Thyroid disease

Question 1

What’s the name of the scan

Answer 1

Technetium scan (it’s radioactive iodine)

Question 2

What does a diffuse uptake indicate

Answer 2

Graves disease

Question 3

From proximal to distal, name the cartilaginous structures in the neck next to the thyroid gland.

Answer 3

Hyoid bone
Thyroid cartilage
Cricoid cartilage
THYROID GLAND
Trachea

Question 4

Recap the hormonal synthesis of thyroxine

Answer 4

Iodide gets absorbed and oxidised into iodine by TPO.

It gets added to the tyrosine residue of thyroglobulin by TPO as well, forming monoiodotyrosine and diiodotyrosine.

TPO then creates T3 and T4 from MIT and DIT.

Question 5

What are the mechanisms of thyrotoxicosis

Answer 5

Increased thyroid hormone synthesis (hyperthyroidism)

Increased release of stored thyroid hormone (subacute thyroiditis).

Question 6

Causes of increased thyroid hormone synthesis

Answer 6

Primary hyperparathyroidism - TSH is low:
- Graves
- Amiodarone
-Toxic multinodular goitre

Secondary hyperparathyroidism - TSH is high:
- TSH adenoma

Question 7

Causes of increased thyroid hormone release and how you’d distinguish between the two

Answer 7

De Quervain’s subacute viral - tender thyroid
Post partum - painless

Question 8

How does amiodarone cause thyrotoxicosis? What are the types?

Answer 8

Type 1 - due to amiodarone (anti arrhythmic drug) containing iodine, thus increasing synthesis
Type 2 - being toxic to the thyroid, causing thyroiditis, leading to release

Question 9

What is a toxic multinodular goitre

Answer 9

Follicular cells become independent of TSH and start working by themselves

Question 10

Besides the usual symptoms of thyrotoxicosis, list some others

Answer 10

Osteoporosis and raised ALP
Oligomenorrhoea/amenorrhoea
Reduced libido, gynaecomastia, erectile dysfunction, abnormal spermatogenesis, polyuria
Brisk tendon reflexes
Inability to concentrate
Pretibial myxedema
Thyroid acropachy

Question 11

Graves eye disease specific symptoms

Answer 11

Periorbital oedema
Increased tear production
Proptosis/exopthalmos
Opthalmoplegia and diplopia
Optic nerve comperssion
Chemosis
Eye pain

Question 12

What is chemosis

Answer 12

Swelling of conjunctiva

Question 13

Are lid lag and lid retraction specific symptoms?

Answer 13

No they are non specific

Question 14

What is thyroid acropachy

Answer 14

bone formation not clubbing