Thyroid Jazz

Question 1

What are serum levels in hyperthyroidism?

Answer 1

high T4 and low TSH

Question 2

What are symptoms of hyperthyroidism?

Answer 2

1. Tremor
2. Anxiety
3. Palpitations
4. Heat intolerance
5. Diarrhoea
6. Olgiomenorrhea

Question 3

What is causes of hyperthyroidism

Answer 3

1. Grave’s disease
2. Toxic multinodular goitre
3. Thyroiditis
4. Drugs (e.g. amiodarone)

Question 4

What is Grave’s disease associated with?

Answer 4

anti-TSH receptor antibodies

Question 5

What is the management of hyperthyroidism?

Answer 5

1. Propranolol: T4 and T3 leads to increased expression of B-adrenergic receptors
2. Carbomazole (TPO inhibitor)
3. Radioiodine

Question 6

What are serum TSH and T4 levels in hypothyroidism?

Answer 6

Low T4 and high TSH

Question 7

What are symptoms of hypothryoidism?

Answer 7

1. Lethargy
2. Cold intolerance
3. Weight gain
4. Constipation
5. Meorrhagia
6. Decreased deep tendon reflexes

Question 8

What are causes of hypothyroidism?

Answer 8

1. Hashimoto’s thyroiditis
2. Subacute (de Quervain’s) thyroiditis
3. Drugs: (e.g. amiodarone, lithium)
4. Iodine deficiency

Question 9

What is hashimotos associated with?

Answer 9

anti-TPO antibodies

Question 10

What is management of hypothyroidism?

Answer 10

levothyroxine

Question 11

What are the features of thyroid cancer?

Answer 11

1. Non functional, painless, rapidly gorwing
2. Solitary irregular (nodular) shape
3. Palpable nodule: hard and fixed
4. HOARSE VOICE
5. Dysphagia
6. Haemoptysis
7. Airway obstruction
8. Cervical lymphadenopathy

Question 12

What are different types of thyroid cancer and how common are they?

Answer 12

1. Papillary carcinoma (70%)
2. Follicular carcinoma (20%)
3. Medullary carcinoma (5%)
4. Anaplastic carcinoma (1%)
5. Lymphoma (rare)

Question 13

How does papillary carcinoma present?

Answer 13

35 y/o female with childhood radiation exposure

Question 14

How does follicular carcinoma present?

Answer 14

50 y/o female with low dietary iodine intake

Question 15

What is a rare variant of follicular carcinoma?

Answer 15

hurthle cell

Question 16

What is medullary carcinoma associated with?

Answer 16

MEN 2A and MEN 2B

Question 17

What investigations are used in thyroid cancer>

Answer 17

• FNAB w/USS
• CT/PET
• thyroid scan
• TFTs can be useful to exclude benign (functional) nodules

Question 18

How does papillary carcinoma grow?

Answer 18

grow with characteristic neoplastic papillae + psammoma bodies + ground-glass nuclei

Question 19

What is a psammoma body?

Answer 19

circular, calcified concentric laminations/rings

Question 20

What is a follicular carcinoma?

Answer 20

invasion of BENIGN follicular adenoma into thyroid capsule or blood

Question 21

Where are follicular and papillary carcinomas dervied from?

Answer 21

follicular cell

Question 22

What is medullary carcinoma associated with?

Answer 22

cancer of C-cells, produces calcitonin (measured in blood)

Question 23

What is management of thyroid cancer?

Answer 23

1. Total thyroidectomy
2. Radioiodine (to kill remaining thyroid tissue)
   Routine thyroglobulin monitoring and thyroid hormone replacement (levothyroxine)

Question 24

In graves disease what other signs may there be?

Answer 24

1. bilateral exopathlamos
2. lid lag (and retraction)
3. pretibial myoxema
4. thyroid acropachy