Thyroid Disease

Question 1

What are the 2 most common types of thyroid cancer?

Answer 1

Papillary

Follicular

Question 2

Thyroid cancer is more common in males. True/False?

Answer 2

False

Females

Question 3

What aetiology has a strong association with thyroid cancer?

Answer 3

Radiation exposure

Question 4

What is the main presenting complaint of thyroid cancer?

Answer 4

Palpable nodule in the neck

Question 5

Follicular thyroid cancer is more common than papillary variant. True/False?

Answer 5

False

Papillary is most common

Question 6

How does papillary thyroid cancer tend to spread?

Answer 6

Lymphatics

Also haematogenous

Question 7

The incidence of follicular thyroid cancer are higher in people deficient of which chemical?

Answer 7

Iodine

Question 8

Lymphatic spread of follicular thyroid cancer is rare. True/False?

Answer 8

True

Question 9

What is the main investigation for thyroid cancer?

Answer 9

Ultrasound-guided fine needle aspiration

Can do lymph node biopsy if spread

Question 10

If the thyroid cancer lesion is greater than _cm, there is clinical prediction of malignancy

Answer 10

4cm

Question 11

What are the main surgical techniques for thyroid cancer?

Answer 11

Lobectomy (uncommon)
Sub-total thyroidectomy
Total thyroidectomy

Question 12

A 36 yr old man with thyroid cancer with no metastases is AMES high risk. True/False?

Answer 12

False

Low risk

Question 13

All patients with metastases of thyroid cancer are AMES high risk. True/False?

Answer 13

True

Question 14

What type of thyroid tumours may be treated by lobectomy?

Answer 14

Papillary micro-carcinoma
Minimally invasive follicular carcinoma
AMES low risk

Question 15

Calcium is checked post-op for thyroid cancer. At what level of calcium is replacement initiated?

Answer 15

Less than 2 mmol/L

Question 16

Why is iodine body scanning done for post-op thyroid cancer?

Answer 16

To detect residual cancer cells

Question 17

How long before an iodine scan must T3 and T4 be stopped?

Answer 17

Stop T4 4 weeks prior

Stop T3 2 weeks prior

Question 18

TSH must be elevated for an iodine scan. True/False?

Answer 18

True

Question 19

What non-surgical technique can be used for thyroid cancer destruction following surgery?

Answer 19

Thyroid remnant ablation

Question 20

Thyroid swellings move on swallowing. True/False?

Answer 20

True

Question 21

Thyroglossal swellings move with the tongue. True/False?

Answer 21

True

Question 22

Autoimmune thyroid disease is the commonest cause of hypo/hyper -thyroidism. True/False?

Answer 22

True

Question 23

In hyperthyroidism, TSH levels are high. True/False?

Answer 23

False

TSH is low in hyperthyroidism, and high in hypothyroidism

Question 24

Why is TSH low in hyperthyroidism?

Answer 24

Hyperthyroidism causes excess T4, so pituitary produces less TSH in order to try and compensate

Question 25

In the context of pituitary gland failure, would TSH levels be high or low in hypothyroidism?

Answer 25

Low | pituitary can't compensate

Question 26

What is myxoedema?

Answer 26

Severe hypothyroidism | N.B. pretibial myxoedema is seen in Grave's disease due to thyrotoxicosis

Question 27

Incidence of hypothyroidism is higher in people with high/low iodine

Answer 27

Low iodine is assoc. with hypothyroidism

Question 28

What is the main goitrous cause of hypothyroidism?

Answer 28

Hashimoto's thyroiditis (chronic/autoimmune thyroiditis)

Question 29

List some drug-induced causes of hypothyroidism

Answer 29

Amiodarone Aminosalicyclic acid Lithium Iodides

Question 30

What are the 2 main origins of secondary hypo/hyper -thyroidism?

Answer 30

Hypothalamus disease | Pituitary disease

Question 31

What happens in Hashimoto's thyroiditis?

Answer 31

Autoimmune destruction of thyroid gland, causing reduced thyroid hormone production

Question 32

Which antibody is very specific for Hashimoto's thyroiditis?

Answer 32

Thyroid peroxidase antibodies (anti-TPO)

Question 33

List some clinical features of hypothyroidism

Answer 33

``` Sparse hair Dry skin, puffiness Cold intolerance Tiredness Vitiligo Constipation Reduced heart rate Weight gain ```

Question 34

Outline treatment of hypothyroidism

Answer 34

Restore metabolic rate | Thyroxine (T4) 50-100 micrograms

Question 35

TSH is useful to mark therapeutic success in secondary hypo/hyper -thyroidism. True/False?

Answer 35

False | It will be low because problem is with pituitary

Question 36

Who does myxoedema coma predominately affect?

Answer 36

Elderly women with longstanding untreated hypothyroidism

Question 37

What is the main autoimmune cause of hyperthyroidism?

Answer 37

Grave's disease

Question 38

List clinical features of hyperthyroidism

Answer 38

``` Agitation/irritability/anxiety Palpitations Heat intolerance/sweating Tremor Loose bowels Exopthalmus, lid lag, proptosis Weight loss ```

Question 39

What causes Grave's disease?

Answer 39

Unknown mix of genetics + environment | Autoimmune destruction

Question 40

Which antibodies are fairly specific for Grave's disease?

Answer 40

Anti-TPO antibody | Anti-TSH-receptor antibody

Question 41

What is the characteristic view of Grave's disease on scintigraphy?

Answer 41

Symmetrical, smooth goitre | Looks like a butterfly

Question 42

What drugs are given for hyperthyroidism?

Answer 42

Carbimazole Propylthiouracil in pregnancy B-blocker if arrhythmic

Question 43

Medullary thyroid carcinomas are derived from which cells?

Answer 43

C cells