Thyroid function

Question 1

What THREE clinical signs are most useful when considering thyroid function?

Answer 1

Weight
HR
Tremor

Question 2

Compare & contrast HYPER & HYPO thyroidism in ELEVEN clinical signs

Answer 2

Hyper/Sign&Sx/Hypo
down/Energy/down
anxious/Mood/depressed
up, nausea/GI/down, constipation
loss/Wt/gain
amenorrhoea/Menstrual/menorrhagia
down/MSK/down
down or agitated/Cognition/down
up/Temperature/down
RAF or palpitations/Heart Rate/reduced or CCF
tremor or hyperreflexive/Neuro/Hyporeflexive

Question 3

Name FOUR types of medication that interfere with thyroid tests:

Answer 3

Thyroxine (artificial TH)
PTU (propylthiouracil) (stops thyroxine formation by preventing Iodine binding to TG)
Amiodarone (inc or dec TH)
Lithium (inc or dec TH)

Question 4

What is the most useful test of thyroid function?

Answer 4

TSH

Question 5

Draw the ‘Gome’ thryoid tictactoe matrix.

Use this matrix to identify and name 9 types of thyroid status.

Answer 5

1. Primary HYPO thyroidism
2. Subclinical HYPO thyroidism - almost about to fail.
3. Secondary HYPER thyroidism
4. Repeat the test - usually normal function
5. Euthyroid
6. Repeat the test - usually normal function
7. Secondary HYPO thyroidism
8. Subclinical HYPER thyroidism
9. Primary HYPER thryoidism

Question 6

What group of patients should not be given TFTs? Why not?

Answer 6

Pts in ICU - because their illness causes their TFTs to be deranged and meaningless.

Question 7

When would there be a high fT3?

Why?

Answer 7

In a T3 thyrotoxicosis.

Most T3 is bound, and free T3 is usually kept constant (based on the amount of TBG).

Question 8

If a patient has secondary hypothyroidism, what is your major concern?

Answer 8

Given secondary hypothyroidism means an inactive pituitary gland, the major concern is the lack of glucocorticoids - from the lack of ACTH. So, primary Rx is to give steroids. Thyroxine supplementation is important but not as critical.

Question 9

Referring to Gome’s thyroid tictactoe, TFTs that show normal to low TH & TSH suggest what diagnosis?

Answer 9

SES - sick euthyroid syndrome.

Question 10

When is iodine supplementation NOT recommended?

Answer 10

In the thyrotoxic - those with high TSH.

Question 11

To avoid cretinism, who and what should be tested? Why? What medication should be used?

Answer 11

Maternal TSH should be tested.
Iodine is to difficult to test and too difficult to monitor.
Give thyroxine to ensure that the baby is sufficiently developed.

Question 12

Name the FOUR clinical reasons to remove a thyroid gland?

Answer 12

Hyperthyroidism
Cancer
Mass effects (no swallowing, breathing etc)
Cosmesis (appearance)

Question 13

Name the FOUR types of thyroid cancer:

Answer 13

Papillary
Follicular
Anaplastic
Medullary

Question 14

Which TWO are collectively known as DTC: differentiated thyroid cancer.
What is the treatment for DTC?

Answer 14

Papillary and Follicular
Total thyroidectomy then Rx with radioactive iodine (I131) followed by thyroxine replacement starting low and titrating to effect.

Question 15

Which is the WORST type of thyroid cancer to get? Why? What is the Rx?

Answer 15

Anaplastic.
The mortality is typically <10% survival in 5/12 as people typically asphyxiate.
Morphine and a holiday.

Question 16

Following total thyroidectomy, what thyroid status will people typically be medicated to and why? [hypo/eu/hyperthyroid]

Answer 16

Following thyroidectomy, patients will be kept at slightly HYPERthyroid levels IOT avoid causing TSH to be secreted IOT avoid stimulating any remnant thyroid cells.

Question 17

When is a TG [thyroglobulin] test useful?

Answer 17

In someone with total thyroidectomy IOT ensure that there are NO functioning thyroid cells. If all thyroid has been removed, TG should be undetectable.

Question 18

Which type of thyroid cancer is typically caused by familial syndromes?

Answer 18

Medullary

Question 19

write some questions on the antibodies

Answer 19

xx