Thyroid disorder

Question 1

How do we measure thyroid function?
Why this marker?

Answer 1

TSH

T3 + T4 is bound to TBG, may be inaccurate

Question 2

What conditions cause a raised TBG?

Answer 2

Pregnancy
Oestrogen +
Hepatitis

Question 3

What conditions cause a low TBG?

Answer 3

Nephrotic synrome
(protein loss)

Question 4

What are the 2 main anti-thyroid drugs?
Which is used in pregnancy?

Answer 4

Carbimazole

Propylthiouracil - pregnancy

Question 5

What are the common side effects of
Anti-thyroid medications?

Answer 5

Rash - common
Agranulocytosis
Hepatitis
Vasculitis

Question 6

How do we measure repose to anti-thyroid medication?

Answer 6

Measure TSH

Question 7

What are 3 cardiac complications of hyperthyroidism?

Answer 7

Palpitations
AF
Heart failure

Question 8

Name 3 GI complications of hyperthyroidism?

Answer 8

Weight loss
Diarrhoea
Vomitus
Raised ALP

Question 9

Name 3 gynae complications of hyperthyroidism.

Answer 9

Raised bHCG
Amenorrhoea
Gynaecomastia

Question 10

Name 2 bone complications of hyperthyroidism.

Answer 10

Hypercalcaemia
Osteoporosis

Question 11

Name 2 cardiac complications of hypothyroidism.

Answer 11

Hypercholesterolaemia
Ischaemic heart disease

Question 12

Name 2 GI complications of hypothyroidism.

Answer 12

Constipation
Weight gain

Question 13

Name 2 gynae complications of hypothyroidism.

Answer 13

Menorrhagia
Infertility

Question 14

Name complications of hypothyroidism relating to muscle.

Answer 14

Raised CK
Muscular chest pain
Muscle cramps

Question 15

In which thyroid disorder would you see a raised CK?

Answer 15

Hypothyroidism

Question 16

In which thyroid disorder would you see gynaecomastia?

Answer 16

Hyperthyroidism

Question 17

In which thyroid disorder would you see menorrhagia?

Answer 17

Hypothyroidism

Question 18

Name 3 treatment strategies for Hyperthyroidism

Answer 18

1. titration - lengthy
2. block n replace
3. radioiodine

Question 19

How is hyperthyroidism managed in pregnancy?

Answer 19

Propylthiourcil titration

Question 20

What features of hyperthyroidism would lead hospital admission?

Answer 20

Head - agitation
Heart - tachycardia
Hot - fever >38

Question 21

What is the treatment for hyperthyroid crisis?

Answer 21

1. Carbimazole - stun
2. Iodine

Question 22

Name 3 main causes of overactive gland thyrotoxicosis?

Answer 22

Hot nodule
Graves disease
Toxic nodular goitre

Question 23

Describe thyrotoxicosis

Answer 23

An issue of XS thyroxine

From an overactive gland
- increased uptake of radioiodine

From exogenous thyroxine
- radioiodine supressed

Question 24

Other than thyroxine ingestion, what conditions cause exogenous thyrotoxicosis?

Answer 24

Thyroiditis:
1. Post viral (DeQuervains)
2. Post partum
3. Silent

Question 25

What is Graves disease?

Answer 25

Auto immune condition of thyrotoxicosis

XS thyroxine

Anti-TSH receptor antibodies are stimulatory

Question 26

Which thyroid related eye signs are only seen in Graves disease?

Answer 26

Retro-orbital inflammation
Extra - occular muscle swelling
Proptosis
Pre-tibial myxoedema

Question 27

Which is the most common thyroid cancer?
What is the treatment?

Answer 27

Papillary - 70%
(in young female)

Remove thyroid

Question 28

What are the features of the least common thyroid cancer?

Answer 28

Anaplastic:
- Poor prognosis,
- malignant,
- older person

Question 29

Which thyroid cancer is associated with MEN II ?

Answer 29

Medullary

Question 30

How is medullary thyroid cancer monitored?

Answer 30

serum Calcitonin levels

Question 31

Lymphoma has been linked to which thyroid condition?

Answer 31

Hashimoto’s disease

Question 32

How does lithium affect thyroid function?

Answer 32

Inhibits T4 release - > hypothyroidism

Question 33

How does Amiodarone affect thyroid function?

Answer 33

Inhibits T4 to T3 conversion

Question 34

Which 2 drugs displace T4/T3 from TBG

Answer 34

Aspirin
Furosemide

Question 35

How do oestrogens affect thyroid function?

Answer 35

Raised TBG -> raised T4 + T3