Thyroid 1 (620-632)

Question 1

What investigations would you consider in a patient presenting with signs of thyroid dysfunction but no features of malignancy?;

Answer 1

Bloods- FBC, TSH, T3, T4. Imaging- US neck. Further investigations depend on results of above.

Question 2

What are the worrying signs and symtoms in a patient presenting with a thyroid nodule?;

Answer 2

Rapid growth or pain, dysphagia, cough, hoarse voice, stridor, palpabale lymph nodes, weight loss, loss of appepitite. PMHx/SHx- prev radiation to area, iodine deficiency, exposure to radiation, family hx, hashimoto’s, MEN 2a and 2b.

Question 3

What investigations would you carry out in a patient presenting with a suspected malignancy of the thyroid?;

Answer 3

Fine needle aspiration aspiration cytology (FNAC) - needle into thyroid nodule and aspirates cells out of it.

Question 4

What ultrasound features suggest a thryoid swelling/pathology to be malignant?;

Answer 4

Hypoechongenicity, irregular margin, increased vascularity, microcalcifications.

Question 5

Name some benign condition of the thyroid gland;

Answer 5

Benign thyroid adenoma or thryoid cystm, toxic multi-nodular goitre, thyroglossal duct cyst (not acyually in thyroid itself though), sick euthyroid, Graves, Hashimotos

Question 6

What specific autoantibodies would you look for in a patient with Hashimoto’s thyroiditis?;

Answer 6

(Hypothyroidism). TPO antibodies (autoimmune disease-both graves and hasimotos). Thyroglobulin antibody (TGAb)

Question 7

What specific autoantibodies would you look for in a patient with Grave’s disease?;

Answer 7

(Hyperthyroidism). . TPO antibodies (autoimmune disease-both graves and hasimotos). Anti-TSH receptor antibodies. TRAb.

Question 8

What are the signs and symptoms in a patient with Grave’s disease?;

Answer 8

(Hypertyroidism). Eye signs- grave’s opthalmopathy (proptosis), lid lag. Skin/hair/nails- brittle, pretibial myxoedema. Resp/cardiac-tachycardia, af. Musuloskeletal- tremor, weakness. Endocrine- sweating, weight loss, heat intolerance

Question 9

What are the medical options for treating Grave’s disease?;

Answer 9

1st line- Carbimazole (if not pregnant). If in1st trimester give proclarine. Can give beta-blockers for symptomatic control. If symtoms not controlled with medication can give radio-iodine if non-child bearing age.

Question 10

What is the key side-effect associated with long-term use of carbimzaole?;

Answer 10

Agranuocytosis.

Question 11

How would you manage a patient with Grave’s disease or a large goitre unresponsive to medical treatment?;

Answer 11

Patient choice: Radioiodine vs surgery (hemi-thyroidectomy or total thyroidectomy [if eye signs])

Question 12

What are the features of DeQuervain’s thyroiditis?;

Answer 12

Sub-acute thyroiditis following a viral infection presents with hyperthryoidism. Features- recent URTI, flu-like symptoms, pyrexia, increased inflammatory markers (ESR), painful gotire. Is self-limiting.

Question 13

What features on a Technetium-99 scan (Tc scan) would suggest malignancy vs benign?

Answer 13

Hot nodule= benign. Cold nodule = malignancy.