thyroid

Question 1

Free T3/4 low
TSH high
?

Answer 1

primary hypothyroidism

Question 2

Free T3/4 high

TSH low

Answer 2

Primary hyperthyroidism

Question 3

Secondary hypothyroidism

values?

Answer 3

Free T3/4 low
TSH low (or ‘normal’)

Question 4

Secondary hyperthyroidism

values?

Answer 4

Free T3/4 high
TSH high (or ‘normal’)

Question 5

what is myxOedema ?

Answer 5

refers to severe hypothyroidism and is a medical emergency

Question 6

Pretibial myxoedema ?

Answer 6

is a rare clinical sign of Graves’ disease, an autoimmune thyroid disease which results in hyperthyroidism!

Question 7

hashimotos - hyper or hypothyroid?

Answer 7

hypothyroid

Question 8

what is the most common cause of hypothyroid in the west?

Answer 8

autoimmune hypothyroidism (hashimotos thyroiditis)

Question 9

hashimotos characterised by?

Answer 9

Antibodies against thyroid peroxidase (TPO)

T-cell infiltrate and inflammation microscopically

Question 10

coarse, sparse hair, expressionless face, periorbital puffiness, pale cool skin that feels doughy to touch, vitiligo may be present . hyper or hypo

Answer 10

hypo

Question 11

what is hypercaretonaemia

Answer 11

editing carotene in blood, can cause yellowing got skin

Question 12

What happens to thermorgulation in hypo?

Answer 12

cold intolerance

Question 13

Fluid in hypo?

Answer 13

get fluid retention

Question 14

what is an autoimmune disease which is an associated cutaneous sign of hypothyroid?

Answer 14

vitiligo

Question 15

what happens to lipids in hypo?

Answer 15

get hyperlipidaemia

Question 16

4 cardiac changes in hypo?

Answer 16

reduced heart rate
cardiac dilatation
pericardial effusion
worsening of heart failure

Question 17

Apeitite and weight?

Answer 17

reduced appetite and increased weight

Question 18

why might you get sleep apnoea in hypothyroid?

Answer 18

get hypoglossia (unusually large tongue)

Question 19

what can happen to the voice? hypo

Answer 19

hoarsness

Question 20

HYPO MUSCLES?

Answer 20

get muscle stiffness and cramps

Question 21

tendon reflexes?

Answer 21

prolongation of tendon jerks

Question 22

intellectual activities and motor activities

Answer 22

decreased

Question 23

Describe periods in hypothyroid?

Answer 23

menorrhagia and later get oligo or amenorrhoea

Question 24

why do you get hyperprolactinaemia?

Answer 24

increased TRH causes increased PRL secretion

Question 25

↑TSH and ↓fT4/3, creatinine kinase and LDL levels?

Answer 25

increased

Question 26

treating hypo, why should metabolic rate be restored gradually and not rapidly?

Answer 26

may precipitate cardiac arythmias

Question 27

what should levothyroxin dose be started at in younger patients

Answer 27

50-100ug

Question 28

in the elderly with history IHD, start levothyroxin at what daily?

Answer 28

25-50

Question 29

in secondary thyroid disease, where is the pathology?

Answer 29

not in the thyroid - hypothalamus or pituitary

Question 30

TSH should be checked every 12-18 weeks

Answer 30

check TSH 2 months after every dose change

Question 31

what is levothyroxin?

Answer 31

t4

Question 32

is t3 therapy used?

Answer 32

rarely, there is no benefit of taking t3 and t4 combined

Question 33

what happens to dose requirements in pregnancy?

Answer 33

they increase by 25-50%

Question 34

myx0edema coma )hypO, get oedema in hypo. What would you see on ECG

Answer 34

bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion, prolongation of the QT interval

Question 35

management of myxoedema ?

Answer 35

Intensive care, remember – A, B, C! Passively rewarm: aim for a slow rise in body temperature Cardiac monitoring for arrhythmias Close monitoring of urine output, fluid balance, central venous pressure, blood sugars, oxygenation Broad spectrum antibiotics Thyroxine cautiously (hydrocortisone)

Question 36

opposite of myx0edema?

Answer 36

thyrotoxicosis. the state arising when tissues exposed to ecess thyroxin

Question 37

thyrotoxicosis, which cardiac abnormality would you see?

Answer 37

atrial fibrilation, palpitation

Question 38

hyperthyroid, bowel movements?

Answer 38

diarrhoea

Question 39

eye changes in thyrotoxicosis?

Answer 39

lid retraction, diplopia, proptosis

Question 40

hair and nails?

Answer 40

brittle nails, rapid fingernail growth