Thyroid Disease

Question 1

What causes diffuse goitres?

Answer 1

Graves
Hashimoto’s - can also be nodular
Multinodular goitre - individual nodules are often too small to feel

Question 2

What causes a solitary nodule?

Answer 2

Tumours
Colloid nodule
Thyroid cyst

Question 3

What causes multinodular goitre?

Answer 3

Non-toxic nodular goitre
Toxic nodular goitre
Amiodarone thyroid disease

Question 4

What suggests cancer or infective cause?

Answer 4

Cervical node enlargement

Question 5

Risk factors:

What sex is more likely to suffer from thyroid disease?

What other autoimmune diseases are associated with thyroid disease?

Answer 5

Females

Pernicious anaemia
Vitiligo
Addison’s
T1DM

Question 6

Causes of mixed thyroid disease:

What drug can cause mixed thyroid disease?

Subacute lymphocytic thyroiditis:

• What is another name for it?
• Is it painful?
• Do the thyroid hormones increase then decrease or are it the other way around?
• Do they get a goitre?

Answer 6

Amiodarone

===
Silent thyroiditis

Painless

High TH before low TH

Small goitre

Question 7

Causes of mixed thyroid disease:

Postpartum thyroiditis:
- Do the thyroid hormones increase then decrease or are it the other way around?

Subacute granulomatous thyroiditis:

• What is another name for it?
• Do the thyroid hormones increase then decrease or are it the other way around?
• What sort of viral infections does it follow after?
• Is it painful?
• What sort of systemic symptoms would they have?

Answer 7

High TH before low TH

De Quervain’s thyroiditis

High TH before low TH

Mumps, influenza, or some other URTI

Painful and tender

Fever

Question 8

Subclinical thyroid disease:

What does subclinical mean?

What is likely compensating for thyroid pathology?

Answer 8

Abnormal TSH but normal T4 and T3

Pituitary compensation

Question 9

Sick euthyroid syndrome:

What is it?

Why does it happen?

Does TFT’s increase or decrease?

Answer 9

Abnormal TFT results during non-thyroid illness

Slowing down of basal metabolic rate to preserve energy

Decrease followed by rebound raised TSH

Question 10

Thyroid tumours:

What is more likely to be malignant - single nodules or multiple nodules?

Adenomas:

• What does being ‘hot’ on a radio-isotope scan mean?
• What does being ‘cold’ on a radio-isotope scan mean?

There are a range of carcinomas but these are very rare!!

Answer 10

Single nodules

‘Hot’ - functioning
‘Cold’ - non-functioning

Question 11

Complications of thyroidectomy:

Recurrent laryngeal nerve damage:

• What happens if it is unilateral damage?
• What happens if it is bilateral damage?
• Why may bleeding and haematoma form?

Answer 11

Hoarse voice

Airway obstruction due to vocal cord closure

The thyroid is highly vascularised