Thyroid

Question 1

Hyperthyroid symptoms (6)

Answer 1

Hyperactive
Weight loss (despite increased appetite
Heat intolerance (prefer cold)
Diarrhea
Palpitations, tremors
Oligomenorrhoea

Question 2

Hypothyroid symptoms (6)

Answer 2

Lethargy
Weight gain (despite reduced appetite)
Cold intolerance (prefer warmth)
Constipation
Bradycardia
Menorrhagia

Question 3

What type of autoimmune disease is associated with thyroid disease? (4)

Answer 3

• Type I DM
• SLE
• RA
• Pernicious anemia (a/w Graves & Hashimoto’s)

Question 4

Risk factors for thyroid disease? (6)

Answer 4

• History of autoimmune disease
• History of cancer elsewhere
• History of thyroid disease
• Occupational history: ionising radiation exposure
• Family history of thyroid cancer
• Smoking

Question 5

What are the compressive symptoms? (3)

Answer 5

-Dyspnea
- Dysphagia
- Hoarseness of voice

Question 6

Inspection of thyroid gland (5)

Answer 6

• Swelling
• Scars
• Skin changes over the mass
• stigmata of hyperthyroid/ hypothyroid
• Plethora of face, distended neck veins

Question 7

A thyroid swelling moves on swallowing, a thyroglossal cyst moves on?

Answer 7

• Swallowing AND
• Protrusion of tongue

Question 8

Characteristics of lump (5)

Answer 8

Site (ant triangle)
Size
Consistency (soft, cystic, hard, multinodular)
Mobility
Tenderness

Question 9

Lymph nodes palpated (7)

Answer 9

Submental
Submandibular
Down SCM (II, III, IV)/ Anterior triangle
Posterior triangle
Pre- auricular
Post- auricular
Occipital

Question 10

If LN are…
a. Separate and tender?
b. Hard and clustered?
c. Soft and rubbery?

suggestive of?

Answer 10

a. Reactive hyperplasia
b. Carcinoma
c. Lymphoma

Question 11

What to look for in the eyes? (6)

Answer 11

a. Lid lag
b. Lid retraction
c. Exophthalmos
d. Chemosis
e. Opthalmoplegia
f. Proptosis

Question 12

Which of the following are seen in Grave disease?
(eyes)
a. Lid lag
b. Lid retraction
c. Exophthalmos
d. Chemosis
e. Opthalmoplegia
f. Proptosis

Answer 12

c-f

Question 13

Describe Lid retraction

Answer 13

Sclera visible between upper limbus of iris and upper eyelid

Question 14

Describe Exophthalmos

Answer 14

Sclera visible between lower limbus and lower eyelid

Question 15

Describe proptosis

Answer 15

Eye visible over supraorbital ridge

Question 16

Lid lag and lid retraction are a result of?

Answer 16

Excess sympathetic activity

Question 17

Describe pretibial myxoedma.

Answer 17

Elevated shin lesions with well defined edges, purplish red or brown and shiny skin with thickened orange peel appearance

Question 18

Pretibial myxedema seen in?

Answer 18

• Graves disease
  -Hypothyroidism

Question 19

Carpal tunnel syndrome associated with?

Answer 19

Hypothyroidism

Question 20

What are the 2 branches of artery arising from the common carotid artery that supply the thyroid gland?

Answer 20

• Superior thyroid artery
• Inferior thyroid artery

Question 21

Benign (2) vs Malignant (4) thyroid swelling

Answer 21

Benign:
- Multinodular swelling
- Hypo/hyperthyroid

Malignant:
- Progressively increase in size
- Solitary
- Painless
- Euthyroid

Question 22

Complications of swelling? Mass effect. (3)

Answer 22

• Dysphagia
• Dyspnea
• SVC obstruction: SOB, edema of upper extremities & face, prominent dilated veins

Question 23

Voice hoarseness of dyspnea suggests?

Answer 23

MALIGNANCY
Voice hoarseness: RLN invasion
Dyspnea: RLN invasion x2

Question 24

Risk factor for thyroid mass? (4)

Answer 24

• Irradiation history of thyroid
• Radiation exposure (Hiroshima, Nagasaki)
• Low iodine (mountainous area)
• Family history of thyroid ca

Question 25

Why do surgery in thyroid mass?

Answer 25

• > 20% increase in size over 6 months
• Cancer
• Compressive symptoms
• Strong family history of thyroid ca