Thyroid and parathyroid

Question 1

Euthyroid Goitre

Answer 1

• Diffuse – younger people

* Multinodular – older

Question 2

Hypothyroid Goitre

Answer 2

• Iodine deficiency – endemic – versusseaweed↑
• Goitrogens
– Drugs–lithium,amiodarone – Diet–cabbage,turnips

Question 3

Pathogenesis of goitre

Answer 3

• Reactive
• Iodine block
• Genetic

Question 4

Benign masses are usually

Answer 4

movable, soft, and non tender.

Question 5

Malignancy is associated

with a

Answer 5

hard nodule, fixation to surrounding tissue, and regional lymphadenopathy.

Question 6

•Hyperthyroidism

Answer 6

Nervousness, heat intolerance, diarrohea, muscle weakness, and loss of weight and appetite

Question 7

•Hypothyroidism -

Answer 7

Cold intolerance, constipation, fatigue, and weight gain, which, in children, is primarily caused by the accumulation of myxedematous fluid.

Question 8

what are red flags in goitres

Answer 8

signs and symptoms of local nerve involvement, dysphagia or hoarseness triggers rapid investigation, because it may indicate a carcinoma with local invasion.

Question 9

Thyroid function tests

Answer 9

Elevated thyroid-stimulating hormone (TSH) level may indicate thyroiditis; a very low TSH level indicates an autonomous or hyperfunctioning nodule

Question 10

Antithyroid antibodie

Answer 10

Helpful in diagnosing chronic lymphocytic thyroiditis (Hashimoto thyroiditis)

Question 11

Full blood count

Answer 11

Abscess

• Value and limitations of fine needle aspiration cytology

Question 12

Ultrasonography

Answer 12

To determine whether the nodule is cystic, solid, or mixed

Question 13

Radioiodine scintigraphy -

Answer 13

To determine whether the nodule is cold, warm, or hot.

Question 14

Chest radiography -

Answer 14

If malignancy is suspected, given the high incidence of early metastases to the lungs
• Computed tomography (CT) scanning and magnetic resonance imaging (MRI)

Question 15

Autoimmune hypothyroidism

Answer 15

– Defective TH production – Loss of parenchyma

– Deficient TSH

Question 16

Graves

Answer 16

• Under 40 years
• Female:male 10:1
• Immune – IgG against TSH receptor on thyrocytes
• Strong family history HLA DR3 and CTLA-4

Question 17

Hashimoto thyroiditis

Answer 17

•Autoreactive CD8 T lymphocytes •Autoreactive antibodies: thyroid microsomal in almost all 95% thyroglobulin in two thirds, minority have blocking TSH receptor antibodies
•Family history strong and other autoimmune diseases
Other causal risks? Increased iodine intake, viral infection

Question 18

benign neoplasms

Answer 18

follicular adenoma

Question 19

malignant neoplasms

Answer 19

– Primary: about 1% of cancers: papillary, follicular,

anaplastic, medullary, lymphoma – Metastatic: lymphoma

Question 20

Follicular adenoma

Answer 20

• 30-50y
• Female>males
• 1-3cminsizeat presentation

Question 21

Papillary carcinoma

Answer 21

• Around 80% of thyroid cancers
• 20-50y
• Females: males 3:1
• Causes:
– Radiation – eg Chernobyl – Family history
– Unknown
• Rearrangement of RET oncogene in most
• B-RAF mutation in half – associated with increased risk of LN mets

Question 22

Secondary hyperparathyroidism

Answer 22

Caused by low calcium (eg chronic renal failure and vitamin D deficiency)

Question 23

Primary hyperparathyroidism

Answer 23

• Adenoma - four fifths

Question 24

Anaplastic carcinoma

Answer 24

• p53 mutation common