Thyroid disease

Question 1

Four symptoms of thyrotoxicosis?

Answer 1

  Diarrhoea 
  ↑ appetite but ↓ wt. 
  Sweats, heat intolerance 
  Palpitations 
  Tremor 
  Irritability 
  Oligomenorrhoea ± infertility

Question 2

Two signs of thyrotoxicosis in the hands?

Answer 2

 Fast / irregular pulse
 Warm, moist skin
 Fine tremor
 Palmar erythema

Question 3

Two signs of thyrotoxicosis in the face?

Answer 3

 Thin hair
 Lid lag
 Lid retraction

Question 4

Two signs specific to grave’s disease?

Answer 4

Opthalmopathy
Pre-tibial myxoedema
thyroid acropachy (thickening of extremities)

Question 5

Two featues of grave’s opthalmopathy?

Answer 5

  Exophthalmos 
  Ophthalmoplegia: esp. up-gaze palsy 
  Eye discomfort and grittiness 
  Photophobia and ↓ acuity 
  Chemosis (swelling of conjunctiva)

Question 6

Two antibodies present in grave’s disease?

Answer 6

TSH receptor, TPO

Question 7

Two associations of grave’s disease?

Answer 7

T1D

Addison’s

Question 8

Three differentials for thyrotoxicosis

Answer 8

Toxic multinodular goitre
Toxic adenoma
Drugs
Thyrotoxic phase of thryoiditis (de quervain’s, hashimoto’s)

Question 9

Two causes of toxic multinodular goitre?

Answer 9

ageing, iodine deficiency

Question 10

Three approaches to treating thyrotoxicosis?

Answer 10

1. Medical
2. Radiological
3. Surgical

Question 11

Two medical approaches to thyrotoxicosis?

Answer 11

symptomatic: beta blocker
antithyroid: carbimazole

Question 12

MOA of carbimazole?

Answer 12

inhibits TPO

Question 13

Major SE of carbimazole?

Answer 13

agranulocytosis

Question 14

Two complications of thyroidectomy?

Answer 14

recurrent laryngeal N damage
hypoparathyroidism
hypothyroidism

Question 15

Three clinical features of thyroid storm?

Answer 15

  ↑ temp 
  Agitation, confusion, coma 
  Tachycardia, AF 
  Acute abdomen 
  Heart failure

Question 16

Two precipitating factors for thyroid storm?

Answer 16

 Recent thyroid surgery or radio-iodine
 Infection
 MI
 Trauma

Question 17

Three symptoms of hypothyroidism?

Answer 17

  Lethargy 
  Cold intolerance 
  ↓ appetite but ↑wt. 
  Constipation 
  Menorrhagia 
  ↓ mood

Question 18

Four signs of hypothyroidism?

Answer 18

  Cold hands 
  Bradycardic 
  Slow-relaxing reflexes 
  Dry hair and skin 
  Puffy face 
  Goitre 
  Myopathy, neuropathy 
  Ascites 
  Myxoedema

Question 19

Four differentials for primary hypothyroidism?

Answer 19

 Atrophic thyroiditis
 Hashimoto’s thyroiditis
 Subacute thyroiditis (e.g. post-partum)
 Post De Quervain’s thyroiditis
 Iodine deficiency (commonest worldwide)
 Drugs: carbimazole, amiodarone, lithium
 Congenital: thyroid agenesis

Question 20

What is atrophic thyroiditis?

Answer 20

thyroid without goitre!

Question 21

One secondary cause of hypothyroidism?

Answer 21

hypopituitarism

Question 22

Two post-surgical causes of hypothyroidism?

Answer 22

thyroidectomy

radioiodine

Question 23

Which autoantibody is present in hashimoto’s?

Answer 23

TPO

Question 24

Treatment for hypothyroidism?

Answer 24

levothyroxine

Question 25

What is the medical emergency that can manifest in hypothyroidism?

Answer 25

myxoedema coma

Question 26

Causes of simple goitre?

Answer 26

iodine deficiency

Question 27

Two complications of mass effect of simple goitre?

Answer 27

dysphagia
stridor
SVC obstruction

Question 28

Treatment for simple goitre and multinodular goitre?

Answer 28

thyroxine, and total/subtotal thyroidectomy if mass symptoms present

Question 29

Treatment of toxic multinodular/plummer’s goitre?

Answer 29

anti-thyroid drugs

Question 30

Two types of thyroid carcinoma?

Answer 30

Papillary
Follicular
Medullary

Question 31

What is the genetic association of medullary thyroid carcinomas?

Answer 31

MEN2, therefore phaeochromocytoma worry

Question 32

Three early complications of thyroid surgery?

Answer 32

Haematoma
Laryngeal oedema
Recurrent laryngeal nerve palsy
Hypoparathyroidism
Thyroid storm

Question 33

Two late complications of thyroid surgery?

Answer 33

hypothyroidism
recurrent hyperthyroidism
keloid scar

Question 34

Patient has moderate goitre with bruit. What is the diagnosis?

Answer 34

Grave’s disease

Question 35

two risk factors for grave’s disease?

Answer 35

family hx, genetic susceptibility, environmental- iodine deficiency, smoke

Question 36

Which other endogenous hormone can mimic the effects of TSH and therefore cause thyoiditis?

Answer 36

HCG (therefore during pregnancy)

Question 37

Which drug can caused hyperthyroidism as a side effect?

Answer 37

amiodarone, it releases 6mg iodine

Question 38

Which drug is used for grave’s disease if pregnant?

Answer 38

don’t use carbimazole, use propylthiouracil

Question 39

Two SE of carbimazole?

Answer 39

infections, rashes, agranuloctysosis- fever, mouth ulcers, sore throat

Question 40

Two differentials for hyperthryoidism symptoms non-thyroid origin?

Answer 40

phaeochromocytoma, alcohol dependency/withdrawal,

Question 41

Two differentials for symptoms of hypothyroidism excluding thyroid origin?

Answer 41

depression, anaemia, hypoadrenalism

Question 42

A woman presents to her GP with a painful neck, rapid heartbeat, palpitations and feeling warm. A couple of weeks ago, she experienced general malaise and fever and suspected she had influenza - this has since resolved. She is otherwise healthy and takes no regular medications.

On examination, she is tachycardic. A goitre is palpable in the neck and elicits pain when examined. Blood tests are taken:

Thyroid-stimulating hormone (TSH) 0.08 mU/L (0.5-5.5)
Free thyroxine (T4) 26 pmol/L (9.0 - 18)
Erythrocyte sedimentation rate 56 mm/hr (1 - 20)

What is the diagnosis and name an appropriate treatment

Answer 42

Thyrotoxicosis with tender goitre = subacute (De Quervain’s) thyroiditis

naproxen