S10 L2 - Thyroid conditions

Question 1

• *Goitre**
• What is this?
• When does it develop pathologically?
• When may it develop physiologically?

Answer 1

Goitre = enlargement of the thyroid

• May accompany hypothyroidism or hyperthyroidism (but not necessarily present in either).
• *When does it develop pathologically?** Develops when the thyroid gland is overstimulated
• *When may it develop physiologically?** Pregnancy and menopause

Question 2

• *Hypothyroidism**
• Signs and symptoms

Answer 2

Question 3

• *Infants – SEVERE hypothyroidism**
• What condition can this lead to?
• Cause
• Signs and symptoms

Answer 3

Question 4

• *Adults – SEVERE hypothyroidism**
• What can this lead to?
• Cause
• Symptoms

Answer 4

Question 5

• *Primary hypothyroidism**
• What is the name of one of the causes of primary hypothyroidism?
• Cause
• Patient type
• Blood test
• Goitre
• Treatment

Answer 5

Hashimoto’s Disease

Question 6

• *Secondary hypothyroidism**
• What is this? Failure of what?
• Blood test
• Goitre present?

Answer 6

Question 7

Subclinical hypothyroidism
Blood test

Answer 7

Blood test: TSH level above the upper limit of normal despite normal levels of serum free thyroxine

Question 8

• *Other causes of hypothyroidism**
• List of 4

Answer 8

• Post-partum hypothyroidism (can result in post-natal depression)
• Dyshormonogenesis – babies born with an underactive thyroid gland
• Medication
• Autoimmune atrophic thyroiditis

Question 9

• *Treatment of hypothyroidism**
• Treatment
• Risk

Answer 9

Question 10

• *Hyperthyroidism**
• Signs and symptoms

Answer 10

Question 11

• *Primary hyperthyroidism**
• Name one cause
• Other Symptoms
• Goitre present?
• Blood test
• Other investigation
• Role of TSI in Grave’s Disease

Answer 11

Question 12

• *Secondary hyperthyroidism – excess Hypothalamic or anterior Pituitary failure**
• Hypothalamic failure
• Anterior pituitary failure
• Blood test
• Goitre

Answer 12

• *Hypothalamic failure** – causes high TRH, and therefore high TSH
• *Anterior pituitary failure** – causes only High TSH
• *Blood test:** High T3 and T4, High TRH and/or High TSH
• *Goitre:** Yes (usually)

Question 13

• *Subclinical hyperthyroidism**
• What is this condition?

Answer 13

Subclinical hyperthyroidism is a condition in which you have low levels of thyroid stimulating hormone (TSH) but normal levels of T3 and T4

Question 14

• *Hypersecreting thyroid tumour**
• What is this?
• Blood test
• Goitre

Answer 14

• *What is this?** Adenoma that has developed in the thyroid and produced T4 (Thyroxine)
• *Blood test:** High T3 and T4, Low TRH and Low TSH
• *Goitre:** No

Question 15

• *Thyroiditis**
• What is this?
• May occur

Answer 15

What is this? Inflammation of the thyroid e.g. from viral infection
Release of T4 into circulation
T4 is high, then low, then recovers again
May occur: After child-birth, medication (e.g. Amiodarone)

Question 16

• *Ectopic Thyroid tissue**
• Also called…
• Leads to…
• Why does it occur?

Answer 16

Question 17

• *Multinodular goitre**
• Key point about this…
• Cause
• What may happen after a number of years?
• Other complication of multinodular goitre

Answer 17

Question 18

• *Hot nodules**
• What is this?
• Cancerous?

Answer 18

Question 19

• *Investigating Thyroid Disorders**
• One method and how does this work?
• What substance does it use?

Answer 19

Question 20

One severe complication of hyperthyroidism
Name of this
Symptoms
How urgent?

Answer 20

Name: Thyroid crisis or ‘thyroid storm’
Mortality is 10%
Symptoms: Hyperpyrexia, tachycardia, cardiac failure, liver dysfunction, pulmonary oedema
How urgent? EMERGENCY

Question 21

• *How is hyperthyroidism treated (incl. Grave’s Disease)**
• Medication name
• Role of this medication
• Risk of this medication
• Surgery route - reasons why may choose this route? Risk of surgery?

Answer 21

Question 22

One way to work out if the lump in the neck is to do with the thyroid gland?

Blood tests – what does fT4 mean? When do blood tests for thyroid disorders need to be taken?

Answer 22

One way to work out if the lump in the neck is to do with the thyroid gland
Thyroid moves when swallowing, so lump will move when swallowing

Note – can only feel the thyroid when it is enlarged

Blood tests – what does fT4 mean? When do blood tests for thyroid disorders need to be taken?
fT4: Free T4
Thyroxine is a stable hormone – it does not change during day or night, so test can be taken at any time

Question 23

• *Thyroglossal cyst**
• Signs that it is a thyroglossal cyst?

Answer 23

Question 24

• *Thyroid cancer**
• Red flag signs
• Examination
• Investigation
• Thyroid surgery risk

Answer 24