Thyroid

Question 1

What is thyroxine also known as?

Answer 1

T4

Question 2

Do you measure free or bound thyroxine?

Answer 2

Free

Question 3

What is more common primary or secondary hyperthyroidism?

Answer 3

Primary

Question 4

What are fT4 and TSH in primary hyperthyroidism?

Answer 4

High fT4

Low TSH

Question 5

What are fT4 and TSH in secondary hyperthyroidism?

Answer 5

High fT4

High TSH

Question 6

Name 3 causes of primary hyperthyroidism. What is the commonest’s cause?

Answer 6

Grave’s disease - commonest
Toxic multinodular goitre
Thyroiditis
Hot nodule - solitary toxic adenoma

Question 7

What autoantibody is seen in Grave’s disease?

Answer 7

TRAbs thyroid receptor antibodies

Question 8

What features in Grave’s disease are not seen in other causes of hyperthyroidism?

Answer 8

Thyroid eye disease
Thyroid acropachy
Pretibial myxedema

Question 9

What features of a goitre help differentiate the cause of hyperthyroidism?

Answer 9

Grave’s: large smooth non-tender goitre
Toxic multinodular goitre: lumpy tender
Thyroiditis: smooth tender

Question 10

Name 3 causes of thyroiditis

Answer 10

Post viral infection
Post-partum
Amiodarone

Question 11

What is the management of grave’s thyroid eye disease?

Answer 11

Steroids
(IV/PO depending on severity)
(sight loss risk)

Question 12

Name 1 cause of secondary hyperthyroidism

Answer 12

TSH secreting pituitary tumour, ectopic thyroid tissue

Question 13

What type of imaging is used first for investigating hyperthyroidism?

Answer 13

US

Question 14

Is a nuclear medicine technetium uptake test done for all with hyperthyroidism?

Answer 14

If antibody negative or diagnostic uncertainty

Question 15

What is seen on Graves’ disease and toxic multinodular goitre in a nuclear medicine technetium uptake test?

Answer 15

Grave’s uniform uptake

TMNG patchy uptake

Question 16

What is the first line management of Graves’ disease?

Answer 16

Carbimazole
(titrate dentist every 6 week until euthyroid)
(cures 50% patients)

Question 17

What is the management of Graves’ disease if pregnant or intolerant of carbimazole?

Answer 17

PTU propylthiouracil

Question 18

What is the common side effect of carbimazole? How is it managed?

Answer 18

Itch/rash – antihistamine

Question 19

What is the rare but important side-effect of carbimazole?

Answer 19

Agranulocytosis - sore throat, dry cough, mouth ulcers, bruising, fever
(monitor FBC, neutrophils, reversible if stop)

Question 20

What is the use of beta-blockers in hyperthyroidism?

Answer 20

For adrenergic type symptoms: tremor sweat anxiety palpitations

Question 21

What is a hot and cold nodule?

Answer 21

Hot - making hormone

Cold – doesn’t make anything (suspicious cancer)

Question 22

Deficiency of what can cause a goitre?

Answer 22

Iodine

Question 23

Following radioactive iodine treatment, how long should patients isolate for?

Answer 23

3 weeks

Question 24

What nerve may be injured in thyroid surgery?

Answer 24

Recurrent laryngeal nerve – hoarse voice

Question 25

Untreated hyperthyroidism can lead to what complication?

Answer 25

Thyroid storm

Question 26

Thyroid storm - High or low temp - Dehydration or fluid overload - Low or high HR - Low or high BP

Answer 26

``` High temp Dehydration High HR Low BP Also confusion/anxiety/delirium, N+V, arrhythmias ```

Question 27

What is the management of a thyroid storm?

Answer 27

``` Fluids + propranolol + PTU + hydrocortisone + paracetamol + phenobarbital + furosemide/ACEI ```

Question 28

What are fT4 and TSH in primary hypothyroidism?

Answer 28

low fT4 | TSH high

Question 29

What are fT4 and TSH in secondary hypothyroidism?

