Thyroid disease

Question 1

Thyroid function tests

Answer 1

TSH - tells you if problem is because of thyroid (primary) or secondary (pit/hyp)
FT4 - hypo or hyper
FT3
Thyroid autoantibodies
Anti-TPO AB - thyroid peroxidase autoantibody
TRAB TSH receptor autoantibody

Question 2

best biomarker of thyroid status

Answer 2

TSH

Question 3

What are the different types of thyroid autoantibodies?

Answer 3

Destructive - target thyroid for autoimmune destruction

Stimulatory - stimulate TSH receptor

Question 4

Symptoms of hypothyroidism

Answer 4

lethargy 
mild weight gain 
cold intolerance 
constipation 
dry skin 
hair loss

Question 5

Signs of hypothyroidism

Answer 5

puffy face 
pale
periorbital oedema 
diffuse hair loss
goitre
croaky voice

Question 6

What are causes of primary hypothyroidism?

Answer 6

thyroiditis 
autoimmune
drugs 
hypo after treatment 
congenital

Question 7

Primary hypothyroidism levels

Answer 7

raised TSH

reduced T4 /3

Question 8

secondary hypothyroidism

Answer 8

Low TSH T3 T4

Question 9

What is myxoedema ?

Answer 9

Accumulation of glycosaminoglycans in interstitial spaces of tissues
when thyroid hormones become very low causing symptoms of confusion, hypothermia and drowsiness

Question 10

What are symptoms of thyrotoxicosis?

Answer 10

weight loss
lack of energy 
heat intolerance 
anxiety 
thirst 
palpitations

Question 11

sign of thyrotoxicosis

Answer 11

tremor 
warm moist skin
tachycardia 
brisk reflexes 
thyroid bruit 
eye signs

Question 12

What are symptoms of thyroid eye disease?

Answer 12

inflammation of all orbital tissues except the eye
fat, muscles, conjunctiva, eyelids
mild symptoms - itchy dry eyes, prominent eyes
worrisome symptoms - loss of sight, loss of colour vision, unable to close eyes fully, ache/pain/tightness in eye

Question 13

sign associated with thyrotoxicosis

Answer 13

hands - fine tremor/warm
pulse - sinus tachycardia/atrial fibrillation
neck - goitre, move when swallow
eyes - lid retraction/proptosis

Question 14

Causes of thyrotoxicosis?

Answer 14

Autoimmune hyperthyroidism (graves disease) 
autoantibody stimulates TSH receptor causing excess thyroid hormone production and thyroid growth (goitre). 

toxic multinodular goitre
toxic adenoma
thyroiditis
drugs - amiodarone

Question 15

gestational thyrotoxicosis

Answer 15

more likely in twin pregnancy
placental BHCG is structurally similar to TSH and similar action on the thyroid.
settles after 1st trimester

Question 16

Graves disease treatment options

Answer 16

medical therapy - carbimazole o PTU 
rare side effect - agranulocytosis 
surgery - subtotal thyroidectomy 
symptom control - BB 
Radioactive iodine treatment I-131 
radiation kills thyroid cells

Question 17

Treatment for a toxic adenoma or toxic multinodular goitre

Answer 17

initially - short term medical treatment to control TFT

subsequent treatment - radioiodine

Question 18

Treatment options for thyroid eye disease?

Answer 18

Encourage smoking cessation
steroids - prednisolone
radiotherapy
surgical treatment - orbital decompression/eye lid surgery

Question 19

Thyroid storm

Answer 19

usually secondary to graves disease

triggered by childbirth, surgery, acute severe illness such as infection, trauma, diabetic ketoacidosis, stroke

Question 20

What are the features of thyroid storm?

Answer 20

affects many systems
CNS - agitation/delirium
GI - nausea/vomiting/diarrhoea
Cardiovascular - tachy, atrial dysrhytmias, ventricular dysfunction, heart failure

Question 21

Thyroiditis

Answer 21

Mild thyrotoxicosis that always resolves 1-2 months

longer hypothyroid phase 4-6 months

Question 22

Who would you consider to test for thyroiditis?

Answer 22

pregnant, within 1 year post partum, increased risk T1D, smoker, tender thyroid

Question 23

What other associations are there with autoimmune thyroid disease?

Answer 23

type 1 diabetes 
penicious anaemia 
coeliac disease
premature ovarian failure 
addisons disease 
syndromes - turners and downs
medications - lithium (inhibits thyroid hormone synthesis)