thyroid

Question 1

What are the investigations for hypothyroidism?

Answer 1

• TFTs (↑ TSH, ↓T3, ↓T4)
• Thyroid antibodies
• FBC (anaemia), U&Es, LFTs
• Creatinine
• Cholesterol
• Guthrie test for congenital screening

Question 2

What are 4 causes of primary hypothyroidism?

Answer 2

• Iodine deficiency
• Hashimotos Thyroiditis
• Post thyroidectomy → No production of T3, T4
• Drug induced → Overtreatment of hyperthyroidism

Question 3

What is lid lag?

Answer 3

Lid lag means delay in moving the eyelid as the eye moves downwards. It is a common finding in thyroid disease when it is known as Graefe’s sign.

Question 4

What are 5 symptoms of Hypothyroidism?

Answer 4

Think about a slowing of the metabolism:

• Weight gain
• Cold intolerance
• Constipation
• Dry skin
• Thinning of hair
• bradycardia
• Depression
• Delayed reflexes

Question 5

What is graves disease?

Answer 5

• Autoimmune condition
• Distinguishable from other hyperthyroidism by eye signs e.g. exophthalmos and other signs e.g. pretibial myxoedema
• Associated with other autoimmune conditions e.g. pernicious anaemia

Question 6

What is the surgical managment of hyperthyroidism?

Answer 6

subtotal thyroidectomy

Question 7

What is the most common cause of hypothyroidism?

Answer 7

Hashimotos thyroiditis

Question 8

What is the treatment or hypothyroidism?

Answer 8

• Conservative: patient education

* Medical: lifelong replacement of thyroid hormone with levothyroxine

Question 9

What is conservative treatment for hyperthyroidism?

Answer 9

patient education, smoking cessation

Question 10

What is the second most common cause of hyperthyroidism?

Answer 10

Toxic multinodular goitre

Question 11

Name 4 clinical signs associated with hyperthyroidism

Answer 11

• Thyroid acropachy
• Onycholysis
• Exophthalmus
• Lid lag
• Pretibial myxoedema

Question 12

What are 4 causes of secondary hypothyroidism?

Answer 12

• Dysfunction of the hypothalamic - pituitary axis
• Pituitary ademona
• Sheehan’s syndrome → Ischaemic necrosis of the pituitary gland after childbirth.
• Infiltrative disease → TB, Haemachromatosis

Question 13

What are the medical treatments options for hyperthyroidism?

Answer 13

• Symptomatic control → Betablockers for palpitations and tremors etc.
• Antithyroid medication → Carbimazole, Propylthiouracil
• Radioactive iodine ablation

Question 14

What are the investigations for Hyperthyroidism?

Answer 14

• TFTs (↓TSH, ↑T3, ↑T4)
• Ultrasound scan of nodules
• Fine needle aspiration of solitary nodules to exclude malignancy
• Isotope scan to assess hot and cold thyroid nodules

Question 15

Name 4 complications of Hyperthyroidism?

Answer 15

• Atrial fibrillation
• High output cardiac failure
• Cardiomyopathy
• Osteoporosis

Question 16

What is a Toxic multi-nodular goitre?

Answer 16

• Excess production of thyroid hormones from functionally autonomous thyroid nodules, which do not require stimulation from thyroid stimulating hormone
• Risk increase with age
• More common in females
• Single nodule suggestive of thyroid neoplasia

Question 17

What is the most common cause of hyperthyroidism?

Answer 17

Graves disease

Question 18

What are the 3 options for the treatment of Hyperthyroidism?

Answer 18

• Conservative
• Medical
• Surgical

Question 19

What is De Quervain’s thyroiditis?

Answer 19

• Transient hyperthyroidism that develops after viral infection
• Goitre often painful
• Period of hypothyroidism may follow

Question 20

What si the difference between primary and secondaryhypothyroidism?

Answer 20

• Primary is dysfunction of the thyroid

* Secondary is dysfunction of the pituitary gland

Question 21

What are 4 symptoms of Hyperthyroidism? Think about speeding up the metabolism.

Answer 21

• Weight loss
• Warm skin/heat intolerance
• Diarrhoea
• Exopthalmus
• Lid lag
• Palpitations
• Anxiety
• Tremor
• Goitre +/- bruit

Question 22

What is hashimotos thyroiditis?

Answer 22

• An autoimmune disease.

* It is associated with type 1 diabetes, addisons + Pernicious anaemia

Question 23

What is thyroid acropachy?

Answer 23

• Clubbing of the fingers
• Thyroid acropachy is characterized by soft-tissue swelling of the hands and clubbing of the fingers.
• Radiographic imaging of affected extremities typically demonstrates periostitis, most commonly the metacarpal bones.

Question 24

What is Onycholysis?

Answer 24

• The separation of a fingernail or toenail from its pink nail bed. The separation occurs gradually and is painless. Commonest cause is trauma.

Question 25

What are 4 complications of hypothyroidism?

Answer 25

• Goitre
• Hypercholesterolaemia
• Complications in pregnancy, e.g. pre-eclampsia
• Hyperthyroidism of hypothyroidism
• Myxoedema coma

Question 26

What is opthalmoplegia, and what is it associated with?

Answer 26

• Paralysis of the muscles within or surrounding the eye.

* Associated with graves disease

Question 27

What is chemosis, and what is it associated with?

Answer 27

• Chemosis is the swelling (or edema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries.
• Associated with hyperthyroidism

Question 28

What is cervical rib?

Answer 28

cervical rib in humans is an extra rib which arises from the seventh cervical vertebra

Question 29

What symptoms can be associated with cervical rib?

Answer 29

• Thoracic outlet syndrome
• Gilliatt-Sumner hand. → atrophy of the abductor pollicis brevis with lesser involvement of the interossei and hypothenar muscles.
• Pain and tingling in hand and fingers