Thyroid Disease

Question 1

Primary thyroid disease affects the…

Answer 1

thyroid gland

Question 2

Secondary thyroid disease affects the ….

Answer 2

hypothalamus or pituitary gland

Question 3

What is the most common cause o hypothyroidisim in the West?

Answer 3

Hashimoto’s thyroiditis

-autoimmune destruction of the thyroid gland

Question 4

What Antibodies are present in Hashimoto’s disease?

Answer 4

1. anti-Thyroid Peroxidase antibodies
   (TPO)
2. Anti-thyroglobulin antibody

Question 5

What are the clinical features of hypothyroidisim?

Answer 5

Hair and skin:

• coarse hair
• periorbital puffiness
• pale cool skin, doughy to touch
• vitiligo (loss of melanocytes)

Thermogenesis:
-cold intolerance

Cardiac:

• reduced heart rate
• cardiac dilatation

Metabolic

• hyperlipidaemia
• decreased appetite
• weight gain

GI
-constipation

Respiratory

• hoarse voice
• obstructive sleep apnoea

Neurology

• peripheral neuropathy
• depression and low mood

Gynae/reproductive
-dysregulation of periods

Question 6

What are the lab findings in hypothyroidism

Answer 6

1. High TSH

2. Low T4/T3

Question 7

What antibodies are detected in Grave’s disease?

Answer 7

1. TSH receptor antibody

2. Anti-TPO (Thyroid Peroxidase) antibody

Question 8

What drug is the mainstay of treatment in hypothyroidism?

Answer 8

Levothyroxine

-synthetic T4

Question 9

_____ _____ is a very serious complication of long-standing hypothyroidism.

Answer 9

Myxoedema coma

Question 10

What are the signs and symptoms of hyperthyroidism (thryotoxicosis)?

Answer 10

Cardiac:

• palpatation - Atrial Fibrillation
• Cardiac failure

Sympathetic:
-tremor, sweating

CNS:
-anxiety, irritability, sleep disturbance

GI:
-frequent, loose bowel movements

Vision

• Lid retraction
• double vision
• bulging eyes (Graves’)

Hair and nails:

• rapid nail growth
• brittle thin hair

Reproductive
-less frequent and lighter periods

Muscles:
-weakness in thighs and upper arms

Metabolism
-weight loss, appetite increased

Thermogenesis
-intolerance to heat

Question 11

Smoking is an aggravating factor for Graves’ disease? (T/F)

Answer 11

True

Question 12

What are the lab findings in Graves’ disease? What are the clinical implications?

Answer 12

1. low TSH and high T4/3
   - cardiac abnormalities
2. Hypercalcaemia
   - increased bone turnover
   - osteoporosis
3. Low WBC count
4. TSH receptor antibody

Question 13

What are the clinical signs of Graves’ disease?

Answer 13

Pretibial myxoderma

Thyroid acropachy (hands)

Eye disease

Throid bruit (rare)

Symmetrical, smooth goitre

Question 14

What are the characteristics of Nodular thyroid disease?

Answer 14

V. high T4/3

Low TSH

Antibody negative

Asymmterical goitre

Question 15

What is the treatment of Graves’ disease?

Answer 15

Dose titrate antithyroid drugs

Question 16

What is an important side effect of Antithyroid drugs?

Answer 16

Agranulocytosis (low WBCs)

-infection in mouth and throat

Question 17

Name the drugs used in hyperthyroidism treatment.

Answer 17

1st line: Carbimazole

1st line in pregnancy: Propulthiouracil (PTU)

Symtom relief: Propranolol (beta-blocker)

Question 18

What is the treatment of relapsed Graves’ disease and nodular thyroid disease?

Answer 18

Radioiodine

Question 19

List the causes of thyroiditis - inflammation of the thyroid.

Answer 19

Hashimoto’s

De Quervain’s: viral infection

Post-partum

Drug-induced

Question 20

What drug can cause Thyroiditis?

Answer 20

Amiodarone

Lithium

Question 21

What is Hashitoxicosis?

Answer 21

Transient period of thyroid hyperfunction in Hashimoto’s thyroiditis, before progressing to hypothyroidism

Question 22

What are the 4 types of thyroid carcinomas? What cells are they derived from?

Answer 22

Papillary - follicular epithelium
Follicular -follicular epithelium
(Medullary) - C-cells
(Anaplastic) - epithelium

Question 23

A benign single mass in the thyroid, surrounded by collagen, tightly packed with follicular cells describes a

Answer 23

Thyroid adenoma

Question 24

What local effects can arise from a thyroid gland cancer?

Answer 24

hoarseness
dysphagia
dyspnoea
persistent cough
pain and swelling