Answer 29

low fT4 | low TSH

Question 30

Name 3 causes of primary hypothyroidism

Answer 30

``` Hashimoto's disease Idiopathic Thyroiditis Iodine deficiency History of thyroid irradiation/surgery ```

Question 31

Name 2 causes of secondary hypothyroidism

Answer 31

Pituitary neoplasm Hypothalamic neoplasm Congenital Sheehan syndrome (pituitary necrosis/apoplexy)

Question 32

Does lithium cause hypo or hyperthyroidism?

Answer 32

Either

Question 33

What autoantibody is associated with Hashimoto's disease?

Answer 33

TPO

Question 34

What is the first line management of hypothyroidism

Answer 34

Levothyroxine T4

Question 35

What is a complication of decompensated hypothyroidism?

Answer 35

Myxedema coma

Question 36

What would be seen on blood results in subclinical hypothyroidism?

Answer 36

Normal fT4, high TSH

Question 37

What is the management of subclinical hypothyroidism?

Answer 37

Repeat TFTs in a few months

Question 38

What is the management of myxoedema coma?

Answer 38

Supportive + IV hydrocortisone + IV levothyroxine T4

Question 39

What is the 5% rule with thyroid cancer?

Answer 39

5% of women have thyroid lumps, 5% of them are malignant

Question 40

Most thyroid nodules are benign hyperplastic lesions – true or false

Answer 40

True

Question 41

Is a thyroid cancer lump tethered to surrounding structures or mobile?

Answer 41

Tethered

Question 42

Cytology determines the staging of thyroid cancer – true or false

Answer 42

False cytology does grading not staging Cytology can't see if invaded the basement membrane (Graded U2-U5)

Question 43

What is the commonest type of thyroid cancer? What is the second commonest type of thyroid cancer?

Answer 43

Commonest papillary | Next follicular

Question 44

TFTs are usually normal in thyroid cancer – T or F

Answer 44

True

Question 45

When investigating thyroid cancer should you check for thyroid autoantibodies?

Answer 45

Yes for exclusion

Question 46

What type of biopsy is done for thyroid cancer?

Answer 46

FNA for cytology

Question 47

Cervical lymphadenopathy + thyroid lump = until proven otherwise

Answer 47

Papillary thyroid cancer

Question 48

If you find cervical lymphadenopathy on the examination, what should he do next on examination?

Answer 48

Check axilla/groin LN | lymphoma

Question 49

Are a isotope scan and a technetium uptake scan the same thing?

Answer 49

Yes

Question 50

What is a hot nodule on an isotope scan diagnostic off?

Answer 50

Solitary toxic adenoma

Question 51

How old is papillary thyroid cancer and most commonly metastasise?

Answer 51

Lymphatic spread

Question 52

Is papillary thyroid cancer associated with younger or elderly patients? More male or female?

Answer 52

Young | M = F

Question 53

Papillary thyroid cancer has an excellent prognosis – true or false

Answer 53

True

Question 54

What is TSH levels in papillary or follicular thyroid cancer?

Answer 54

Normal or slightly elevated

Question 55

Does follicular thyroid cancer metastasise early or late? Where does it spread to?

Answer 55

Early to bone/lung

Question 56

What type of thyroid cancer is associated with CEA?

Answer 56

Medullary

Question 57

What type of thyroid cancer is associated with MEN?

Answer 57

Medullary

Question 58

What is used as a tumour marker for monitoring thyroid cancer post surgery?

Answer 58

Thyroglobulin

Question 59

What is the presentation of MEN1?

Answer 59

3 Ps | Parathyroid, phaeochromocytoma, pancreas (insulinoma, gastrinoma, PUD Zollinger Ellison syndrome)

Question 60

What gene is mutated in MEN1?

Answer 60

MEN 1 gene

Question 61

What gene is mutated in MEN2?

Answer 61

RET gene

Question 62

What is the Mx of low risk thyroid cancer (under 50yr, under 4cm)?

Answer 62

Lobectomy (most function ok after few months with half thyroid)

Question 63

What is the Mx of low risk thyroid cancer (over 50yr, over 4cm)?

Answer 63

Total thyroidectomy