then high then normal

Question 54

What is Thyroid storm?

Answer 54

severe hyperthyroidism resp and cardio collapse hyperthermia may be linked to infection

Question 55

What is treatment of thyroid storm?

Answer 55

lugols iodine, glucocorticoids, PTU, B blockers, fluids, monitoring

Question 56

Treatment of hyperthyroidism?

Answer 56

carbimazole | propylthiouracil (preferred in pregnancy)

Question 57

What else should be used in hyperthyroid to treat symptoms?

Answer 57

propranolol

Question 58

If a patient presents with tiredness/goiter and has a high TSH but a normal T4 what is the diagnosis?

Answer 58

subclinical hypothyroidism