Thyroid Conditions

Question 1

What is postpartum thyroiditis?

Answer 1

It is a phenomenon observed following pregnancy and may involve hyperthyroidism, hypothyroidism or the two sequentially

Question 2

What is the difference in investigation findings between Grave’s disease and subacute lymphocytic thyroiditis?

Answer 2

Radioactive Iodine Uptake (RAIU) test:
In Grave’s, there is increased iodine uptake.
But in the hyperthyroid phase of subacute lymphocytic thyroiditis, iodine uptake is suppressed. In the hypothyroid phase, iodine uptake is increased.

Question 3

Lid lag is a sign of hypo or hyperthyroidism?

Answer 3

Hyperthyroidism

Question 4

Proximal Myopathy is a sign of hypo or hyperthyroidism?

Answer 4

Hyperthyroidism

Question 5

What are the symptoms defining Grave’s disease?

Answer 5

Smooth symmetrical goitre with bruit.
Thyroid associated orbitopathy: Exophthalmos
Thyroid associated dermopathy: Pretibial myxoedema
Thyroid acropachy (clubbing)

Question 6

How long does postpartum thyroiditis affects women?

Answer 6

For 1 year.
In the first 2-6/12, there is hyperthyroid symptoms.
In the second phase, which is from 3-12/12, there is hypothyroid symptoms.
Euthyroid symptoms resumes after 1 year.

Question 7

What is the cause of exophthalmos?

Answer 7

Secondary to retro-orbital swelling/inflammation of tissues and infiltration of lymphocytes.

Question 8

What are the medications available for hyperthyroidism?

Answer 8

Beta-blockers such as propranolol. Can use Diltiazem/other calcium channel blockers as an alternative.
Iodide
Carbimazole OD 5-40MG
Propylthiouracil TDS 50-150MG

Question 9

Which has a shorter half life: Carbimazole or Propylthiouracil?

Answer 9

Propylthiouracil

Question 10

When is surgery considered?

Answer 10

• Large goitre or severe disease
• Patient choice: example if patient does not want radiation
• Medication failure
• Thyroid eye disease

Question 11

How is radioactive iodine given? Is it for the treatment of hyperthyroidism or hypothyroidism?

Answer 11

Radioactive iodine is given as a capsule to be swallowed. It is a treatment for hyperthyroidism.

Question 12

What is the advantage of radioactive iodine?

Answer 12

The treatment is permanent.

Question 13

Patient with menorrhagia. Does she has hypothyroidism or hyperthyroidism?

Answer 13

Hypothyroidism.

Oligomenorrhoea occurs in hyperthyroidism.

Question 14

Macroglossia could indicate hypothyroidism or hyperthyroidism?

Answer 14

Hypothyroidism

Question 15

Pericardial effusion is a sign of hypothyroidism or hyperthyroidism?

Answer 15

Hypothyroidism

Question 16

How is thyroxine manufactured and given?

Answer 16

Thyroxine is manufactured as sodium tablets, Levothyroxine Sodium, which are taken once daily.
In sizes of 25, 50 and 100 micro-grams.

Question 17

What are the adjustments made to Levothyroxine Sodium in severe liver disease?

Answer 17

Less Levothyroxine Sodium may be needed in severe liver disease, as thyroxine is metabolised in the liver.

Question 18

What is the amount of thyroxine produced in the body?

Answer 18

~100micrograms/day

Question 19

What is the maintenance dose of Levothyroxine Sodium?

Answer 19

For adults 18-49yo, 100-200micrograms as maintenance dose

For adults >50yo, 50-200micrograms as maintenance dose.

Question 20

Grave’s and Hashimoto’s are linked with which conditions?

Answer 20

Autoimmune conditions such as vitiligo, T1DM and Addison’s disease.

Question 21

What are the conditions associated with hypothyroidism?

Answer 21

Cystic Fibrosis, Primary Biliary Cirrhosis, Turner’s syndrome and Down’s syndrome

Question 22

Can Lithium cause hypothyroidism, hyperthyroidism or both?

Answer 22

Both hypo and hyperthyroidism, but more commonly, hypothyroidism

Question 23

There is bruits detected in hyper or hypothyroidism?

Why?

Answer 23

Bruits are heard in Hyperthyroidism (Grave’s) as there is increased blood flow

Question 24

Anti-TPO antibodies are used to diagnose hypo or hyperthyroidism?
TRAb are used to diagnose hypo or hyperthyroidism?

Answer 24

Anti-TPO antibodies are used to diagnose hypothyroidism (Hashimoto’s)
TRAb are used to diagnose hyperthyroidism (Grave’s)

Question 25

MEN 2a and 2b are linked with?

Answer 25

Medullary thyroid carcinoma

Question 26

What are the triggers of Grave’s disease?

Answer 26

Stress, Infection and childbirth

Question 27

In which patients are thyroxine given with caution? Why?

Answer 27

Patients with liver disease or liver failure, and patients with ischaemic heart disease.
This is because thyroxine is metabolised in the liver. Thyroxine can also precipitate angina or MI. Hence, give thyroxine cautiously in lesser amounts.