Thyroid Disease

Question 1

What is the difference between primary and secondary thyroid disease?

Answer 1

Primary affects the thyroid itself while secondary is hypothalmic/pituitary pathology

Question 2

What hormone is measured to assess thyroid function?

Answer 2

TSH

Question 3

What is the first stage of the hypothalamic-pituitary-thyroid (HPT) axis?

Answer 3

Hypothalamus releases TRH which stimulates pituitary

Question 4

What is the second stage of the HPT axis?

Answer 4

Pituitary releases TSH which stimulates thyroid

Question 5

What is the third stage of the HPT axis?

Answer 5

Thyroid releases T4 which needs converted to active T3

Question 6

In primary hypothyroidism, free T3/T4 is high/low and TSH is high/low

Answer 6

Low

High

Question 7

In primary hyperthyroidism, free T3/T4 is high/low and TSH is high/low

Answer 7

High

Low

Question 8

TSH levels remain normal in secondary hypo/hyperthyroidism. True/false?

Answer 8

True

Question 9

What is myxoedema?

Answer 9

Severe hypothyroidism

Question 10

Give some causes of primary hypothyroidism

Answer 10

Chronic thyroiditis (Hashimoto’s)
Iodine deficiency
Atrophic thyroiditis
Amiodarone/lithium

Question 11

What occurs in Hashimoto’s thyroiditis?

Answer 11

Autoimmune destruction of thyroid gland

Question 12

What antibody is raised in Hashimoto’s?

Answer 12

Antibody against thyroid peroxidase (TPO)

Question 13

Give some cutaneous features of hypothyroidism

Answer 13

Sparse hair
Eye puffiness
Pale skin
Vitiligo
Peripheral oedema

Question 14

Restoration of metabolic rate in hypothyroidism should be rapid. True/false?

Answer 14

False - may cause arrhythmia

Question 15

What is the main drug given in hypothyroidism?

Answer 15

Levothyroxine

Question 16

A myxoedema coma occurs in who?

Answer 16

Elderly women with long standing hypothyroidism

Question 17

What is thyrotoxicosis?

Answer 17

The clinical state resulting from the tissues being exposed to excess thyroid hormone

Question 18

Give some signs of thyrotoxicosis

Answer 18

Palpitation
Tremor
Sweating
Thin hair
Fingernail growth

Question 19

What is the commonest disease caused by excessive thyroid stimulation?

Answer 19

Graves’ disease

Question 20

What antibody is suggestive of Graves’ disease?

Answer 20

TSH receptor antibody

Question 21

Give some clinical signs of Graves’ disease

Answer 21

Pretibial myxoedema
Clubbing
Goitres
Eye disease

Question 22

Nodular thyroid disease is commoner in who?

Answer 22

Older patients

Question 23

The goitre in nodular thyroid disease is symmetrical/asymmetrical?

Answer 23

Asymmetrical

Question 24

Thyroid storm can be treated conservatively. True/false?

Answer 24

False - medical emergency

Question 25

Who gets thyroid storm?

Answer 25

Hyperthyroid patients with an acute infection or recent thyroid surgery

Question 26

What is the first line drug in hyperthyroidism?

Answer 26

Carbimazole

Question 27

How does carbimazole work?

Answer 27

Blocks thyroid peroxidase preventing thyroid hormone synthesis

Question 28

What antithyroid drug (ATD) is first line in pregnancy?

Answer 28

Propylthiouracil (PTU)

Question 29

What is the most important side effect of ATDs?

Answer 29

Agranuolcytosis - absence of neutrophils and granules in blood

Question 30

Which beta blocker is used in hyperthyroidism?

Answer 30

Propranolol

Question 31

Radioiodine is used in what conditions?

Answer 31

Relapse of Graves’

Nodular thyroid disease

Question 32

A thyroidectomy is used when?

Answer 32

When radioiodine is contraindicated

Question 33

Thyroiditis is what?

Answer 33

An inflammation of the thyroid

Question 34

Non-thyroidal illness is caused by what?

Answer 34

An intercurrent illness affecting the HPT axis