thyroid

Question 1

Name the symptoms of throtoxicosis

Answer 1

Weight Loss
Increased appetite
Tremor
Oligomenorrhoea
Polyuria
Weakness, fatigue
Diarrhoea
Insomnia, anxiety
Change in heat preference – cold not hot.

Question 2

Name some signs of thryotoxicosis

Answer 2

sweaty hands, palmar erythema, tremor, goitre.
Eyes - lid lag and and retraction. Exopthalamos and proptosis .
In grave’s only: grittiness and redness, conjunctival oedema, periorbital oedema, opthalmoplegia.

Question 3

what is sick euthyroidism

Answer 3

Euthyroid sick syndrome is a condition in which serum levels of thyroid hormones are low in clinically euthyroid patients with nonthyroidal systemic illness. Diagnosis is based on excluding hypothyroidism. Treatment is directed toward the underlying illness; thyroid hormone replacement is not indicated

Question 4

what effect does amiodarone have on TFTs

Answer 4

patients have elevated fT4, low/normal T3 and will initially have a high TSH.

Question 5

define thyrotoxicosis

Answer 5

Thyrotoxicosis is the syndrome resulting from excessive free thyroxine (fT4) and or free tri-iodothyronine (fT3).
Can occur without hyperthyroidism.

Question 6

define hyperthyroidism

Answer 6

Hyperthyroidism refers to thyroid over activity resulting in thyrotoxicosis.

Question 7

Give 3 primary causes of thyrotoxicosis

Answer 7

Grave’s disease
Toxic multi-nodular goitre
Toxic adenoma

Question 8

Give 3 secondary causes of thyrotoxicosis

Answer 8

TSHoma (pituitary adenoma)
Gestational thyrotoxicosis - due to high levels of hCG
Thyroid hormone resistance syndrome

Question 9

how would you investigate hyperthyroidism

Answer 9

antibodies +/- nuclear medicine scan

Question 10

which antibodies would you check and which ones are most specific

Answer 10

anti-TPO: preset in 45-80% of Grave’s disease
TRABs - anti-TSH receptor antibodies: harder to measure but are most reliable for diagnosing Grave’s disease. Important in pregnancy to determine the cause of thyroid disease in pregnancy as well as assess the risk of neonatal thyrotoxicosis

Question 11

how would you treat Grave’s

Answer 11

Carbimazole (could consider block and replace if brittle or normal is reducing regimen) and hope she goes into remission, as well as propanalol for her symptoms.

Question 12

which anti-thyroid drug would you use in pregnancy

Answer 12

PTU

Question 13

who is radioactive iodine contra-indicated in

Answer 13

pregnancy, lactation and those with active thyroid eye disease. Should also be avoided in those who have or work with young children

Question 14

factors that increase the risk of Grave’s opthamology

Answer 14

male sex, age, smoking, radio-active iodine treatment.

Question 15

how would you treat grave’s opthamolopathy

Answer 15

can give artificial tears for grittiness, eyelid: eye lids can be taped at night to avoid damaging the cornea, steroids and radiotherapy for proptosis
Steroids can also help the optic neuropathy

Question 16

what would be the differential diagnosis when considering hypothyroidism

Answer 16

anaemia, depression, hypoadrenalism (addison’s)

Question 17

what are the symptoms of hypothyroidism

Answer 17

tiredness, weight gain, cold intolerance, constipation, myalgia, carpal tunnel syndrome, menorrhagia

Question 18

what are the signs of hypothyroidism

Answer 18

excess weight, thick coarse facial features, dry skin, fine, brittle hair (can lose the outer eyebrows)
Later stages - can have delayed relaxation of the ankle and other tendon reflexes

Question 19

what are the possible causes of hypthyroidism

Answer 19

• Autoimmune Hashimoto’s thyroiditis
• Destructive thyroiditis
• Secondary to hypothalamic or pituitary failure
• Idiopathic atrophic hypothyroidism
• Iodine deficiency
• Following treatment for thyrotoxicosis

Question 20

how do you treat hypothyroidism

Answer 20

levothyroxine.

Question 21

what is myxoedema

Answer 21

severe hypothyroidism where here is an accumulation of hydrophillic mucopolysaccharides in the dermis which leads to thickened facial features and doughy skin.
Features of myxoedema: Dull, expressionless face, sparse hair, periorbital puffiness, macroglossia
Pale, cool, skin which is rough and doughy
Pericardial effusion
Megacolon/ intestinal obstruction
Cerebellar ataxia
Prolonged relaxation phase of deep tendon reflexes
Peripheral neuropathy

Question 22

what can myxoedema progress to

Answer 22

myxoedema coma
Uncommon, reduced consciousness and hypothermia common – not necessarily with coma. Heart failure, hypotension, hyponatraemia and hypoventilation also occur. Treatment is supportive with intravenous fluids, slow rewarming, ventilation and intravenous T3 followed by oral or nasogastric T4 once improving.