Thyroid

Question 1

What is in the Graves triad?

Answer 1

Exopthalmos, thyroid acropachy and pretibial myxoedema

Question 2

Causes of hyperthyroidism?

Answer 2

Graves (most common) (TSHRAbs)
Toxic multinodular goitre
Toxic adenoma
De Quervains thyroiditis = increased release

Question 3

What are toxic multinodular goitre features?

Answer 3

Autonomously functioning thyroid that secretes excess

In Elderly and iodine deficient areas

Question 4

Features of De Quervains thyroiditis?

Answer 4

Post-viral infection, transient hyper->hypo->Euthyroid

Painful goitre, fever and raised ESR

Question 5

Hyperthyroid investigations?

Answer 5

Thryoid exam and ECG
Bloods
Radioisotope scan for uptake

Question 6

Thyroiditis management?

Answer 6

Usually self limiting, NSAIDS for thyroid pain and may require additional if very hyper/hypothyroid

Question 7

Graves management?

Answer 7

Beta blockera
Anti-thyroid drugs e.g. cRBIMAZOLE OR PROPYLTHIOURACIL
rADIOIODINE THERAPY
tHYROIDECTOMY

Question 8

Complications of hyperthyroidism?

Answer 8

Thyroid storm : fever, tachycardia, confusion and agitation, nausea and HTN
Management: 4Ps (propylthiouracil, poatssium iodine (lugols), propanolol, prenisolone (steroids)

Atrial fibrillation

Question 9

Breakdown of thyroid cancer?

Answer 9

Papillary = 80% (young females and good prognosis)
Follicular = 10%
Medullary = 4% (carcinoma of parafollicular cells), secrete calcitonin and part of MEN 2a/b syndromes

Anaplastic = elderly women and not responsive to treatment. Compression = dysphagia and hoarsness
Lymphoma = associated with Hashimotos thyroiditis

Question 10

Thyroid cancer signs and symptoms?

Answer 10

palpable thryoid nodule, most are cold nodules. COmpression symptoms = hoarsness, dyspnoea and dysphagia and cervical lymphadenopathy

Question 11

Investigations for thyroid cancer?

Answer 11

TSH, USS neck, FNA biopsy and laryngoscopy

Question 12

What are the MEN 1 conditions?

Answer 12

Autosomnal dominant 3 P’s

Pituitary tumour (prolactinoma/GH)
Parathyroid hyperplasia 
Pancreatic tumours (gastrinoma, insulinoma, zollinger-ellsion)

Question 13

What are the MEN 2a conditions?

Answer 13

Mutation in RET
Parathyroid hyperplasia
Phaeochromocytoma (headaches, palpitations,sweating)
Medullary thyroid cancer (increased calcitonin)

Question 14

What are the MEN2B conditions?

Answer 14

Phaeochromocytoma
Medullary thyroid cancer
Marfinoid habitus
Neuroma

Question 15

Other tumour markers?

Answer 15

CEA for colon
CA15-3 in Breast
CA19-3 - pancreatic
Calcitonin = medullary thyroid cancer
Metenephrines = phaeochromocytoma
5-HIAA in carcinoid tumours
alpha-fetoprotein is HCC

Question 16

WHat is carcinoid syndrome?

Answer 16

Neuroendocrine tumours of the GIT or lungs which secrete serotonin and other vasoactive peptides

Question 17

Signs and symptoms of carcinoid syndrome?

Answer 17

CARCinoid

Cutaneous flushing
Asthmatic wheeze
Right sided murmur
Cramps + diarrhoea

Palpitations, hypotension and telangiectasia

Question 18

Investigations for Carcinoid syndrome?

Answer 18

24hr urine collection shows increased 5-HIAA levels (serotonin metabolite)

CT/MRI to localise the tumour

Question 19

WHat does phaeochromocytoma show in urine?

Answer 19

Increased urinary metanephrones and catecholamines

Question 20

Signs and symptoms of acromegaly?

Answer 20

Increased GH production secondary to pituitary adenoma.

I look different in photos, my rings and shoes dont fit, headaches.

SPade like hands, clubbed nailes, Carpal tunnels syndrome and high BP

Coarse facial features (bossing, prognathism, diaphoresis, pituitrary enlargmenet signs, macroglossia

Deep voice and sleep apnoea

Question 21

Complications of acromegaly?

Answer 21

Diabetes, HTN, cardiomyopathy and colorectal cancer. Impaired gluocse tolerance

Question 22

Ix for Acromegaly?

Answer 22

Serum IGF-1 (1st line)

ral glucose suppresion test

Pituitary MRI

Question 23

Mx for acromegaly?

Answer 23

Surgery = trans-spenoidal hypophysectomy (1st line)

Medical if sugery unseccessful/inoperable
Medical = 1) somatostatin analogi=ue (octreotide)
2) GH receptor antagonist (pegvisomant)
3) Dopamine agonist (bromocriptine/cabergoline)

Radiotherapy

Question 24

Hypogonadism Presentation in females?

Answer 24

Delayer puberty, amenorrhoea, infertility, decreased libido, night sweats, hot flushes and dysparenuia, symptoms of cause

Question 25

Causes of primary female hypogonadism?

Answer 25

Gonadal dysgenesis = Turners Gonadal damage = radiotherapy, chemo, suergeyr, autoimmune damage Primary ovarian failure PCOS

Question 26

Causes of secondary female hypogondism?

Answer 26

Problem with hypothalamus/pituitary/secondary Kallmans (failure of GnRH neurone migration = GnRH secretion decrease) pITUITARY/HYPOTHALMIC PROBLEM E.G. ADENOMA OR HAEMOCHROMOTOSIS hYPERPROLACTINAEMA Functional = stress, weight loss and eating disorders Post OCP

Question 27

Female signs of hypogonadism and underlying cause?

Answer 27

``` Pre-pubertal = primary amenorrhoea, no secondary sexual characteristics Post-pubertal = regression of sexual characteristics ``` ``` Kallmans = anosmia Turners = webbed neck and short stature Hyperprolactinaemia = galactorrhoea, visual field defects ```

Question 28

Hypogonadism female Ix?

Answer 28

Pregnancy test Bloods for decreased oestradiol Primary = increased LH and FSH Secondary = decreased LH and FSH Prolactin and TFTS ``` primary = genetic testing and pelvic MRI/USS secondary = pituitary funtion tests and MRI ```

Question 29

Hypogonadism in Males presentation?

Answer 29

Delayed puberty, erectile dysfunction, infertility, decreased libidio and symptoms of cause

Question 30

Primary hypogonadism in males causes?

Answer 30

``` Gonal dysgnesis = Klinefelters Gonadal damage (torsion, irridation, trauma) Post-orchitis (mumps and autoimmune) ```

Question 31

Secondary hypogonadism males causes?

Answer 31

Kallmans Pituitary.hypothalamic lesions Hyperprolactinaemia Prader-willi syndrome

Question 32

Signs of male hypogonadism?

Answer 32

``` Pre-pubertal = no secondary sex charactersitc Post = hynaecomastia and hair loss ``` ``` Klinefeleters = low IQ and behavioural Kallmans = anosmia ```

Question 33

UIx for male hypogonadism?

Answer 33

Bloods = serum testosterone, SHBG, LH and FSH amnd prolactin Genetic testing and MRI pituitary