Thyroid Disease Tutorial

Question 1

of all thyroid complaints, how many are cancer?

Answer 1

<5%

Question 2

what enzyme activates iodine to deiodinate?

Answer 2

peroxidase

Question 3

causes of goitre?

Answer 3

iodine deficiency
multinodular goitre
graves
thyroiditis
tumour
cysts
inherited

Question 4

what types of thyroiditis are subacute?

Answer 4

de quervains

viral

Question 5

what types of thyroiditis are acute?

Answer 5

bacterial

Question 6

causes of drug induced thyroiditis?

Answer 6

lithium

amiodarone

Question 7

would a FHx of autoimmune disorders make you think benign or malignant?

Answer 7

benign

Question 8

what autoantibodies are looked at in thyroid disease?

Answer 8

TPO
anti-thyroglobulin
TSH receptor antibody

Question 9

causes of hyperthyroidism?

Answer 9

autoimmune eg graves
multinodular goitre
toxic solitary nodule
thyroiditis
exogenous thyroid hormones
thyroid cancer
TSH secreting pituitary tumour

Question 10

how is thyroid storm managed?

Answer 10

high dose carbimazole
b blockers
hydrocortisone
potassium iodide
iv fluids
inotropes

Question 11

what is thyroid acropachy and what disease is it present in?

Answer 11

soft tissue swelling and periostial bone changes in graves disease

Question 12

what eye symptoms other than proptosis and eyelid retraction is present in graves patients

Answer 12

gritty, watery eyes
visual blurring
painful eye movements

Question 13

iatrogenic causes of hypothyroidism?

Answer 13

radioiodine

post surgery

Question 14

what dose of thyroxine should you start at?

Answer 14

50-100mcg

Question 15

maintenance dose of thyroxine

Answer 15

100-150mcg

Question 16

1st, 2nd and 3rd line tests for a new thyroid lump?

Answer 16

1. TFTs
2. USS
3. FNA

Question 17

risk factors for malignant thyroid tumour?

Answer 17

acute onset
previous radiation
thyroid FH
pain
voice change
swallowing problems
smoker

Question 18

what would a grade 1 result on FNA mean?

Answer 18

inappropriate sample

Question 19

what would a grade 2 result on FNA mean?

Answer 19

benign

Question 20

how long before radioiodine do you need to stop thyroid medication

Answer 20

2 weeks

Question 21

where do papillary and follicular tumours of the thyroid arise from?

Answer 21

epithelial cells

Question 22

where do medullary tumours arise from?

Answer 22

calcitonin secreting cells

Question 23

most severe form of thyroid tumour?

Answer 23

anaplastic

Question 24

how long can you not have close contact with people if youre taking radioiodine?

Answer 24

6-8wks

Question 25

best treatment for toxic multinodular goitre?

Answer 25

radioiodine

Question 26

is it safer to be hypo or hyperthyroid and why?

Answer 26

hypo because it can be controlled with HRT

Question 27

how can you examine for exopthalamus?

Answer 27

look at white of sclera

Question 28

how can you examine for proptosis?

Answer 28

look from above to see if the eyes protrude

Question 29

tests for graves?

Answer 29

TFTs

TSH antibody

Question 30

what warning should be given before taking antithyroid medication and why?

Answer 30

come and see you if they get:
sore throat
mouth ulcers
high temp
incase of agranulocytosis

Question 31

how should you treat mild graves?

Answer 31

antithyroid drugs

Question 32

how should you treat severe graves?

Answer 32

radioiodine

Question 33

what should you warn a young patient about before taking radioiodine?

Answer 33

dont conceive for 6-8 months after

Question 34

who is most likely to get graves?

Answer 34

young/middle aged women

Question 35

how long should you try carbimazole in graves to see if it works?

Answer 35

12-18 months