Thyroid disorders

Question 1

What are 2 auses of hypothyroidism?

Answer 1

Hashimotos thyroiditis

Iodine deficiency

Question 2

Which drug can induce iodine deficiency?

Answer 2

Amiodarone

Question 3

Epidemiology of Hashimoto’s thyroiditis

Answer 3

Females > males 
45-60 y/o
High antibody levels 
Maternally transmitted 
May be preceded by transient hyperfunction

Question 4

Pathogenesis of Hashimoto’s thyroiditis

Answer 4

CB+ve cells may mediate destruction of thyroid epithelium (y interferon from T cell activation recruits macrophages)

Question 5

How is Hashioto’s thyroiditis characterised?

Answer 5

Presence of thyroid peroxidase antibodies

T cell infiltrate

Question 6

Hair/skin symptoms of hypothyroidism

Answer 6

Sparse, coarse hair 
Pale cool doughy skin 
Perioribtal puffiness 
Vitiligo 
Dull expresionless face

Question 7

Cardiac symptoms of hypothyroidism

Answer 7

Decreased HR
Pericardial effusion
Cardiac dilation

Question 8

Resp symptoms of hypothyroidism

Answer 8

Deep hoarse voice
Sleep apnoea
Macroglossia

Question 9

Neuro symptoms of hypothyroidism

Answer 9

Carpal tunnel
Stiffness, cramps
Peripheral neuropathy
Decreased visual

Question 10

GI symptoms of hypothyroidism

Answer 10

Constipation
Megacolon
Intestinal obstruction
Ascites

Question 11

Gynae symptoms of hypothyroidism

Answer 11

Menorrhagia
Oligo/amenorrhoea
Hyperprolactinaemia

Question 12

Metabolic symptoms of hypothyroidism

Answer 12

Pitting oedema
Decreased appetite
Weight gain

Question 13

Biochemical findings of hypotyhroidism

Answer 13

HIGH TSH 
LOW T3/4
High CK
High LDL 
Low sodium

Question 14

Management of hypothyroidism

Answer 14

Thyroxine (start low go slow) - taken before breakfast

Question 15

What is the risk of overzealous immediate thyroxine treatment of hypothyroidism?

Answer 15

Arrhythmia;s

Question 16

Causes of hyperthyroidism

Answer 16

Graves
Modular (multi-nodular goitre, toxic adenoma)
Thyroiditis (post partum)
Iodine

Question 17

How does toxic adenoma tend to present?

Answer 17

Older patients
Insidious onset
Assymetrical goitre

Question 18

How does Graves disease tend to present?

Answer 18

Females > males
Smoking
Smooth symmetrical goitre

Question 19

Cardiac symptoms of hyperthyroidism

Answer 19

Palpitations/AF
Cardiac failure (rare)

Question 20

CNS symptoms of hyperthyroidism

Answer 20

Tremor
Sweating
Anxiety
Sleep disturbance

Question 21

Reproductive symptoms of hyperthyroidism

Answer 21

Lighter less frequent periods

Question 22

Metabolism symptoms of hyperthyroidism

Answer 22

Weight loss

Appetite gain

Question 23

GI symptoms of hyperthyroidism

Answer 23

Frequent loose stools

Question 24

Visual symptoms of hyperthyroidism

Answer 24

Bulgin eyes

Double vision

Question 25

Hair/skin symptoms of hyperthyroidism

Answer 25

Thin brittle hair

Rapid fingernail growth

Question 26

Muscle symptoms of hyperthyroidism

Answer 26

Muscle weakness - thighs + upper arms

Question 27

Treatment of hyperthyroidism

Answer 27

Carbimazole
Propathiouracil
Radioiodine

Question 28

Biochemical features of Hyperthyroidism

Answer 28

LOW TSH

HIGHT T3/4

Question 29

Side effect of carbimazole

Answer 29

Agranulocytosis

Question 30

Levels of TSH aimed for in pregnancy

Answer 30

1st trimester

Question 31

First line investigation of neck lump

Answer 31

Ultrasound

Question 32

Changes in thyrosine dose in pregnancy

Answer 32

+25%

Question 33

Hyperthyroidism in pregnancy

Answer 33

1st trimester - propathiouracil

2nd/3rd trimester - carbimazole