thyroid disease and malignancy

Question 1

what does hypothalamus release to pituitary and what does this do

Answer 1

TRH

stimulates thyrotrophs to produce TSH

Question 2

Role of TSH

Answer 2

Stimulates increased thyroidal iodine uptake by thyroid and synthesis of t3 and t4
-COnversion of t4 to t3 stimulated by TSH in peripheral tissues

Question 3

what is compensated euthyroidism

Answer 3

if t4/3 low, increased TRH and tSH to increase T4/3. T3/4 now normal but increased TSH drive resulting in high TSH

Question 4

What are some autoimmune causes of hypothyroidism

Answer 4

Atrophic thyroiditis
Hashimotis
Post partum thyroiditis

Question 5

What are some defects of hormone synthesis causes of hypothyroidism

Answer 5

iodine deficiency
Dyshormogenesis
Anti-thyroid drugs

Question 6

What are some post irradiation causes of hypothyroidism

Answer 6

Radioactive thyroid therapy

External neck irradiation

Question 7

features of hashimotos

-What are clinical features

Answer 7

Thyroid firm and rubbery on palpation but may be soft

-TPO antibodies present

Question 8

Atrophic autoimmine thyroiditis features

-WHy can this sometimes resolve

Answer 8

Associated with antithyroid autoantibodies leading to lymphoid infiltration of the gland and atrophy and fibrosis

-If autoantibodies that block the tsh receptor are the cause

Question 9

Features of post party thyrotoxicosis

Answer 9

transient lymphocytic thyroiditis that can also cause hyperthyroidism
-WOmen present with post party depression should have tft

Question 10

how does hypo display in children

Answer 10

may not show classic symptoms but can grow poorly, perform poorly at school and may not develop at puberty. Babies are assessed for congenital hypothyroidism in the heel-prick test.

Question 11

hypo in young women>

Answer 11

hypothyroidism should be excluded in patients that present with problems with menstruation (dysmenorrhoea, oligomenorrhoea, menorrhagia, infertility).

Question 12

Signs of hypothyroidism

Answer 12

tiredness 
Weight gain 
Bradycardia 
Slow relaxing reflexes 
Mental slowness
Dry skin\Dry thinning hair/brows

Question 13

what tests to do if patient is hypothyroid and hashimotis disease is suspected

Answer 13

• Thyroid peroxidase antibodies (TPOAb) [raised]

- thyroglobulin antibodies (TgAb) [may be raised]

Question 14

autoimmune causes of hyperthyroidism

Answer 14

Graves
Toxic multonodular goire
Solitary toxic nodule/adenoma

Question 15

Acute thyroiditis causes of hyperthyroidism

Answer 15

Viral (de-Quervain’s), autoimmune

Question 16

aetiology of graves (hyper)

Answer 16

serum IgG autoantibodies attach to TSH receptors in the thyroid gland, stimulating thyroid hormone production. These thyroid-receptor antibodies (TSH-rAb) are specific to Graves’ disease.

Question 17

Features of solitary nodule/adenoma

Answer 17

Firm painless lump in neck. Mobile when swallowing.

Question 18

Features of toxic multi nodular goitre

Answer 18

Often occurs in women

Question 19

Features of de quervains thyroiditis

Answer 19

transient hyperthyroidism associated with inflammatory process
(viral infection). Fever, malaise, pain in the neck and tachycardia; can cause hypothyroidism after initial over-active phase. Acute phase treatment is with aspirin and steroids may given in severe cases.

Question 20

Clinical features of hyperthyroidism

Answer 20

AF, tachycardia or HF 
Increase in height and behavioural problems in children 
Lid lag and stare
Thyroid acropachy: clubbing, swollen fingers and periosteal new bone formation
Heat intolerance
goitre
Thyroid bruit
Full pulse, warm vasodilator peripheries

Question 21

what ro test for to confirm graves

Answer 21

TSH receptor antibodies (TSHR-Ab).

Thyroid peroxidase antibodies (TPO-Ab)

Question 22

risk of antithyroid drugs

Answer 22

Agranulocytosis

Question 23

Treatment options of hyper

Answer 23

Drugs
Radioiodine therapy (iodine taken up and localised radiation destroys the gland)
Thyroidectomy

Question 24

most likely cause of diffuse goitre

Answer 24

smooth soft enlargement with no apparent cause; if hypothyroid- Hashimotos thyroiditis: hyperthyroid likely Graves’ disease.

Question 25

most likely cause of multi nodular goitre

Answer 25

; patient is usually euthyroid but can be hyperthyroid or borderline (supressed TSH with normal T3/T4).

Question 26

most likely cause of solitary nodule

Answer 26

Malignancy- requires investigation

Cystic.benign

Question 27

What to look for in goitre assessment

Answer 27

Size
Shape
Consistency (hard, soft, smooth, firm)
Mobility (mobile or feels adhered to surrounding tissue)
Can the lower border be defined on palpation? (If lower border cannot be
defined may indicate retro-sternal extension, which may increase likelihood goitre may affect breathing/swallowing.)

Question 28

types of thyroid malignancy

Answer 28

Papillary 
Follicular 
Medullary cell (from calcitonin producing C cells)
Anapaestic (from C cells)
Lymphoma

Question 29

How to diagnose thyroid malignancy

Answer 29

Ultrasound and fine needle aspiration

Question 30

Treatment of papillary and follicular carcinomas

• Post operatively
• monitoring for recurrence?

Answer 30

Surgical: (total thyroidectomy) with regional dissection for any spread.
Radioiodine ablation: most tumours take up iodine and treatment of residual tissue is recommended.
Post-operatively: patients are treated with levothyroxine (to suppress TSH levels).
Monitoring for recurrence: serum thyroglobulin (TBG) is used as a tumour marker as it is secreted by most tumours.

Question 31

Treatment for medullary carcinomas

Answer 31

Surgical- thyroidectomy with wide lymph node clearance; medical oncology treatment s with biologics can be used

Question 32

ANaplastic carcinoma and lymphoma treatment

Answer 32

brief response to radiotherapy

Question 33

Clinical presentation of malignancy

Answer 33

Solitary thyroid lump (unexplained)
Voice changes (e.g. hoarseness) [from damage to recurrent laryngeal nerve)
Cervical lymphadenopathy (usually deep cervical or supraclavicular)
Difficulty swallowing, breathing or persistent cough (rarely)
Painless thyroid lump rapidly increasing in size (rare: occurs in anaplastic thyroid cancer or lymphoma)

General signs: weight loss, shortness of breath.
Symptoms of metastatic disease [e.g. neurological symptoms]

Question 34

most common thyroid cancer

Answer 34

Papillary and follicular

Question 35

which lymph nodes most likely enlarged In thyroid cancer

Answer 35

deep cervical or supralavicular