clinical thyroid disease

Question 1

hypothyroidism clinical features

Answer 1

weight gain 
lethargy 
feel cold
constipation 
heavy period
dry skin/hair
bradycardia
slow reflexes
goitre
severe: puffy face, large tongue, hoarseness, coma

Question 2

hyperthyroidism clinical features

Answer 2

weight loss
anxiety/irritable 
heat intolerance
palpitations
bowel frequency 
light periods
sweaty palms
palpitations
hyperreflexia/tremors
goitre

Question 3

hormone levels: 1ry hypothyroidism

Answer 3

raised TSH

Low T4 and T3

Question 4

hormone levels: compensated hypothyroidism

Answer 4

raised TSH

normal T4 and T3

Question 5

hormone levels: 2ry hypothyroidism

Answer 5

low TSH

low T4 and T3

Question 6

causes of 1ry hypothyroidism: congenital

Answer 6

developmental - maldevelopment

dyshormogenesis - trapping/organification

Question 7

acquired causes of 1ry hypothyroidism

Answer 7

autoimmune: Hashimoto’s
iatrogenic: post-op
chronic iodine deficiency
post-subacute thyroditis

Question 8

causes of 2ry/3ry hypothyroidism

Answer 8

pituitary/hypothalamic damage

• pituitary tumour
• craniopharyngioma
• post pituitary surgery or radiotherapy

Question 9

investigating hypothyroidism

Answer 9

TSH/T4

autoantibodies: thyroid peroxidase antibodies

Question 10

treatment of hypothyroidism

Answer 10

levothyroxine

initial dose 1.6mcg/kg then titrate in 25mcg steps according to TFT

Question 11

subclinical hypothyroidism

Answer 11

repeat tests after 2-3 months with TPO antibodies

consider treatment =TSH>10

TSH>5 with symptoms - trial therapy 6mo and continue if symptomatic imprivement

Question 12

hypothyroidism and pregnancy

Answer 12

inc levothyroxine requirements during pregnancy

optimise preconceptually

Question 13

goitre causes - physiological

Answer 13

puberty

pregnancy

Question 14

goitre causes - autoimmune

Answer 14

grave’s

hashimoto’s

Question 15

goitre causes - thyroiditis

Answer 15

acute

chronic fibrotic

Question 16

goitre types

Answer 16

multinodular
diffuse - colloid, simple
cysts
tumours (adenoma, carcinoma, lymphoma)
sarcoidosis 
tuberculosis

Question 17

solitary thyroid nodule investigations

Answer 17

thyroid function test
USS (benign vs malignant)
FNA

Question 18

thyroid cancer - papillary

Answer 18

most common
multi-focal, local spread to lymph nodes
good prognosis

Question 19

thyroid cancer - follicular

Answer 19

usually single lesion
metastases to lung/bone
good prognosis if resectable

Question 20

thyroid cancer management

Answer 20

near total thyroidectomy

high dose ablative ratioiodoinde

Question 21

when is thyroid Ca prognosis poorer

Answer 21

age <16 >45
tumour size
spread outside thyroid capsule
metastases
TNM stage

Question 22

causes of primary hyperthyroidism

Answer 22

grave’s
toxic mulitnodular goitre
toxic adenoma

Question 23

causes of 2ry hyperthyroidism

Answer 23

pituitary adenoma secreting TSH

Question 24

Grave’s disease

Answer 24

autoimmune driven condition

thyroid peroxidase antibodies
TSH receptor antibodies

Question 25

Grave’s disease diagosis

Answer 25

hyperthyrpidism

TSH receptor antibodies

Question 26

multinodular goitre

Answer 26

most common cause of thyrotoxicosis in elderly

characteristic goitre and absence Grave’s

Question 27

subacute thyroiditis

Answer 27

viral trigger
painfull goitre +/- fever, myalgia
ESR raised

may require short term steroids and NSAIDs

Question 28

antithyroid drugs

Answer 28

carbimazole

titration regime

Question 29

radioiodine

Answer 29

treat with ATD

usually give high/ablative dose

Question 30

subclinical hyperthyroidism

Answer 30

TSH suppressed

normal TH