Hyper/ hypothyroidism

Question 1

35 years old female, anterior neck swelling, weight loss, heat intolerance, grittiness of eyes.

What medical condition would you suspect (1)

Answer 1

Hyperthyroidism

Question 2

35 years old female, anterior neck swelling, weight loss, heat intolerance, grittiness of eyes.

2 eyes signs associated (2)

Answer 2

Change in vision, exophthalmos (protruding eyes)

Question 3

35 years old female, anterior neck swelling, weight loss, heat intolerance, grittiness of eyes.

2 more symptoms of the condition (2)

Answer 3

Heart palpitations, weight loss with increased appetite, tremors, nervousness and irritability

Question 4

35 years old female, anterior neck swelling, weight loss, heat intolerance, grittiness of eyes.

2 investigations for the problem (2)

Answer 4

Level of TSH (thyroid-stimulating hormone); level of T3 and T4
(TSH is a hormone made by the pituitary gland in the brain that tells the thyroid gland how much hormone to make.)
(Hyperthyroidism: low TSH; high T3 and T4)

Question 5

35 years old female, anterior neck swelling, weight loss, heat intolerance, grittiness of eyes.

Why does the heart pulse need to be monitored? (2)

Answer 5

To prevent atrial fibrillation (an irregular and often rapid heart rate)
Heart is also weaker

Question 6

What is the management of hyperthyroidism?

Answer 6

Antithyroid Medications: e.g. carbimazole
(Other: beta adrenergic blocking agents are prescribed to block the action of thyroid hormone on the heart and thus relieve symptoms. Unless the hyperthyroidism is caused by thyroiditis, these drugs are used in conjunction with other treatments.)

Surgery: e.g. thyroidectomy,

Diet: lower iodine (e.g. no to seaweed)

Radioactive Iodine: This is the preferred treatment of hyperthyroidism caused by Graves’ disease.

Question 7

How does radioactive iodine work?

Answer 7

A radioactive iodine tablet is ingested and then taken up by thyroid cells. These overactive cells are damaged so that the thyroid can shrink in size and produce hormones at normal levels. Although this is a safe treatment, most people eventually become hypothyroid after radioactive iodine therapy and therefore require lifelong thyroid hormone replacement therapy. Radioactive iodine therapy cannot be given to pregnant women or those who are breastfeeding.

Question 8

Give the correct FT4 and TSH levels in the following diseases

Primary hypothyroidism
Secondary hypothyroidism
Primary hyperthyroidism
Secondary hyperthyroidism

Answer 8

Primary hypothyroidism (FT4 decrease, TSH increase)

Secondary hypothyroidism (FT4 decrease, TSH normal/ decrease)

Primary hyperthyroidism (FT4 increase, TSH decrease)

Secondary hyperthyroidism (FT4 increase, TSH increase)

Question 9

b. 1 clinical manifestation of Grave’s disease (hyperthyroidism) (1)

Answer 9

Protruding eyes (Anson: exophthalmos)

Question 10

What is cretinism (1)

Answer 10

Congenital hypothyroidism

Question 11

1 medication for hyperthyroidism (1)

Answer 11

Antithyroid drug, e.g. carbimazole

Question 12

Hyperthryoidism signs and symptoms

Answer 12

1. Intolerance to heat
2. Exophthalmos
3. Tachycardia
4. Weight Loss + muscle wasting
5. Enlarged thyroid (Goiter)
6. Tremors
7. Facial flushing
8. Fine straight hair

Question 13

Hypothyroidism signs and symptoms

Answer 13

1. Intolerance to cold
2. Extreme fatigue
3. Muscle weakness
4. Anorexia
5. Hair loss