The list - endocrine

Question 1

Hyperthyroidism:

State 3 mechanisms for increased levels of thyroid hormone

Answer 1

1. Overproduction of thyroid hormone
2. Leakage of preformed hormone from thyroid
3. Ingestion of excess thyroid hormone

Question 2

Hyperthyroidism:

State some causes of hyperthyroidism

Answer 2

Graves' disease
Toxic multinodular goitre
Toxic adenoma
Congenital hyperthyroidism
Thyroiditis

Question 3

Hyperthyroidism:

State 7 symptoms of hyperthyroidism

Answer 3

1. Weight loss
2. Tachycardia
3. Anxiety
4. Heat intolerance
5. Sweating
6. Diarrhoea
7. Menstrual disturbance

Question 4

Hyperthyroidism:

Name some Graves’ specific signs

Answer 4

Diffuse goitre
Thyroid eye disease
Acropachy (thickening of extremities - clubbing/swelling)

Question 5

Hyperthyroidism:

Name 3 investigations you would do for suspected hyperthyroidism

Answer 5

1. Thyroid function test (blood test for T3, T4 and TSH)
2. Clinical history, physical signs
3. Supporting investigations such as thyroid antibodies

Question 6

Hyperthyroidism:

What is the treatment for hyperthyroidism (name 4)?

Answer 6

First line - antithyroid drugs
Beta blockers for symptoms
Radioiodine
Surgery (partial/subtotal thyroidectomy)

Question 7

Hyperthyroidism:
Name 3 antithyroid drugs (thionamides) used in the treatment of hyperthyroidism

And how they work

Answer 7

Carbimazole, Propylthiouracil (PTU) and methimazole.

Decrease new thyroid hormone synthesis, PTU also inhibits conversion of T4 to T3 (do not treat underlying cause).

Question 8

Hyperthyroidism:

Name the common side-effect, and some less common side-effects of thionamides

Answer 8

Common - rash
Less common - arthralgia, hepaitis, neuritis

Most severe is agranulocytosis

Question 9

Graves’ disease:

Describe the pathology of Graves’ disease

Answer 9

An autoimmune disease where the immune system targets TSH receptors on the thyroid gland (via antibodies - TSH receptor stimulating antibody) This cause the gland to be overactive => Hyperthyroidism.

Question 10

Graves’ disease:

In a thyroid function test, what would TSH, T4 and T3 be?

Answer 10

T3+T4 high
TSH low

TRAb (TSH-receptor stimulating antibody) has the same effect as TSH.

Question 11

Graves’ disease:

Signs and symptoms

Answer 11

1. Anxiety
2. Fine tremor of hnds
3. Heat sensitivity, increased perspiration or warm, moist skin
4. Weight loss, despite normal eating
5. Goiter
6. Bulging eyes - Graves’ ophthalmology
7. Thick, red skin on shins/dorsum of foot - Graves’ dermopathy

Question 12

Graves’ disease:

What 4 investigations might we do?

Answer 12

Physical examination of eye - protrusion
Pulse and blood pressure - signs of tremor
Blood sample - looking at TSH and T3/4
Ultrasound to identify enlarged thyroid gland

Question 13

Graves’ disease:

What is treatment (include what first line)

Answer 13

First line (NICE) - radioactive iodine therapy

Can give:

1. Anti-thyroid medications
2. Beta blockers - provide rapid relief for irregular heartbeats, tremors, heat intolerance and muscle weakness
3. Orbital decompression surgery/corticosteroids for eyes
4. Thyroidectomy

Question 14

Graves disease:

Describe radioiodine

Answer 14

We give 131I (as oppose to 127I). This emits beta energy with minimal tissue penertration

Question 15

Hashiomotos thyroiditis/autoimmune hypothyroidism:

Describe pathology

Answer 15

This is an autoimmune condition where autoantibodies destroy the thyroid gland causing hypothyroidism

Symptoms are same as hypothyroidism

Question 16

Hashimotos thyroiditis:

Describe management

Answer 16

First line - synthetic thyroid hormone replacement
Also resection of obstructive goitre.

(same treatment as any hypothyroidism)

Question 17

Hypothyroidism:

Describe the difference between primary, secondary and tertiary

Answer 17

Primary >99% - problem with the thyroid gland
Secondary - pituitary/hypothalamic dysfunction
Tertiary - withdrawal of thyroid suppressive therapy such as radioiodine

Question 18

Hypothyroidism:
Name some causes of hypothyroidism
(3 primary, 1 secondary)

Answer 18

Primary: Hashimotos thyroiditis/autoimmune hypothyroidism, thyroidectomy, iodine deficiency
Secondary: Pituitary/hypothalamic disease

Question 19

Hashiomotos thyroiditis/autoimmune hypothyroidism:

Describe pathology

Answer 19

Antibodies bind and block TSH receptors and destroy thyroid cells leading to inadequate thyroid hormone secretion

Question 20

Hypothyroidism:

Describe the symptoms

Answer 20

Fatigue, loss of energy, lethargy
Weight gain
Decreased appetite
Cold intolerance
Dry skin
Muscle pain, joint pain, weak extremities
Depression/emotional lability
Impaired memory/ability to concentrate 
Constipation
Menstrual disturbances
Decreased perspiration
Paraesthesia/nerve entrapment
Blurred vision

Question 21

Is thyroiditis hyper or hypo?

Answer 21

Usualy inflammation from Hashimotos or chronic lymphocytic thyroiditis leads to hypothyroidism

Question 22

Hashiomotos thyroiditis/autoimmune hypothyroidism:

Name investigations which confirm diagnosis

Answer 22

Diagnosis is based on signs and symptoms
Blood tests include hormone test (high TSH, low T3/T4) or antibody test (TPO antibodies, or antibodies against thyroid peroxidase)

Question 23

Thyroid cancer:

describe pathology

Answer 23

Epithelial tumours that originate from thyroid follicular cells.
From what I have read it neither causes hypo or hyper