Thyroid

Question 1

Goitre examinations

Answer 1

Examine from front and sides
Palpate from behind
Assess swallow - inspection and palpation
Protrude tongue
Percuss sternum for inferior border
Auscultation - bruit = Grave’s

Question 2

Multinodular goitre

Answer 2

Iodine deficiency
Physiological
Grave’s
Hashimoto’s
De Quervain’s thyroiditis

Question 3

Solitary nodule

Answer 3

Thyroid adenoma
Toxic adenoma
Thyroid cysts
Thyroid cancer

Question 4

Differentials

Answer 4

• Congenital - thyroglossal cyst, branchial anomalies
• Lymphadenopathy - bacterial, viral, granulomatous
• Vascular - carotid artery aneurysm
• Salivary - sialadenitis, salivary gland tumour

Question 5

Painful thyroiditis

Answer 5

De Quervain’s - subacute granulomatous thyroiditis - hyperthyroid –> hypothyroid –> euthyroid
Infectious thyroiditis - acute or chronic infections
Radiation thyroiditis

Question 6

What are the causes of painless thyroiditis

Answer 6

Hashimoto’s - with return to euthyroid
Postpartum thyroiditis

Question 7

Diagnosis and investigation of a thyroid nodule

Answer 7

TFTs, thyroid scintigraphy, US, fine needle aspirate

Question 8

Thyroid malignancy

Answer 8

• Papillary - most common, most favourable prognosis
• Follicular
• Ananplastic - highly aggressive
• Medullary thyroid cancer - assoicated with MEN2

Question 9

MEN2

Answer 9

MEN2a - autosomal dominant - medullary thyroid cancer, phaeochromocytoma, primary hyperparathyroidism
MEN 2b - autosomal dominant - medullary thyroid cancer, phaeochromocytoma, mucosal membrane neuromas, Marfan’s

Question 10

Hyperthyroidism

Answer 10

Thin, fidgety, sweaty, palmar erythema, fine tremor, tachycardia, lid lag and lid retraction, proximal myopathy, weight loss, diarrhoea, palpitations, heat intolerance

Question 11

Hypothyroidism

Answer 11

Elevated BMI, generalised slowness, dry hair, dry skin, cool peripheries, periorbital swelling, generalised, non-pitting oedema, cold intolerance, weight gain, constipation, fatigue

Question 12

Causes of hyperthyroidism

Answer 12

Increased hormone synthesis:
- Grave’s
- Hashimoto’s
- Toxic adenoma
- Toxic multinodular goitre
- Iodine-induced hyperthyroidism
Gland inflammation:
- de Quervain’s thyroiditis
- #infective thyroiditis
- Radiation thyroiditis
- Postpartum thyroiditis

Question 13

Causes of hypothyroidism

Answer 13

Autoimmune (Hashimoto’s) thyroiditis
Idiopathic atrophy
Previous radioiodine treatment or thyroidectomy
Iodine deficiency
Antithryoid drugs - amiodarone, lithium

Question 14

Autoantibodies in hypothyroidism

Answer 14

anti-thyroglobulin
anti-thyroid peroxidase

Question 15

Grave’s ophthalmology

Answer 15

Oedema - due to deposition of glycoasaminoglycans and water - periorbital oedema and chemosis
- Exophthalmos- sclera is visible above lower eyeid
Ophthalmoplegia - due to infiltration, oedema and fibrosis of extra-ocular muscles
- Exposure keratosis and corneal ulceration
-Optic nn compression
-Glaucoma

Question 16

Features of Grave’s

Answer 16

Grave’s ophthalmopathy
Pretibial myxoedema
Thyroid acropachy
Goitre

Question 17

Pathophysiology of Grave’s

Answer 17

Autoimmune disease - hyperthyroidism due to thyroid stimulating antibodies

Question 18

Management of Grave’s

Answer 18

Symptomatic - beta blockers
Thionamides - carbimazole and propylthiouracil
Radioiodine ablation
Surgery
Exophthalmos - eye drops, lateral tarsorrhaphy, smoking cessation