Thyroid

Question 1

History questions?

Answer 1

Sleep problems

Irritability/depression

Muscle weakness

Weight change

Periods?

Heat/Cold intolerance

Thought processes dulled?

CIBH

Activitiy

Visual changes

Question 2

Triad of Graves’ disease

Answer 2

Thyrotoxicosis

Goitre

Eye signs

TSI - thyroid stimulating immunogobulin

Question 3

Peripheral signs of Graves?

Answer 3

Hands - acropachy, fine tremor, moist palms, tachycardia, ? AF

Arms - Biceps reflex - slow relaxation in hypothyroid; Proximal myopathy

Legs - pre-tibial myxoedema

Question 4

Graves eye disease (5)

Answer 4

Ophthalmoplegia - lid lag

Proptosis

Periorbital oedema, chemosis

Exposure keratopathy

Lid retraction - autonomic mediated so present in all forms hyperthyroid

Question 5

Rx options in Grave’s

Answer 5

Low dose Carbimazole for ~18 months

Block (high dose carbimazole) and Treat (thyroxine) - avoids refractory goitre and hypothyroid

Surgery

Radioiodine

Question 6

When consider surgery in someone Hyperthyroid

Answer 6

• A solitary enlarging nodule.
• Previous neck irradiation.
• Family history of endocrine tumour.
• Hoarseness or voice changes without other obvious cause.
• Neck glands.
• Young age (before puberty).
• Older age (65 or more).

Question 7

Signs in hypothyroidism

Answer 7

Deep voice

Coarse facial features

Puffy face with peri-orbital oedema

Dry skin

Loss of hair - outer third of eyebrow

Myxoedema - purplish swelling of subcut tissue

Goitre - hashimoto’s

Slow relaxing Biceps reflex

?HTN

Question 8

Exopthalmos v Proptosis

Answer 8

2 options

1. Exop is protrusion >18mm, while proptosis is ≤18mm
2. Exop is protrusion dependent on endocrine dysfunction, while proptosis is non-endocrine mediated