Thyroid

Question 1

What questions do you need to ask if someone has weight loss?

Answer 1

RED FLAGS
GI symptoms – anorexia, abdominal pain, diarrhoea, symptoms of Inflammatory bowel disease, coeliac disease, peptic ulcer
Symptoms of depression – low mood, loss of interest, sleep disturbance
Symptoms of eating disorder – decreased food intake, self-induced vomiting, over-exercise. Anorexia nervosa and bulimia may commonly present in this age group
Polyuria and polydipsia - Type 1 Diabetes mellitus may present with weight loss
Drug use – including alcohol, cocaine, amphetamines, cannabis. Weight loss can occur with several drugs of abuse
Night sweats or fever - Although malignancy is rare in this age group, lymphomas may present with weight loss. Tuberculosis and HIV can also present in this way.

Question 2

What are the possible causes of weight loss?

Answer 2

Infection
Depression
Eating Disorder
Malignancy
Metabolic Disease
Inflammatory Disease
HIV
Diabetes
Drug abuse
Other

Question 3

Physical signs of hyperthyroidism?

Answer 3

agitation
tremor
onycholysis
acropachy (clubbing)
palm sweats
opthalmoplegia
exopthalmos
lid lag
hyperreflexia
proximal myopathy
pretibial myxoedema
conjunctival oedema

Question 4

Elevated T3/4 and low TSH indicates what?

Answer 4

Primary hyperthyroidism

Question 5

Where is thyroid gland?

Answer 5

Below thyroid cartilage of larynx, anterior to trachea

Question 6

What does it make?

Answer 6

T3 and thyroxine (T4)

Question 7

What is the thyroid hormone precursor?

Answer 7

thyroglobulin

Question 8

What do the C cells make?

Answer 8

calcitonin

Question 9

Which transporters/receptors help iodide and thyroglobulin into colloid?

Answer 9

TSHR transports thyroglobulin (Tg) and NIS (sodium iodide symporter)

Question 10

What does Thyroid PeriOxidase do?

Answer 10

helps iodine and Tg get together

Question 11

What do T3/4 feedback to?

Answer 11

Hypothalamus, pituitary gland

Question 12

What are the target tissues for T3/4?

Answer 12

Heart, liver, bone, CNS

Question 13

What are the three commonest causes of hyperthyroidism?

Answer 13

Grave’s disease, toxic multinodular goitre, solitary toxic adenoma

Question 14

What clinical features are only found in hyperthyroidism due to Grave’s disease?

Answer 14

Pretibial myxoedema, thyroid acropachy, exopthalmos, opthalmoplegia

Question 15

What is the potentially serious side effect of carbimazole?

Answer 15

Neutropenia and agranulocytosis

Question 16

What does carbimazole do?

Answer 16

Decreases the uptake of iodine by thyroid, and once converted to its active form of methimazole, it inhibits TPO = reduces T3/4

Question 17

What should the patient look out for if they are on carbimazole?

Answer 17

Report signs of infection especially sore throat.

Question 18

What results of FBC would indicate stopping carbimazole?

Answer 18

If white cell count is low.

Question 19

What are the drug options for hyperthyroidism?

Answer 19

Carbimazole Propylthiouracil (if C intolerant)
Levothyroxine sodium
Iodine
Propranolol hydrochloride
Hydrocortisone

Question 20

What are the drug options for hyperthyroidism?

b) in pregnancy?

Answer 20

Carbimazole Propylthiouracil (if C intolerant)
Levothyroxine sodium
Iodine
Propranolol hydrochloride
Hydrocortisone

b) Propylthiouracil for trimester 1 and switch to carbimazole in trimester 2