Thyroid Disease

Question 1

Bruit?

Answer 1

Extreme amounts of blood flowing through thyroid

Question 2

Retrosternal goitre causes?

Answer 2

Deviation of trachea

Question 3

How many people have thyroids checked?

Answer 3

1 in 4

Question 4

Thyroid autoantibodies?

Answer 4

Anti TPO AB thyroid peroxidase- adds iodine to thyroglobulin.

TSH receptor TRAB

Question 5

Symptoms of hypothyroidism?

Answer 5

Lethargy, mild weight gain, cold intolerance, constipation, facial puffiness, dry skin, hair loss, hoarseness and heavy menstrual periods

Question 6

Severe hypothyroidism?

Answer 6

Stupor or coma, median nerve compression, ascites etc

Question 7

Causes of hypothyroidism?

Answer 7

1. Autoimmune
2. Iatrogenic
3. Iodine deficiency
4. Congenital hypothyroidism
5. Drugs
6. Thyroditis

Addict

Question 8

Secondary hypothyroidism hormone level?

Answer 8

TSH, T3 and T4 low

Question 9

Treat of hypothyroidism?

Answer 9

T4 100 micro gram daily

If old and ishchaemic heart disease, start at 25 to 50

Question 10

Myxedema?

Answer 10

Accumulation of glycosaminoglycans in interstitial space of tissues, severe hypothyroidism

Question 11

Symptoms of thyrotoxicosis, hyperthyroidism?

Answer 11

Weight loss, increased appetite, lack of energy, thirst, palpitations, heat intolerance, anxious irritable, oligomenorrhoea

Question 12

Signs of thyrotoxicosis?

Answer 12

Tremor, warm moist skin, tachycardia, brisk reflex, eye signs, thyroid bruit, muscle weakness and atrial fibrillation

Question 13

Thyroid eye disease?

Answer 13

20% of people with Graves’ disease

Question 14

TED symptoms?

Answer 14

Itchy, dry eyes, prominent eyes.
Diplopia (double vision), loss of colour vision, redness and swelling of conjunctival unable to close eyes, tightness behind eye

Inflammation of all orbital tissues except eye

Question 15

Proptosis?

Answer 15

Pushing forward of eyes

Question 16

Opthamolplegia?

Answer 16

When eyes don’t move smoothly

Question 17

Causes of thyrotoxicosis?

Answer 17

1. Graves- accounts for 75%
2. Toxic multinodular goitre
3. Toxic adenoma
4. Thyroiditis
5. Drugs (amiodarone )

Question 18

What % of hyperthyroidism is graves?

Answer 18

75

Question 19

Gestational thyrotoxicosis?

Answer 19

Placental beta human chorionic gonadotrophin act like TSH

Question 20

Symptom control for graves?

Answer 20

Beta blockers, propranolol, not in asthmatics

Question 21

Medical therapy for hyperthyroidism

Answer 21

Carbimazole or propylthiouracil
18 months to 2 year.
Rare side effect- agranulocytosis

Question 22

Long term cure medication?

Answer 22

1/3

Question 23

Severe thyroid eye disease?

Answer 23

Worsens with radioiodine

Question 24

Which hormone takes longer to re-equilibrium?

Answer 24

TSH, monitor T4

Question 25

Thyroid eye disease treatment?

Answer 25

Radiotherapy, immunosuppressive steroid-sparing agents, pulsed iv methylpred oral prednisolone, orbital decompression, eyelid surgery, stop smoking

Question 26

Thyroid storm causes?

Answer 26

Multisystem condition Surgery childbirth Acute severe illness: PE, stroke, diabetic ketoacidosis, infection trauma

Question 27

Thyroiditis?

Answer 27

Mild thyrotoxicosis, may use beta blockers Then long hypothyroid phase, may use thyroxine. Triggered by viral or pregnancy

Question 28

Drugs that affect thyroid function?

Answer 28

Lithium- inhibits thyroid hormone secretion synthesis | and amiodarone

Question 29

Thyroid nodule, cancer percentage?

Answer 29

5

Question 30

How to treat toxic adenoma or toxic multinodular goitre?

Answer 30

Short term medical therapy then radioiodine

Question 31

Causes of hypothyroidism?

Answer 31

1. Graves 2. Toxic Multinodular goitre 3. Toxic Adenoma 4. Thyroiditis 5. Drugs

Question 32

Thyroid eye disease may be graves in what percent of the cases?

Answer 32

20

Question 33

Goitre with a bruit is?

Answer 33

Graves

Question 34

To test for graves what scan should you do and what would you find?

Answer 34

Thyroid uptake scan, darker areas where increased activity

Question 35

What percent after radioiodine risk hypothyroidism?

Answer 35

40%

Question 36

When cant you use radioiodine?

Answer 36

Not in pregnant, breast feeding, in severe thyroid eye disease

Question 37

In order to do thyroidectomy patient must first be?

Answer 37

Euthyroid

Question 38

Treatment for a toxic adenoma or toxic multinodular goitre?

Answer 38

Short term medical therapy and then radioiodine

Question 39

Features of thyroid storm?

Answer 39

``` Graves Thyroid eye disease Goitre 140 bpm< High pyrexia Atrial dysrhytmias Ventricular dysfunction Heart failure CNS agitation/delirium Vomiting Diarrhoea Heaptocellular dysfunction ```

Question 40

Consider thyroiditis in following patients?

Answer 40

If pregnant/ within 1 year post partum- increase risk of t1d Very tender thyroid Thyroid status does not fit lab Not graves Current/recurrent treatment of immunomodulatory meds

Question 41

How long does TSH take to change?

Answer 41

6 weeks

Question 42

Further investigations for graves?

Answer 42

Thyroid autoantibodies | Thyroid uptake scan

Question 43

Radioactive iodine treatment?

Answer 43

Radiation kills thyroid cells, | First do medical therapy until euthyroid

Question 44

How many people after radioactive iodine risk hypothyroidism?

Answer 44

40%

Question 45

What are the risks with thyroid surgery?

Answer 45

``` Anaesthetic Neck scar Hypothyroidism Hypoparathyroidism Vocal cord palsy ```