Thyroid Passmed Qs

Question 1

De Quervain’s thyroiditis AKA

Answer 1

Subacute thyroiditis

Question 2

DQ thyroiditis during thyroid scintigraphy

Answer 2

Globally reduced uptake of iodine

Question 3

Sick euthyroid syndrome

Answer 3

Caused by systemic illness
Low total + free T4/3 (levels only mildly below normal)
Normal TSH

Question 4

Increased TSH

Normal T4

Answer 4

Subclinical hypothyroidism

Question 5

Papillary thyroid cancer

Answer 5

65%
Young females
Metastasis to cervical lymph nodes
Thyroglobulin used as tumour marker
Orphan Annie eyes on light microscopy
Good prognosis

Question 6

Follicular thyroid cancer

Answer 6

20%
Generally women > 50
Metastasis to lung and bones
Thyroglobulin can be used as tumour marker
Moderate prognosis

Question 7

Medullary thyroid cancer

Answer 7

5%
Sporadic or part of MEN2 syndrome
Originates from parafollicular cells which produce calcitonin
Calcitonin can be used as tumour marker

Question 8

Anaplastic thyroid cancer

Answer 8

V rare
Elderly
Poor prognosis

Question 9

Lymphoma

Answer 9

5%

Dysphagia or stridor

Question 10

MEN 1

Answer 10

Pituitary adenoma
Parathyroid hyperplasia (leading to hyperparathyroidism)
Pancreatic tumours- insulinoma, gastrinoma

Question 11

MEN 2A

Answer 11

Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma

Question 12

MEN 2B

Answer 12

Mucosal neuroma
Marfanoid appearance
Medullary thyroid carcinoma
Phaeochromocytoma

Question 13

Hashimoto’s thyroiditis clinical features

Answer 13

Hypothyroidism
Goitre
Anti-TPO

Question 14

Toxic multi nodular goitre treatment

Answer 14

Radioactive iodine treatment of choice

Question 15

DQ thyroiditis presentation

Answer 15

Thought to occur after viral infection
Typically presents with hyperthyroidism
Painful goitre
Raised ESR
Reduced iodine 131 uptake on scan

Question 16

Thyrotoxicosis with tender goitre

Answer 16

Subacute (DQ) thyroiditis

Question 17

Secondary hypothyroidism

Answer 17

Low TSH
Low T4
–> do MRI of gland

Question 18

Grave’s + eye symptoms

Answer 18

Doesn’t need to have eye symptoms to be graves

Question 19

Low thyroxine compliance

Answer 19

If don’t take thyroxine, High TSH and low T4- often patients over compensate before appointment, leading to an increase in T4 without enough time for TSH to be compressed (days/weeks)
–> High TSH and High T4

Question 20

Subclinical hypothyroidism in elderly

Answer 20

Watch and wait

Question 21

Carbimazole + agranulocytosis

Answer 21

ESR test needs to be done

Warn of sore throat

Question 22

Toxic adenoma

Answer 22

Low TSH

Hot solitary nodule

Question 23

Hyperthyroidism + period

Answer 23

Associated with oligomenorrhea

Question 24

Subacute thyroiditis

Answer 24

Causes hyper then hypothyroidism

Question 25

Thyrotoxic storm treatment

Answer 25

Beta blockers
Propylthiouracil
Hydrocortisone

Question 26

Myxoedemic coma

Answer 26

Hypothermia
Hyporeflexia
Bradycardia
Seizures

Question 27

Myxoedemic coma treatment

Answer 27

Thyroxine

Hydrocortisone

Question 28

Iron + thyroxine

Answer 28

Iron reduces its absorption

Question 29

Graves autoantibodies

Answer 29

TSH receptor stimulating antibodies (90%)

Anti-thyroid peroxidase antibodies (75%)

Question 30

Changes in vision with thyroid eye disease

Answer 30

Urgent review by specialist

Question 31

Subclinical hypothyroidism

Answer 31

Normal T3
High TSH
If TSH between 4-10: Below 65 give levothyroxine, above 65 watch and wait, if asymptomatic observe + repeat TFTs 6 months
If TSH above 10- Below 70 start thyroxine

Question 32

Subclinical hyperthyroidism

Answer 32

Normal T3
Low TSH
Causes- multinodular goitre, excessive thyroxine
Effects CVS (AF), Osteoporosis
Increased risk dementia
Give low dose anti-thyroid drugs for 6 months

Question 33

Hypothyroidism electrolyte

Answer 33

Decreased Na

Question 34

Hyperthyroidism electrolyte

Answer 34

Increased Ca

Question 35

Hypothyroidism + periods

Answer 35

Menorrhagia

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