Thyroid Cases Flashcards
What is the most likely cause for the following TFT results:
Patient is stable and has been complaining of tiredness and weakness for the past 5 weeks. O/e there is a smooth neck central neck swelling.
T3: Raised
T4: Raised
TSH: Low
Primary hyperthyroidism: Low T3/T4 Low TSH
Grave’s disease.
Most common cause of hyperthyroidism.
What is the most likely cause for the following TFT results:
Patient with sepsis goes into AF the F1 decides to check the TFT’s.
T3: Low
T4: Raised
TSH: Normal
Sick Euthryoid Syndrome.
T3, is largely produced by peripheral ie non-thyroidal conversion of thyroxine, T4.
In sick patients this can be reduced. Causing a low T3 but normal or raised T4. TSH will normally be normal but may be suppressed in the elderly.
The AF is due to the patients infection.
What is the most likely cause for the following TFT results:
A patient who had been feeling cold, gaining weight and complaining of tiredness. O/e: there is no neck swelling.
T3: Low
T4: Low
TSH: Raised
Primary hypothyroidism: Low T3/T4 with raised TSH
Atrophic thyroiditis:
Most common cause in UK.
No goitre points to this over Hashimoto’s thyroiditis
Both may involve Anti TPO
What is the most likely cause for the following TFT results:
A patient develops a painful swelling in there neck, they have otherwise been well other than cold like symptoms 2 weeks previous.
T3: Raised
T4: Raised
TSH: Low
Transient thyroiditis/De Quervain’s thyroiditis/Post partum thyroiditis
Often post viral infection or post partum.
Neck swelling is painful (big clue shouldn’t be painful in other thyroid conditions)
Initially there is a subclinical hyperthyroid (2 weeks) period followed by a longer hypothyroid period (6 weeks)
What is the most likely cause for the following TFT results:
A patient has noticed a lumpy centrally located neck swelling. They have no other symptoms.
T3: Normal
T4: Normal
TSH: Normal
Non toxic nodular/multinodular goitre OR malignancy.
Needs an US scan of neck lump and potentially a fine needle biopsy.
What is the most likely cause for the following TFT results:
A patient has been complaining of heavy periods and tiredness. O/e: a smooth goitre is present.
T3: Low
T4: Low
TSH: Raised
Primary hypothyroidism: Low T3/T4 + Raised TSH
Hashimoto’s thyroiditis.
Symptoms of hypothyroidism
Goitre present
What is the most likely cause for the following TFT results:
A patient that was previously hyperthyroid. There are no neck swellings on examination.
T3: Low
T4: Low
TSH: Raised
Iatrogenic:
Over treated hyperthyroidism:
- Carbimazole
- Radioactive iodine
- Thyroidectomy
What is the most likely cause for the following TFT results:
A patient had TFT screening done she is asymptomatic and has a normal neck examination.
T3: Normal
T4: Normal
TSH: Low
Subclinical Hyperthyroidism
Not symptoms and T3/T4 levels are normal but the Low TSH would fit with a picture of hyperthyroidism.
If T3/T4 levels are normal and TSH is raised this would be subclinical hypothyroidism.
What is the most likely cause for the following TFT results:
A patient presents to her GP as she has amenorrhoea, weakness and fatigue. She has no other complaints and has a normal neck examination.
T3: Low
T4: Low
TSH: Low
Secondary hypothyroidism. Low T3/T4 but also low TSH (In primary TSH would be raised)
Non functioning pituitary adenoma
LH is the 1st hormone to become deficient (amenorrhoea). Followed by GH (weakness and decreased muscle bulk) TSH follows (tiredness).
ACTH and LH are last to become deficient.
