Thyroid Disorders

Question 1

Diagnostic imaging used to determine thyroid size accurately

Answer 1

Ultrasound

Question 2

Sign seen in large retrosternal goiters; may cause venous distention over the neck and difficulty breathing especially when arms are raised

Answer 2

Pemberton’s Sign

Question 3

Features to note in PE of thyroid gland

Answer 3

Size, consistency, nodularity, tenderness, fixation

Question 4

Low TSH, High FT4

Answer 4

Prinary thyrotoxicosis: Graves’ disease, multinodular goiter, toxic adenoma
Destructive thyroiditis, excess iodine intake, excess thyroid hormone

Question 5

Low TSH, Normal FT4

Answer 5

Subclinical hyperthyroidism (if normal FT3), T3 Toxicosis (if high T3)

Question 6

Normal/High TSH, High FT4

Answer 6

Secondary thyrotoxicosis: TSH secreting adenoma, thyroid hormone resistance syndrome

Question 7

High TSH, Normal FT4

Answer 7

Subclinical hypothyroidism

Question 8

High TSH, Low FT4

Answer 8

Primary hypothyroidism

Question 9

Normal TSH, Low FT4

Answer 9

Drug effects, sick euthyroid syndrome, central hypothyroidism

Question 10

Most common sign of thyrotoxicosis

Answer 10

Tachycardia

Question 11

Clinical picture of hyperthyroidism

Answer 11

Palpitation, tremors, unintentional weight loss

Tachycardia, bilateral proptosis, diffusely enlarged thyroid gland

Question 12

Graves’ ophthalmopathy

Answer 12

Proptisis, lid retraction, periorbital edema

Question 13

Thyroid dermopathy

Answer 13

Non inflamed “orange skin” plaque

Question 14

Repeat thyroid function test after starting treatment for hyperthyroidism

Answer 14

After 4-6 weeks

Question 15

Treatment for hyperthyroidism

Answer 15

Antithyroid drugs (PTU, Methimazole), Radioactive Iodine (RAI) (definitive treatment) , Propanolol (for control of adrenergic symptoms), Methyprednisolone pulse therapy (for severe ophthalmopathy), surgical (for large goiters with nodules)

Question 16

Most serious manifestation of Graves ophthalmopathy

Answer 16

Optic nerve compression

Question 17

Acconpanying symptoms of thyroid storm

Answer 17

Fever, delirium, seizures, coma, vomitinh, diarrhea, jaundice

Question 18

Burch and Wartofsky Score

Answer 18

< 25 Storm unlikely
25-44 Impending storm
> 45 High likelihood of storm

Question 19

Parameters under Burch and Wartofsky scoring

Answer 19

Temperature, CNS effects, Gastrointestinal-hepatic dysfunction, Tachycardia, Congestive heart failure, Atrial fibrillation, Precipitant history

Question 20

Management of Thyroid Storm

Answer 20

PTU, Methimazole, Hydrocortisone
Propanolol
Saturated solution of potassium iodide (SSKI) to be given one hour after first dose of PTU, Sodium iodide

Question 21

Most common cause of hypothyroidism worldwide

Answer 21

Iodine deficiency

Question 22

Most common cause of hypothyroidism in iodine-sufficient areas

Answer 22

Hashimoto’s thyroiditis, iatrogenic (Tx for Hyperthyroidism)

Question 23

Clinical picture of hypothyroidism

Answer 23

Fatigue, weakness, weight gain, menstrual abnormality

Puffy eyelids, dry skin, enlarged thyroid, bradycardia, delayed tendon reflex relaxation

Question 24

Management of Hypothyroidism

Answer 24

Levothyroxine (30 mins before breakfast)

Question 25

Discrete, firm, non tender nodule, approximately 1 cm, palpable lateral to midline of neck which rises when patient swallows

Answer 25

Thyroid nodule

Question 26

Size of nodule to be detectable on palpation

Answer 26

> 1cm

Question 27

Hot nodule

Answer 27

Increases uptake = hyperfunctioning = almost never malignant

Question 28

Cold nodule

Answer 28

Decreased uptake = hypofunctioning = 10-20% are malignant

Question 29

Diagnostic algorithm for thyroid nodule

Answer 29

First: TSH
If TSH is low > Thyroid scan
If TSH is high > UTZ guided FNAB