Thyroid Disease Burgess

Question 1

What are the consequences of low iodiine in the diet

Answer 1

Miscarriage
Mental retardation
physical 
Goitre
Reduced fertility
Speech and growth impairment

Question 2

What is the recommended daily intake of iodine?
for Adults?
Pregnancy?
Children?

Answer 2

Recommended daily intake
• Adults 150ug/day
• Pregnancy 250
• Children 90-120

Question 3

What do TFTS test for?

Answer 3

TSH and FREE T3 in the circulation (lots bound in circulaton)

Question 4

What is a normal TFT?

Answer 4

Euthryoid TSH normal (0.4-4.0)
Hypothyroid TSH elevated (>5.0)
Hyperthryoid TSH low (<0.05)

Hypothalamus recognizing that there is excessive thyroid hormone and hence cutting down levels of TSH

The FT3 and FT4 are used:
• as confirmatory tests at diagnosis of thyroid dysfunction
• when the hypothalamic-pituitary axis is impaired.

Question 5

What are the causes of hyperthyroidism with an increased iodine uptake?

Answer 5

Autoimmune thyroid: Grave’s disease, hashitoxicosis
Could just be normal thyroid tissue
Toxic adenoma
Toxic multinodular goitre
TSH mediated hyperthyroidism (TSH excessively produced) -> TSH producing pituitary adenoma,

Question 6

What are causes of hyperthyroidism with a decreased iodine uptake

Answer 6

Thyroiditis- Subacute granulomatous (de Quervain’s) thyroiditis
Post partum thyroiditis
Amiodarone (also may cause iodine induced hyperthyroidism)
Radiation thyroiditis
Palpation thyroiditis
 --- > Exogenous thyroid hormone intake
o	Excessive replacement therapy
o	Intentional suppressive therapy
o	Factitious hyperthyroidism
Ectopic hyperthyroidism

Question 7

In Graves disease, waht auto antibody would you test for?

Answer 7

TRAB

Question 8

What do post partum women often get?

Answer 8

Hypothyroidism
“Post Partum thyroiditis”
5%

Question 9

What is Hashimoto’s disease?

Answer 9

Autoimmune Hypothyroidism

Question 10

What Antibody would you test for in Hashimoto’s?

HOw would you treat it?

Answer 10

ATPO

Treatment : T4 replacement (thyroxine

Question 11

Autoimmune hypothyroidism is more dangerous if

Answer 11

TSH is high, and you have ATPO

Question 12

Treatment for Autoimmune hypothyroidism

Answer 12

thyroxine
- treating to targets
Aim to get TSH 0.5-2.0 (assumption that pituitary function is normal)
Even if FT4 is ‘high’ (ie T4 is a replaced substrate for T3)
• TSH 1.5 (0.4-4.0), FT4 26 (9-20) = satisfactory
Reduce thyroxine if TSH is low, even if the FT4 is normal.
• TSH 0.10 (0.4-4.0), FT4 15 (9-20) = unsatisfactory

Question 13

Explain Adenoma/ toxic nodules

Answer 13

Iodine deficiency results in hyperplasia -> focal proliferation -> MNG

Some nodules ultimately become autonomous (non TSH dependant)
Exposure to additional iodine can then unmask hyperthyroidism (IIH)

Question 14

What is the most common type of thyroid carcinoma?

What is the management

Answer 14

Papillary Thyroid Cancer

Management of Thryoid carcinoma
• Resection
• Radioiodine (PTC, FTC)
• Replacement of T4